THE DPET GUIDE
A HANDBOOK FOR DIRECTORS OF PREVOCATIONAL EDUCATION AND TRAINING |
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1. ONLINE RESOURCES
HOW YOU ARE SUPPORTED
NSW IMET Standards of Education, Training and Supervision for Prevocational Trainees and Post AMC Supervised Training (Version 4.3)
Appendices: Standards of Education, Training and Supervision
NSW IMET Guidelines: The Accreditation Survey for the Facility
EDUCATION PROGRAM
UWA Education Centre: Teaching on the Run (Adult learning)
Australian Curriculum Framework for Junior Doctors
WORKING WITH PREVOCATIONAL TRAINEES
NSW Prevocational Trainee Directory 2008
NSW Progress Review Form - Formative (Mid Term) Appraisal
NSW Progress Review Form - Summative (End of Term) Assessment
Completing the NSW Progress Review Form - Guidelines for Term Supervisors
NSW IMET Generic Trainee Term Evaluation Template
NSW Health Policy Directive Grievance Resolution (Workplace) PD2005_584
WORKING RELATIONSHIPS
Term Supervisor, Position Description
Network Committee for Prevocational Training (NCPT): Terms of Reference
General Clinical Training Committee (GCTC): Terms of Reference
TERM DESCRIPTIONS
Term Description Template
SUCCESSION PLANNING
Position Description, Director of Prevocational Education and Training
REPORTING AND FINANCIAL MANAGEMENT
Six Monthly Performance Report
© NSW Institute of Medical Education and Training 2006
This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the NSW Institute of Medical Education and Training.
Requests and inquiries concerning reproduction and rights should be addressed to NSW IMET.
Ph: 02 9844 6551. Facsimile: 02 9844 6544.
Email: info@imet.health.nsw.gov.au
First Published 1994
Revised Edition 1996
Revised Edition 1999
Revised Edition 2003
Revised Edition 2006
Revised Edition 2007
Revised Edition 2008
The NSW Institute of Medical Education and Training kindly acknowledges the prior work of the Education & Resource Development Committee: Dr Marie Louise Stokes, Dr Stephen Myers, Dr John Chang, A/Prof Peter Reed, Dr Leanne Cheung, Dr John Roberts, Dr Matthew Chu, Dr Robert Russo, Dr John Fardy, A/Prof Merrilyn Walton, Dr Scott Forty, Dr Ashley Watson, Dr Marisa Magiros, Ms Tayia Yeates as well as the more recent work of the Prevocational Training Council members.
Produced by the NSW Institute of Medical Education and Training.
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2. WELCOME
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To new Directors of Prevocational Education and Training
I know from several past years as a DPET that this is simultaneously a really gratifying job mixed with a dose or two of stress and uncertainty. I believe that those of you undertaking this role are truly at the forefront of shaping the next generation of doctors and your work is paramount to establishing the education and training base for our prevocational trainees.
This Guide has been written by your co-DPETs, in conjunction with the NSW Institute of Medical Education and Training (NSW IMET), with just these thoughts in mind.
It is designed to give you a feel for the job along with practical information to support you through the time you are in the role. You'll be helping to create a great teaching environment in your facility as you work with junior doctors, their Attending Medical Officers, administration staff and registrars.
As their advocate, you'll be helping prevocational trainees through their sometimes difficult early postgraduate years and you'll find this a very satisfying part of your job as you get to know them and help them.
Fortunately, you won't be doing it alone. NSW IMET, other DPETs in your network, and perhaps ex-DPETs at your facility, can all offer you support and advice. Other VMOs, especially Term Supervisors in your facility area also part of your committed network.
Thank you for taking on this important role. I hope you find it both rewarding and enjoyable.
Regards
Professor Mark Brown
Director, NSW IMET
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3. INTRODUCTION
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How much you will need to refer to the Guide and its relevance to your specific situation will vary enormously because of the nature of medical education and training, the operation of facilities and regional particularities. It will also depend on the number of prevocational doctors under your care, your connection to the facility, and the level of infrastructure and support available to you.
This guide works in conjunction with an induction session which is held for new DPETs before each DPET forum. We urge you to attend this informal information brief and NSW IMET will arrange travel and accommodation to assist you. For further information please contact the NSW IMET Program Coordinator for Prevocational Training Mr Craig Bingham: cbingham@imet.health.nsw.gov.au; or 02 9844 6511.
How to use the guide:
NSW IMET recognises that newly appointed DPETs need assistance to take on the role. The role involves undertaking tasks with which you may have had no previous experience and it requires a considerable commitment of time.
The development of this Guide has been a collaborative effort by the NSW IMET Prevocational Training Council (PvTC) and the previous PMC Education and Resource Development Committee including DPETs, Prevocational Trainees, JMO Managers, Directors of Workforce Development and academics.
The compilation of information from DPETs currently working in facilities throughout NSW guarantees it is a relevant, practical resource. By necessity, the Guide presents the ideal. But we acknowledge that there are ambiguities and complexities in the role and that, while the Guide presents the role in isolation, you may be wearing more than one hat within the facility's training structure.
Finding Information:
To ensure information is easy to find and use, all material pertaining to each section is placed together in the following order:
- Overview of the section
- Detailed information
- Frequently asked questions
- Resources
We Need Your Feedback:
The strength of this guide will lie in its continuing usefulness and currency. We would welcome your suggestions for how we can improve this resource. Please forward your feedback to the IMET Program Coordinator for Prevocational Training Mr Craig Bingham: cbingham@imet.health.nsw.gov.au; or 02 9844 6511.
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4. HISTORY OF THE ROLE OF THE DPET
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The Postgraduate Medical Council of NSW (PMC) was formed in 1988 following the Reid Harris report and the Doherty Committee of Inquiry into Medical Education and Medical Workforce issues. These reports highlighted the need to provide guaranteed and standardised experiences for prevocational trainees during the first two postgraduate years.
