IS THERE AN END IN SIGHT REGARDING THE PRACTICALYEAR-PRESSURE?

Text: Matias Jacomet | NOME 2022/2023

The practical year (dt. “Wahlstudienjahr”, fr. “anné de stages”, it. “anno di stage”) is a part of Swiss medical education many students are looking forward to: Not only does it give the possibility to gain a lot of hands-on clinical experience in the various fields of medicine, it is also an important “reality-check” regarding everyday working conditions and differences between hospitals and also between specialties. Many students hope to gain clarity during this year, regarding which path their future career as a medical professional should take. As interests vary between students according to their personal strengths, ambitions and other preferences, having the liberty to organise the practical year individually and without many requirements is generally appreciated.

Unfavourable trends for students and hospitals

However, there also seems to be downsides to the application process. Some local students associations noticed that medical students started to apply earlier and earlier in their medical studies for practical year spots. Some students confirmed that they already applied for positions during their first and second year of medical education. It’s worth noticing that some faculties haven’t covered a lot (if any) of their clinical courses and lectures at this point in their curriculum. In reaction to that, peers of those students start to fear missing out on presumably desirable spots and start to apply as well, even though they are often not sure if they are actually interested in that particular specialty or that particular spot.

Other unfavourable phenomena arising from this trend are “double-bookings” (students applying for multiple spots for the same time period with the intent to cancel the least interesting spot at a later point) and other short-noticed cancellations of spots that are not interesting to the student by the time the practical year takes place. Although cancellations can sometimes not be avoided for various reasons, double-bookings are likely avoidable, if students would not feel pressured to apply so soon and would have enough time to figure out what they really want to see.

Needless to say, this situation leads to additional and unnecessary administrative burden for the hospitals/clinics as well as increased planning insecurity, especially in hospitals that have to rely on the work of the practical year students. As a result, some hospitals have introduced measures against such behaviours.

How big is the problem?

To find out if the points described above are really trends happening or only rumours of single cases, the commission on medical education (AK/ CoFo) conducted a national survey last autumn. There were 923 participants from all Swiss medical faculties and all study years. The following conclusions were drawn:

1. Students feel increasingly peerpressured to apply for spots early in their studies.

This was shown by the fact that 34% of the 1st year and 66% of the 2nd year students indicated that they experience such pressure (Please notice, that the survey was conducted at the beginning of the study year and numbers can still increase during the ongoing year). Luckily, only a few students also indicated to already having booked spots during their first and second year. The majority of students seem to apply for their first spot in the course of the 3rd study year.

2. Students apply “blindly” for disciplines not yet covered in their studies and in which they have lost interest by the time of their practical year.

409 of the surveyed students (44%) admitted that the spots they applied for were not yet covered during their education. Further a substantial number of students (n = 288) indicated regretting booking a spot even before they started the internship. The main reasons for this were 1) not enough time left to see other specialties (n = 94) and 2) no longer being interested in the specialty (n = 87).

3. Students start “hoarding” spots, causing administrative burden and planning insecurity for the healthcare institutions and blocking spots for other interested students.

The results luckily showed that only a minority of students participate in such behaviours: There were 105 participants (14%) indicating to have one or more double-bookings and 151 participants (20%) that had to cancel a spot. Nevertheless, both situations have a negative impact on hospitals as well as on the students.

How could the situation be improved?

The results of the survey seem to support the impression that there are negative trends taking place at the moment due to the current application process. On a closer look it seems that those situations are emerging from hoard-behaviour due to the fear of missing out and could be solved, if students would no longer be afraid of being too late to apply for desirable positions.

One possible solution to this is the introduction of a time-limitation for the application process, meaning that there would be a national starting point from which students can apply for practical year spots. The student’s opinion regarding such a solution was clearly shown in the survey:

The vast majority of students (n = 829; close to 90%!) is supporting the introduction of a time-limitation for practical year applications.

The preferred time-limitations were one year before the spot takes place (n = 319) or after reaching the bachelor’s degree (n = 208). However, both options have advantages and disadvantages, especially since there are substantial differences between the medical curricula in Switzerland (e.g. the practical year doesn’t take place at the same time at all faculties).

To reach an optimal solution which takes into account all those differences and other relevant factors of the application process, there have been discussions with student delegates from all faculties and the local associations have been included in the decision process as well. We strive to find an ideal solution and to present this to the deans of the Swiss medical faculties in March, hoping to gain the support of the universities for this endeavour. If we’re able to find such a time-limitation, the goal is to propose a change in the application process to all the healthcare institutions involved in the practical year in the course of this spring/summer and hopefully improve the student’s situation in doing so.

If you want to know more about the project, do not hesitate to reach out to nome@swimsa.ch

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