Understanding barriers for neurology trainees in UK to take up MS as an area of sub-speciality interest

MS Intermediate MasterClass 8, 2019

Introduction

The care of patients with multiple sclerosis (MS) has evolved significantly in the recent years. As the burden of MS in society has increased, so has our ability to make an early diagnosis, treatment to modify disease course and patient outcome. This also means we need adequate resources to run effective MS services.

In a recent MS national meeting (MS Service Provision in the UK: Raising the Bar 2019), poor representation was observed from the UK neurology trainees (3 out of 117 delegates, 2.6 %) with a similar trend in the previous year.

To develop a comprehensive MS service we need an appropriate number of neurology trainees who are actively interested in MS and ready to face the future growing needs to run local MS services soon after their CCT. This will have a significant impact on reducing the variance in MS services across the UK.

Aims of the project

• To understand the views of neurology trainees in England about multiple sclerosis as a sub-speciality interest.
• What the barriers are for trainees in pursue MS as a sub-speciality?
• What changes in training will improve neurology trainees experience and interest in this field.

Method:

An initial survey questionnaire (version 1) was prepared. Questions in that survey were updated following a pilot survey with senior neurology trainees (ST5 and above). The revised questionnaire (version 2) was used for a further pilot survey among junior trainees (ST3/ ST4) to understand if the survey was robust enough to capture views of junior trainees. Further modifications were made before the 3rd version (Version 3) of the pilot survey was run among a mix of junior and senior neurology trainees. The final version (version 4, appendix) of the survey was disseminated to neurology trainees in England via regional ABN trainee representatives in mid-October 2019.

Results:

A total of 24 survey questionnaires were retuned by 8/11/2019. Only 2 expressed an interest to pursue MS as a sub-speciality interest. Out of the 24 trainees, 6 trainees were undecided what sub-speciality they would like to pursue. Most trainees (16) who chose to pursue a subspecialty decided to do so by ST4 level. Of the trainees who chose to pursue other sub-specialities, 15 would never choose to do MS as a sub-speciality and 7 expressed they might change their mind based on circumstances. Most trainees had the opportunity to attend MS clinics led by MS consultants. While the changing landscape of disease modification was the most exciting aspect in MS as perceived by the trainees, previous poor experiences with the MS team or the patient would deter trainees about this area. About half of the trainees were not aware of the fully funded academic meetings by the MS academy. The other half who were aware of the MS academy meetings, only 4 so far have attended a meeting by the MS academy. Three trainees found the meetings very motivational to consider this field as a sub-speciality. Seventeen of the 24 trainees (71 %) of the trainees feel that a trainee support network with availability of mentorship would encourage them in the field of MS. Most trainees were interested to participate in MS clinical trials if provided with appropriate support. Twenty-three of the 24 trainees (96%) think that a 3 monthly MS academy bulletin containing MS courses/ research opportunities will be helpful for trainees to plan ahead. The 3 most important things trainees felt will help them to develop a sub-speciality interest in MS were: (i) Having an enthusiastic and motivated MS consultant who will be their mentor during their rotation with the MS team to guide on professional development, (ii) Incorporating the opportunity for trainees to attend MS DMT MDTs during training to better understand the complexities of choosing DMTs, and (iii) discussing research opportunities in MS with the trainees.

Conclusion:

Though the trainee response rate, to date, to this survey has been low, the views of the trainees were recurring. Most trainees seem to choose a sub-speciality interest early in their career. While the new developments in the field of MS are of keen interest, trainees voiced that an enthusiastic and motivated MS consultant who would act as a mentor for the trainees during their rotation with the MS team will improve their training experience and views about choosing this area as a sub-speciality interest. The training programme also has to incorporate the opportunity for trainees to attend the MS DMT MDTs.

Acknowledgements:

Dr David Rog, Salford Royal Hospital NHS Foundation Trust

Dr Elaine Cameron, University of Manchester

ABN trainee representatives