The NSW Institute of Medical Education and Training (NSW IMET) is the result of a convergence between PMC and the Medical Training and Education Council (MTEC) in 2005. NSW IMET works closely with doctors-in-training, clinician teachers, health services and those that manage them and Colleges and Universities in the pursuit of excellent patient care through the delivery of high quality medical education and training in NSW.
Explicit in the NSW IMET strategic plan is the need to maintain adequate levels of supervision and education for prevocational trainees in NSW and the ACT.
During the formation of the PMC and its subsidiary structures, and subsequently with NSW IMET, it was recognised that each facility employing prevocational trainees needed to have someone appointed whose specific role was to supervise the implementation of NSW IMETs guidelines. This person had to be free to act independently from other administrative structures within each facility and mandated to act as an advocate for the professional development of prevocational trainees.
The title ‘Director of Clinical Training’ (DCT) was originally adopted for the person appointed to this position. Following the recent review of Prevocational Training in NSW, the title was changed to 'Director of Prevocational Education and Training' (DPET), to provide better definition to the position. The role of the DPET has now been defined and the infrastructure required to allow this person to fulfil their designated role has been specified.
During the past fourteen years, the experience of being a prevocational trainee within NSW and ACT facilities has improved appreciably and, in some cases, dramatically. The PMC and subsequently NSW IMET has been responsible for the relatively smooth implementation of significant changes in education, supervision, workforce allocation and facility accreditation during this time. Much of the credit for these significant changes is due to the work of individual DPETs. The position of DPET has come to be regarded as one of importance by clinicians, administrators and prevocational trainees. NSW IMET have carried on PMC’s ideology on this issue and continue to progress issues that will assist DPETs to advocate on behalf of prevocational trainees.
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5. THE ROLE OF THE DPET
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WHAT IS YOUR JOB?
Dr Greg Davis (DPET St George Facility)
For those of you who are new to the job this may be a bewildering time.
Most of us in facility medicine are used to having very clear roles as clinicians, having worked through the system as medical students, RMOs, registrars and, ultimately, consultants in our chosen specialty. In contrast, most of us are talked into doing the DPET job (in my case by Professor Brown, the former chair of NSW IMET) and have little experience in medical administration or education, other than direct clinical teaching. Despite these drawbacks, I believe strongly that having active clinicians as DPETs adds to credibility and the respect from the other clinicians in the facility.
The simple fact is that your role as DPET is what you choose to make of it and there are many different approaches. It is critical to remember that your responsibilities are to the patients, your prevocational trainees, NSW IMET and the facility, and in that order. My style has been to forge a strong bond with my JMO Manager and then behave like firm but fair parents, always supporting our trainees but expecting them to behave responsibly and work hard. They need immediate feedback if they step out of line but unconditional support. It is important to remember that for many of them this is their first full time job and they learn at different speeds. It is also important to embrace the diversity of your flock as many of the doctors trained overseas will have worked for years, and often in jobs other than medicine, while they try to get into the Australian medical system.
You are also responsible with your JMO Manager for ensuring that your trainees are receiving (and attending) appropriate teaching and this is covered in Section 4. You need to meet with them all each term to talk about careers and any issues. How you do this is up to you and will depend on your time available. You are expected to see them individually (see section 5) but in a big facility this may not always be possible so small groups works well, reserving individual interviews for those who are having problems or those who request one.
One of your more delicate jobs is to ensure your Term Supervisors (TS) are doing their jobs properly (see resource 12 Position Description for TS). This means that each TS is providing an accurate Term Description, giving an appropriate orientation to the term and meeting the trainees for mid term and end of term assessments. Most do a great job most of the time. However if they don't, this can be very difficult. Your ultimate weapon is the power to remove junior staff (after consultation with NSW IMET) upon whom all hospital specialists are dependent. Less drastic strategies which can be used are providing feedback from trainees on the term, a phone call or a letter if you want to be more formal and/or to document it. We routinely get feedback from our trainees on all aspects of the term and present them in a collated form to our first meeting with TS each year. That way, trainees can't be identified and it plays to the competitive nature of most clinicians. It is good to meet with all your TS two to three times a year - early to give them this feedback and let them know how you expect the year to go, mid year and then late in the year after recruitment.
What you will find is that the bulk of your trainees will take very little of your time but that there will be a few who will take inordinate amounts of time. The latter are usually those "in difficulty" and there is a separate resource “Managing a trainee in difficulty – A Handbook for DPETs” to refer to for more help. There are many ways of dealing with this issue but I think the underlying principles are that your first priority is to the patients, and secondly the trainee and that flexibility, lateral thinking and innovative solutions are often necessary.
There will always be lots of meetings. I've mentioned those with TS and trainees but you answer to the General Clinical Training Committee (GCTC) which is responsible for reviewing your performance each year. How this is done will depend on your GCTC but the more active your GCTC is, the more help they will be in planning educational activities and passing on information to the rest of the facility. With this in mind, it is often helpful to have people on the GCTC who have had experience in medical education e.g. clinical academics, who may have access to other educational resources. You will also need to keep in contact with the hospital management to maintain the profile of trainees’ issues. How you do this will depend on your facility organisation but is usually through the Director of Medical Services or their equivalent.
The other great resource which we often overlook is other, more experienced DPETs. This is definitely a job where you learn from experience so make use of it. You need to maintain contact with other DPETs and find one or two who you relate well to and ask them for guidance or ideas. There are also two DPET forums each year where you can attend an induction session and meet other DPETs.
