Exploring doctors’ trade-offs between management, research, and clinical training in the medical curriculum: a discrete choice experiment in southern Africa

Background and Objective: Public health requires doctors to fulfil roles that extend beyond that of a clinician. There is consensus that management and research training in medical curricula will reinforce evidence-based practices. The study aimed to establish how much clinical activity training time doctors in southern Africa would give up for time spent on research and management training, as well as possible teaching methods. Methods: A discrete choice experiment (DCE) was used. Five attributes were included: i) management content; ii) research content; iii) teaching method iv) placement; and v) clinical training hours in a week. Respondents were presented with 10 choice tasks generated from a D-efficient design. A resistance to change-beliefs scale assessed respondents’ preference for tradition or change. Demographic information was collected to assess observed preference heterogeneity. Analysis of the DCE data was based on the Random Utility Maximization framework using variants of the multinomial logit model. Willingness to Give Up Time (WTGUT) was estimated for all attributes i.e., how many hours respondents would be willing to give up from the current 40 hours clinical training to be used for management and/or research training instead. The online pilot DCE survey was sent to 50 medical doctors in September 2022. Results: Parameter estimates suggested face validity in terms of direction of preference. Relative to no management training, respondents preferred all other levels of content. There was a preference for students to learn how to use, not do, research. Relative to face-to-face teaching at the beginning of the curriculum, respondents preferred the hybrid method throughout all years. However, WTGUT estimates lacked face validity and respondents did not distinguish between clinical training levels. Conclusions: Pilot study findings suggest the clinical training levels did not push individuals to their maximum. Revised levels will have to be included in the main study in 2023.