You also may be aware that along with the recent reorganisation of training networks there have been Network Committees for Prevocational Training established. The chair of each of these committees is usually an experienced DPET, most often from one of the 5 Term Home Facilities. The role of the Network Committee is to coordinate the allocation, training and education of junior medical officers across the Network. Most meet four to five times per year to discuss these, and any other issues related to that particular network. They are also an easy means of access to other DPETs who are, at least, somewhat familiar with your facility and its particular requirements and usually happy to offer advice and assist where they can.
The remainder of the guide goes through your role in more detail. Hope that it helps but remember there will always be issues not covered and you will have to respond as you see fit.
Good luck
| Dr Greg Davis |
| Director of Obstetrics, Director of Prevocational Education & Training, St George Hospital |
| Network Committee for Prevocational Training Chair, Network 8 |
| Founding member, NSW Prevocational Training Council (PvTC) (March 2005 - July 2008) |
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6. HOW YOU ARE SUPPORTED
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The role of DPET is an important one and is essential for the well-being of prevocational trainees. DPETs will be required to accept certain responsibility which involves additional time commitment. This will depend on a range of factors in your local environment including the number of prevocational trainees; the skill set available in your team; and the extent of administrative and educational support that the facility contributes to you and trainees.
The effective teaching of trainees is a task which requires input from many sources. It is not and cannot be the responsibility of one person. NSW IMET, through its staff publications, website and meetings, is a source of support, ideas and information. Staff within the facility provides one of the greatest resources. Teaching at the bedside, in clinics and during operations and procedures is renowned for its effectiveness. To this end, it is vital you involve AMOs, registrars and other staff in the General Clinical Training Committee (GCTC).
PROFESSIONAL DEVELOPMENT:
NSW IMET will provide DPETs with regular forums to discuss relevant issues about training and education. The aim is to allow DPETs to gain from the experience of others, exchange information on effective strategies and promote learning.
DPETs are urged to attend Teaching on the Run workshops which are being held throughout NSW presently.
The Teaching on the Run training modules were developed by the Education Centre at the Faculty of Medicine and Dentistry at the University of Western Australia with funding from the Commonwealth Department of Health and Ageing.
TEACHING ON THE RUN:
Dr Fiona Lake and her team at the Education Centre, Faculty of Medicine and Dentistry, University of Western Australia have produced this amazing program to help you become a better educator and clinical supervisor. The success of this program comes from its ability to be run in small groups in your own setting with the help of an experienced facilitator. Participate, facilitate and become a champion of this program in your local setting and see the improvement in how your junior doctors are supported during their training.
Teacher training sessions are important in raising clinical teacher' awareness of their responsibilities in teaching and supervising junior medical staff, and to increase their skills and confidence in this area. As clinical teachers are usually stretched with many commitments, staff development sessions like Teaching on the Run, which are short, highly relevant and accrue CME points, have been developed to increase the likelihood of involvement.
The purpose of the Teaching on the Run course is to:
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Help clinical teachers recognise opportunities for teaching in various clinical settings
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Encourage clinical teachers to do more incidental teaching as they work with junior staff
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Build confidence so that senior doctors feel confident in sharing what they know and teach more effectively
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Encourage quality appraisal and assessment in the clinical setting.
The Teaching on the Run package contains all the resources necessary to run these staff development programs in your setting.
What does a Teaching on the Run workshop look like?
Six modules have been developed for the program:
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Clinical (Bedside) Teaching
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Skills
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Assessment & Appraisal
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Junior Doctor in Difficulty
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Planning Term Learning
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Effective Group Teaching
Each module runs for 2-3 hours and can be run alone, or together as part of a weekend package. Modules 4-6 build on the core modules 1-3. Where possible, participants should complete modules 1-3 before attending modules 4-6. The target audience is clinicians who have experience teaching undergraduate and postgraduate doctors, but who have had little or no formal teaching instruction.
Each half-day program contributes to CME points from various colleges (RACP, RACS, RANZCR, ANZCA, RACGP, ACEM, RANZCP, RANZCO). In general, facilitators receive a greater number of CME points.
Make Teaching on the Run an essential component of your training program. Encourage all your supervisors to participate and then facilitate sessions. Become a champion for this important program.
STAFF DEVELOPMENT PACKAGE FOR CLINICIANS
For information on how to establish Teaching on the Run courses in NSW, please visit:
www.imet.health.nsw.gov.au
The Standards:
NSW IMET accredits all facilities employing prevocational trainees. Accreditation is conducted using the Standards for prevocational trainee Education & Supervision (the Standards). The Standards are designed to encourage and support facilities in continually improving the supervision, education and welfare of prevocational trainees. This is also a useful instrument for you to use in defining relationships within the facility and advocating the interests of your trainees. See resources for a summary of the NSW IMET Standards for Prevocational Trainee Education and Supervision.
Resources:
The Standards for Prevocational Trainee Education & Supervision and guidelines on NSW IMET accreditation have been included within the resources section of this document.
NSW IMET undertakes a number of reviews and projects and all final documents can be found on the NSW IMET website: www.imet.health.nsw.gov.au. Additional resources or links to educational resources will be found also on the website.
Contacts:
If you encounter a problem that you cannot solve locally, feel free to contact the NSW IMET Program Coordinator for Prevocational Training Mr Craig Bingham: cbingham@imet.health.nsw.gov.au; or 02 9844 6511.
FACILITY LEVEL
Your facility can offer their support to you by:
- Contributing financially towards the education of prevocational trainees - this support is entirely independent of the DPET funding from the NSW Department of Health
- Contributing financially towards supporting the DPET, either through salary or backfilling
- Ensuring you have an effective voice in matters relating to prevocational training - you should be an active participant in the Network Committee for Prevocational Training (NCPT) and General Clinical Training Council (GCTC), or its equivalent. IMET recommends that a DPET should be the Chair of the NCPT. However, DPETs should not be the chair of the GCTC as there are conflicts of interest
- Providing adequate office accommodation, clerical assistance and supplies
- Providing appropriate accommodation for educational activities, library facilities and educational aids
- Reviewing the position of DPET at regular intervals to ensure that the most appropriate appointment is maintained and that adequate institutional support is being provided.
Some facilities may employ additional management/administrative support to take on some of the responsibilities of establishing an effective education program for prevocational trainees.
Web Resources:
NSW IMET Standards of Education, Training and Supervision for Prevocational Trainees and Post AMC Supervised Training (Version 4.3)
Appendices: Standards of Education, Training and Supervision
NSW IMET Guidelines: The Accreditation Survey for the Facility
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7. EDUCATION PROGRAM
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CREATING A LEARNING ENVIRONMENT
A dynamic culture of learning needs to be part of every facility. The GCTC and Network Committee for Prevocational Training (see the Resources section of this document) and DPET may share the role of undergraduate teaching as well as of advanced trainees within specialities. Prevocational training in this context is an important part of the training continuum.
Australian Curriculum Framework for Junior Doctors (ACF):
The ACF outlines the knowledge; skills and behaviours required of prevocational trainees in order to work safely in NSW facilities and other healthcare settings (see resources section). As such it provides a bridge between undergraduate curricula and the curricula that underpin college training programs. The ACF provides prevocational trainees with an education template that clearly identifies the core competencies and capabilities that are required to provide quality health care. For further information on the Australian Curriculum Framework, please visit www.cpmec.org.au
Your role as DPET:
Encourage the attitude that ongoing education is integral to the work of a trainee. It is important that all trainees are exposed to and maximise appropriate educational experiences. As a DPET you will be involved in education programs at the design, implementation and evaluation stages.
Your principle responsibilities are to:
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Develop, coordinate and promote the clinical training of prevocational trainees, in association with prevocational trainee staff management, the General Clinical Training Committee (GCTC) and the Network Committee for Prevocational Training (NCPT)
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Participate in education of prevocational trainees
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Assist the GCTC to evaluate training programs, clinical educators and educational resources
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Promote professional responsibility and ethics among prevocational trainees
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Play a major role in planning, delivery and evaluation of prevocational orientation programs including acting as a resource for clinical teachers.
EDUCATION GOALS
The goals to which all education development should lead include:
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Training to become safe and competent doctors
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Improving interpersonal skills with peers, teaching and medical staff, patients and administration staff
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The ability to empathise and understand from another's perspective
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Understanding issues surrounding doctors' well being such as work attitudes, the ability to work with others, stress and time management
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Improving attitudes to ongoing learning
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Understanding and performing research
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Ethics.
RUNNING EFFECTIVE EDUCATION SESSIONS
Content:
Effective education sessions are:
- Simple
- Interactive
- Practical
- Case based
Content should be relevant to the experience of prevocational trainees and to their work at the facility. Education sessions should target issues which are of greatest concern to trainees such as the care of critically ill patients. The Standards for Prevocational Trainee Education & Supervision require that education be coordinated across the Network, through the Network Committee. The value of the education sessions will be enhanced by changing the perspective and involving a range of presenters such as registrars, consultants, academics with clinical appointments, and other health professionals, as well as having trainee led sessions.
We recognise that DPETs have an inherent interest in adult education but that you are unlikely to have formal teacher training. The University of Western Australia Education Centre has developed a series of approaches to adult learning and teaching skills that can guide you on the development of effective education sessions (see the Resources section of this document). We strongly encourage you to read this Resource. They have also developed the Teaching on the Run teaching modules which are excellent in providing help to improve the quality of teaching and supervision by clinicians.
IMPROVING ATTENDANCE
Create incentives for prevocational trainees to attend education sessions:
- Keep an attendance list
- Establish a points system for attendance, participation and presentations
- Run lunchtime sessions and provide refreshments
- Ensure education sessions are protected time: nursing staff should be instructed not to page trainees during sessions and Term Supervisors should be made aware of the facility's education program
- Send reminders by group email or phone text messages
EVALUATION
The Standards require that hospitals evaluate the education program.
The key points to remember are:
- The feedback you receive through the evaluation process should be used to improve the quality of the education sessions
- Implement changes on a timely manner: it is important that prevocational trainees are aware that you are acting on their comments
- Discuss the changes with the trainees to ensure that the changes are meeting the trainee's needs.
Web Resources:
UWA Education Centre: Teaching on the Run (Adult Learning)
Australian Curriculum Framework for Junior Doctors
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8. WORKING WITH PREVOCATIONAL TRAINEES
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8.1 DEFINING A PREVOCATIONAL TRAINEE:
Prevocational trainees are in their first two years of clinical practice. Trainees in their first postgraduate year, interns, are now referred to as Post Graduate Year 1s (PGY1s). Residents, in their second postgraduate year, are now referred to as Post Graduate Year 2s (PGY2s) / RMO1s.
Australian Medical Council (AMC) Graduates, undertaking their year of supervised training, also fall into your area of responsibility as a DPET.
Australian Medical Council (AMC) Graduates:
Most Australian Medical Graduates (AMCs) will undertake a year of supervised training in parallel with the internship period of local graduates and therefore the DPETs responsibility.
At times AMC doctors may require additional support including:
- Increased supervision as they become adapt to the new system
- Need for extra support and resources
- Cross cultural issues
- Communication issues
- Developing English language skills
- Supervising AMC Pre-Employment program - clinical attachment.
Contact with prevocational trainees:
You will need to meet with the trainees at the start of the year and keep in contact by attending educational and social activities in the facility and by formally interviewing each trainee at intervals.
In smaller facilities you may be able to meet each trainee at least at the start and end of each term. In large home facilities, you may only be able to formally interview each trainee two or three times annually. The assessment forms from Term Supervisors should be reviewed and discussed at these meetings.
Initial Interview:
Your initial interview with a prevocational trainee will provide you with useful information and also gives the trainee an opportunity to get to know you and to understand your role as educator, advocate and mentor. A frank and confidential discussion is to take place it is important that you emphasise your independence from facility administration.
Discussion topics could include information about clinical exposure, ability to carry out procedures, anxieties and current career plans. You will also need to give the trainee referrals to other people who can help them. Discuss the trainee’s goals and, in particular, their procedural skills. Encourage them to use the medical literature and library facilities and possibly to plan and implement simple research projects.
You could open discussion with topics such as:
- Satisfaction with teaching at both registrar and consultant level
- Whether the trainee has undertaken any self education activities
- Has there been any feedback from the registrars and consultants and, if so was it fair and constructive
- Have there been any problems with peer groups, nursing or other health professionals
- Does the trainee have any suggestions which would improve the quality of the term which the DPET could discuss with administration on their behalf.
The Second Interview:
Prior to conducting the second interview it is helpful to have feedback from Registrars and the Term Supervisors. The interview is to assess the trainee’s progress and enquire as to workload, case mix, procedural activities and development of career plans. It is also an opportunity to help the trainee overcome, where possible, any difficulties they may be having. You may need to provide referral to appropriate professionals.
Subsequent Interviews:
Subsequent interviews are an ongoing review process with growing emphasis on career plans and re-appointment applications.
Feedback:
You are responsible for providing information to your prevocational trainees on the assessment and appraisal systems, and feedback on the results of their performance. NSW IMET has developed an assessment tool called the NSW Progress Review Form (see 5.2) to appraise and assess prevocational trainee performance. Term Supervisors perform the assessments.
8.2 PREVOCATIONAL TRAINEE PROGRESS REVIEW FORMS
The NSW Medical Board requires prevocational trainees to undergo term assessment for the purposes of general registration (that is, without conditions imposed) and has delegated responsibility for the management of this process to NSW IMET. Facilities will need to nominate a Term Supervisor who is able to look after the interests of the trainee and make judgements about their performance. While the Term Supervisor is the person responsible for the appraisal and assessment of trainees, it is expected that they will consult with other medical, nursing, and allied health professionals in completing this assessment.
The Progress Review Form is designed to:
- Provide prevocational trainees with useful feedback on their performance during both the Formative (Mid Term) Appraisal and the Summative (End of Term) Assessment
- Provide an instrument to assess prevocational trainees (PGY1) for the purposes of general registration
- Encourage improved contact between the Term Supervisors and their trainees.
The form is compulsory for PGY1. 100% compliance with the form is expected, including nights and relief terms.
The form involves three steps:
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At the beginning of term, Term Supervisors are to discuss objectives and training goals with their prevocational trainees
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Formative (Mid Term) Appraisal, Term Supervisors are to review progress at the mid term stage and provide feedback to assist and accelerate learning
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Summative (End of Term) Assessment, Term Supervisors must assess each trainee’s performance and assign a grade which contributes to decisions on registration with the NSW Medical Board.
8.3 PREVOCATIONAL TRAINEE ATTACHMENT: FEEDBACK AND APPRAISAL FORM
There have been ongoing discussions regarding the best way of obtaining feedback regarding prevocational education and training and specifically the use of the Feedback and Appraisal Form (JAFA). NSW IMET recognises that feedback is essential for continuous quality improvement for a range of people involved in training, including those at facility, network and state oversight level (NSW IMET) and it forms part of the Standards for Prevocational Trainee Education and Supervision – 2002. The JAFA form provided one way of accessing information on prevocational training experiences.
After some discussion regarding the use of the JAFA form, NSW Prevocational Training Council (PvTC) agreed that feedback and appraisal is best developed, analysed and utilised at facility and network level. Therefore, NSW IMET is encouraging facilities to review their methods for obtaining feedback on prevocational education and training.
The options are:
- developing their own tailored form; or
- customising the previous JAFA form for use locally
- NSW IMET Generic Term Evaluation Template.
These options support facilities fulfilling their responsibilities under the current Standards for Prevocational Trainee Education and Supervision (2002) for obtaining feedback and utilising the information obtained. In light of this decision, from September 2006 NSW IMET will no longer circulate or collate the JAFA forms.
8.4 RESOLVING PROBLEMS AND GRIEVANCES
As a DPET you need to be accessible to the prevocational trainees in your care and able to promptly assist any with problems.
Personal contact is also essential for trainees with special needs, such as those doctors identified by the Medical Board, those with communication difficulties, and doctors with known problems such as past drug abuse, physical and psychological disabilities.
During any term, there will be situations and encounters that will leave trainees feeling upset and unhappy. Prevocational trainees often feel they are not in a position to raise issues within the medical hierarchy.
It is essential that trainees know there is a resolution process in place and a formal grievance mechanism is part of local grievance policy. Trainees must be made aware they have been empowered to deal with issues of concern.
In the first instance, issues should be discussed with the Term Supervisor. Then, any problems with nursing, or facility staff in general, should be taken up with the person concerned or, if that is difficult, with their Supervisor (e.g. the Nursing Unit Manager). If it is not resolved at this point, the issue should then be escalated to you.
If further action is required which you cannot undertake, the problem should be passed to the Director of Medical Services and the GCTC.
Problems identified by you, or Term Supervisors, should prompt additional interviews to initiate remedial action.
You should keep the trainee informed of all action taken. And, you will need to maintain adequate confidential records, including detailed notes, of each case and its resolution process.
8.5 DISCIPLINARY ACTIONS
Where there is an inquiry or disciplinary meeting, you will need to refer to the NSW Health Policy Directive PD2005_584 on the process to follow.
Web Resources:
NSW Prevocational Trainee Directory 2008
NSW Progress Review Form – Formative (Mid Term) Appraisal
NSW Progress Review Form – Summative (End of Term) Assessment
NSW IMET Generic Term Evaluation Template
NSW Health Policy Directive PD2005_584
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9. WORKING RELATIONSHIPS
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As Director of Prevocational Education and Training you will:
- Liaise with term supervisors, NSW IMET, Facility Administration and other DPETs in the network
- Actively participate in the Network Committee for Prevocational Training (NCPT)
- Participate in GCTC
- Attend the annual DPET Forum and NSW IMET Symposium, and report to the GCTC and NCPT on these meetings
- Assist the facility to maintain its accreditation status with NSW IMET
- Implement a DPET discussion plan.
You are part of a team and four key areas of support and liaison for the DPET role include:
- Term Supervisors
- Facility Administration
- The Network Committee for Prevocational Training (NCPT)
- General Clinical Training Committee (GCTC)
TERM SUPERVISORS
Term Supervisors are responsible for prevocational trainees allocated to their team or unit and report to the General Clinical Training Committee (GCTC), or equivalent, and the DPET. There is a close relationship between the Term Supervisor and each trainee as they provide orientation, assessment, feedback and teaching throughout the term. One of your responsibilities as a DPET is to work with Term Supervisors to support them in their supervisory role and as clinical teachers.
This may involve but will not be limited to:
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Reviewing data as a mechanism for assessing trainee perceptions of clinical teaching in individual terms
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Recognising Term Supervisors for effective teaching through assessment reports, a personal 'thank you' call or visit, or a formal certificate
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Discussing problems regarding clinical teaching with the GCTC
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Meeting with Term Supervisors, either individually and informally, or as a group at a Term Supervisor breakfast, to discuss issues related to clinical teaching and supervision - you may decide to use a portion of your DPET Grant for this purpose.
The position description for the Term Supervisor can be found in the resources section of this document.
In summary:
The key responsibilities for Term Supervisors according to the Standards for Prevocational Trainee Education and Supervision 2002 include:
- Ensuring the adequacy and effectiveness of education within normal team operation
- Monitoring the performance of prevocational trainees in their term and advise the DPET or JMO Manager in a timely manner where a prevocational trainee has performance issues
- Ensuring the currency of term descriptions which are to be reviewed at least annually in consultation with other Attending Medical Officers
- Encouraging and monitor handovers
- Providing orientation to all prevocational trainees at the commencement of each term. This will include:
- Outlining the roles and responsibilities and expectations of the prevocational trainee
- Providing the prevocational trainee with a job description
- Explaining the term specific knowledge and skills required for safe practice
- Explaining the assessment and feedback process
- Describing the term structure and activities
- Encouraging the evaluation of the term by the prevocational trainee.
FACILITY ADMINISTRATION
Role in the Management of Prevocational Trainees:
According to NSW IMETs standards and accreditation guidelines, the facility is to provide the DPET with adequate secretarial and administrative support.
The facility is responsible for:
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Preparing rosters, allocations, employment details, time sheets, rotations, industrial matters, staffing levels and the relationship between the prevocational trainees and the senior management of the health service
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Undertaking administrative duties referred by the DPET
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Conducting disciplinary and medical staff administration matters.
Within the home facility, the person with the main responsibility for management of prevocational trainees is the JMO Manager. The JMO Manager should ensure there is effective communication with the equivalent person in each rotation facility about all relevant rotation arrangements. This includes adequate notice of rotations and their relief.
Maintaining Standards:
Between surveys, facility management must ensure that prevocational trainees are only allocated to accredited terms. Similarly, educational activities must continue to meet the necessary standards. Should any substantial change occur, it is the facility management's responsibility to notify NSW IMET and advise how such changes would affect the standards of prevocational training, supervision and workload.
Recruiting Prevocational Trainees:
NSW IMET currently allocates prevocational trainees to Networks and the Network Committee for Prevocational Training determines the distribution across the accredited sites within the Network. Only home facilities are permitted to employ PGY2s. At a local level the JMO Manager/medical administration department coordinates their appointment.
THE NETWORK COMMITTEE FOR PREVOCATIONAL TRAINING (NCPT)
Facilities receiving prevocational trainees are part of a network which comprises of a home facility and its rotation facilities.
The Standards for Prevocational Trainee Education & Supervision (the Standards) requires that each network has a Network Committee and that membership of the Network Committee must include the Directors of Prevocational Education and Training.
The facility is responsible for actively participating in the management of the network. The facility participates in the Network Committee.
A formal education program is planned, promoted and monitored by the Network Committee.
The Network Committee coordinates the education program across the home facility and rotation hospitals through:
- Promoting optimal and equitable staffing and allocation of prevocational trainees across the network
- Monitoring and evaluating the progress of all trainees within the network, particularly those experiencing difficulties or with special needs
- Reviewing the needs of impaired registrants
- Liaising with NSW IMET about issues of concern.
GENERAL CLINICAL TRAINING COMMITTEE (GCTC)
The GCTC is established and appropriately constituted with delegated authority. The effectiveness of the DPET is routinely evaluated by the GCTC.
The GCTC also supports the DPET through:
- Determining the specific training and education needs of prevocational trainees
- Supporting clinicians in providing education and training to prevocational trainees
- Planning, promoting and monitoring the education program for effectiveness
- Developing, implementing, monitoring and evaluating all aspects of the clinical training programs for prevocational trainees
- Advising on educational resources needed to support the education programs
- Monitoring the progress of the prevocational trainees
- Reviewing and evaluating the role and function of the Director of Prevocational Education and Training.
Web Resources:
Term Supervisor, Position Description
Network Committee for Prevocational Training (NCPT): Terms of Reference
General Clinical Training Committee (GCTC): Terms of Reference
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10. TERM DESCRIPTIONS
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The facility provides the prevocational trainee with a written term description which should reflect the Australian Curriculum Framework for Junior Doctors and be made available to the prevocational trainees some weeks in advance of the commencement of the term.
The Term Supervisor ensures clinical content and workload are equitably distributed, with opportunities for optimal teaching and supervision, by defining the term description. The Term Supervisor has clear responsibility for the currency of the term description which is reviewed at least annually.
There is a term description for every term including nights and relief. The facility term description includes all the elements of NSW IMETs term description template.
The term description should contain at a minimum:
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The name of the Term Supervisor, the name of the term and the term duration
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An overview of the team or unit structure and its particular work
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The term objectives (knowledge and competencies to be acquired during the term)
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Any knowledge or skills required before undertaking the term
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How assessment and feedback will occur
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Unit or team activities, including clinics, meetings and theatre sessions
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Prevocational trainee responsibilities and daily tasks
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The educational resources available to trainees
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Specific learning/educational goals for the term (knowledge and skills)
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Staff members responsible for supervision and how to contact them
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The trainees’ need for attendance at each session should be made clear
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Any features of the term that warrant further detail
If there are any protocols, peer articles and special features associated with the term, the Term Supervisor should create a specific reference folder.
Web Resources:
Term Description Template
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11. SUCCESSION PLANNING
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As an outgoing DPET it is likely you will have at least some input to the appointment of your replacement and ongoing contact with the new DPET. This section gives you an overview of all aspects of the process of appointment, whether or not you are required to be involved.
11.1 SELECTION PROCESS
You must notify the NSW IMET of your resignation or impending resignation. Although you may participate in the selection process, the executive of the facility will nominate a new DPET with specific input from the outgoing DPET and General Clinical Training Committee (GCTC) (See the Resources section of this document for the GCTC Terms of Reference).
You may be required to work with a deputy DPET in the period prior to your resignation who will be appointed as DPET when you leave or who can act in the DPET role in your absence.
Where a number of candidates are identified, facilities may need to seek applications and interview prospective candidates.
A formal letter is to be sent to NSW IMET from the Executive of the facility with specific input from the General Clinical Training Committee (GCTC) with a recommendation for a new DPET (including their curriculum vitae).
The NSW IMET Prevocational Training Council (PVTC) reviews the facility's recommendation and advises of their consideration and sends a letter of welcome to the new DPET.
11.2 DPET SELECTION CRITERIA
The selection criteria for DPETs include:
11.3 FACILITATING THE HANDOVER TO A NEW DPET
DPETs have commented that it can sometimes take years to completely comprehend the nuances of the role.
With this in mind, to facilitate an efficient handover to a new DPET, it is recommended that the outgoing DPET:
- Starts planning for handover 12 months before resigning from the role
- Acts as deputy for at least 12 months following the new DPETs appointment.
And, the incoming DPET should attend the induction meeting (held bi-annually) as soon as possible following their appointment to the role.
Web Resources:
Position Description, Director of Prevocational Education and Training
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12. REPORTING AND FINANCIAL MANAGEMENT
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REPORTING
As at May 2006, a new reporting tool for Directors of Prevocational Education and Training has been implemented – the Biannual Performance Report.
What am I reporting on?
The Six Monthly Annual Performance Report replaces the annual report on expenditure of funding.
You are required to report on the following sections:
- Data collection
- Financial summary
- Summary of achievement
- Sign off
The reports require you to provide a cumulative summary of expenditure for the year. As such, the final report will provide an annual financial summary for the year.
WHEN ARE MY DPET PERFORMANCE REPORTS DUE?
Biannual Performance Reports are due around the second week in January and July. A reminder will be emailed to you a few weeks prior to the reporting date.
WHY ARE WE REPORTING?
Information from the report is collated and analysed by NSW IMET to review the support provided by facilities and DPETs at sites for the education and training of prevocational trainees. NSW IMET also has reporting obligations to the NSW Department of Health and the information provided will influence future funding policy decisions.
WHO CAN HELP ME?
There are a number of people who can help you. For most DPETs the JMO Manager or Medical Administration Department should be able to offer assistance in completing the report. Your Finance Department should also be able to help with the financial summary section of the report. NSW IMET staff members are also able to help you and you should contact us if you are experiencing difficulties.
WHAT HAPPENS IF I DON'T COMPLETE THE REPORT BY THE DUE DATE?
Where satisfactory reports are not provided by the due date, or where outcomes are not achieved, NSW Department of Health Finance can withhold funding until satisfactory progress is demonstrated. Where targets are not being achieved, explanations are required.
WHAT IS THE REPORTING PROCESS?
The process for completing these reports is illustrated below.
Six Monthly Performance Reporting Process
FINANCIAL MANAGEMENT
The financial aspect of the DPET role is often the one which causes the most anxiety because of the complex nature of financial statements and reporting.
Most facilities accredited by NSW IMET receive annual funding to promote education and supervision of prevocational trainees within the facility.
This section explains the processes involved in receiving and managing the funding. It also provides advice about local management issues.
WHO ALLOCATES MY DPET FUNDING AND HOW IS THIS DETERMINED?
The NSW Department of Health provides identified funding for the education and training and supervision of prevocational trainees in NSW.
Funding is currently based on a formula that involves a base amount, a loading for home facilities and a variable component determined by trainee numbers.
The distribution of DPET funding is based on the following principles:
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The funding formula will fit the budget
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Each eligible facility will receive a minimum amount for fixed costs
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There will be no differentiation between rural and metropolitan facilities for the purposes of funding
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Home facilities will receive a minimum loading
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A weighted formula will be based on the number of prevocational trainees per facility.
IS THERE ANY OTHER FUNDING PROVIDED?
In addition to the DPET funding, NSW IMET funds all travel, accommodation and conference costs for the annual DPET Forum.
The forum’s purpose is to:
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Inform DPETs on the progress of important projects and their implementation
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Provide an opportunity for external organisations to provide relevant information to DPETs
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Provide an opportunity for DPETs to discuss issues relevant to their work including financial issues and the new DPET Manual
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Orientate incoming DPETs and provide opportunities for networking
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Consult with attendees regarding emerging issues and provide a peer discussion forum
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Provide information to DPETs on the broader work of NSW IMET.
Facilities and Area Health Services are expected to contribute financially to supporting both the DPET and the education of prevocational trainees.
WHEN IS THE MONEY ALLOCATED AND WHERE IS IT HELD?
DPET funding will be cash-flowed directly to Area Health Services from the NSW Department of Health. Area finance should then send the funds to the facility to be held in a specific Director of Prevocational Education and Training cost centre.
WHAT CAN I SPEND THE MONEY ON?
Funds may be used for the purpose of promoting prevocational education and training including:
- Conducting or supporting educational activities
- Establishing or improving educational resources and activities
- Facilities / rotation facilities
- Undertaking research.
Funding should not be used for:
Innovative examples of what the funds have been used for in the past include:
- Funding of a research project on prevocational training
- Purchase of equipment, such as digital camera, data projector, educational software
- Funding prevocational trainee attendance at courses such as emergency life support, or national prevocational conferences
- Catering for functions such as education sessions, end of term debriefing, Term Supervisor breakfasts or a welcome meeting for prevocational trainees at the beginning of the year.
WHAT ARE THE FUNDING CONDITIONS?
- Cash will be provided up to the approved levels where the Health Service provides necessary reports and demonstrates achievement of outcomes (see Section A: Reporting)
- Where satisfactory reports are not provided by the due date or outcomes are not achieved, Finance will withhold cash at a value agreed with the Director, Workforce Development and Leadership until satisfactory progress is demonstrated by the Health Service.
HOW DO I MANAGE THE FUNDING?
When you take over as DPET you will need to meet with Finance to:
- Identify your local cost centre
- Review cost centre and budget reports to date
Ensure your systems include being sent monthly cost centre reports and learn how to interpret them: this is where your contact in Finance can help you.
Keep your own record of expenditure so that you can check it against the cost centre reports. Given that nothing should come out of the cost centre without your signature these two documents should tally.
Where the account needs to be countersigned, ensure the designated person is someone who you have regular access to. NSW IMET would recommend someone from medical administration such as the Director of Medical Services or the JMO Manager.
WHO HAS THE APPROVAL TO EXPEND THE DPET FUNDING?
The DPET is the Cost Centre Manager. Approval and payment of expenditure is to be consistent with the Area / facility’s finance department policy and procedure. AHS and facilities ensure delegations include the provision for DPETs to expend their funding.
WHAT IF THE FUNDING ALLOCATION HAS NOT BEEN SPENT WITHIN THE FINANCIAL YEAR?
Area Health Services and facilities must carry forward unexpended funds from year to year. Any rollover of unexpended funds must be noted on the Quarterly Performance Report along with the plan for expending the funds.
It is imperative that you notify Finance by mid-April if you expect to rollover unused funds at the end of the financial year. This must be done in writing. Check on 1 July that the unused funds have been rolled over.
If funds are to be rolled over for more than one financial year DPETs are to provide expenditure proposals to the AHS, facility and NSW IMET. Failure to provide this proposal may result in suspension of funding.
WHAT TO DO IF I CAN'T ACCESS DPET FUNDING?
Discuss the issue with you Finance Department. If they are unable to resolve the issue they should take the issue up with the AHS on your behalf.
If you are still unable to find the answers after these initial enquiries contact NSW IMET for support.
WHAT TO DO IF YOUR DPET FUNDING HAS BEEN SPENT
Unfortunately, you will need to wait until the next financial year. By creating an expenditure budget for the year and keeping track of actual expenditure on a monthly basis, you will be better equipped to use the DPET funding across the year.
WHO CAN HELP ME?
The outgoing DPET and other people who manage cost centres, such as Nursing Unit Managers and JMO Managers, will be able to guide you to the most helpful administrative and management staff within Finance.
You need to identify a person in Finance who has experience working with DPETs and with whom you can deal with when you have problems or need information.
Establishing a good working relationship with your facility’s Finance Department will create an essential support mechanism for your term as DPET.
An experienced DPET or your contact person in Finance will be able to help you:
- Interpret the facility’s budget and other regular reports
- Understand the systems
- Manage your cost centre
If your Finance Department requires any further information or is not providing you with the assistance you need, NSW IMET will contact Finance or take the issue up on your behalf. NSW IMET is responsible for overseeing the allocation of funding to the DPET in all eligible facilities.
WHAT IF THERE IS A DISPUTE OVER FUNDING?
Where there is a dispute between the DPET and hospital administration in relation to the expenditure of the grant, the matter should be referred to the AHS and to the Executive of NSW IMET.
Please be aware that some of the information quoted here is from the DoH Policy Directive 2005_259 which has since been superseded by DoH initiatives. Those sections still applicable have been included.
CONTACTS
For details on DPET funding allocations and reporting, contact the IMET Program Coordinator for Prevocational Training Mr Craig Bingham:
The NSW Institute of Medical Education and Training
Email: cbingham@imet.health.nsw.gov.au
Ph: 02 9844 6511 Fax: 02 9844 6544
Web Resources:
DPET Six Monthly Performance Report Template
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13. NSW INSTITUTE OF MEDICAL EDUCATION AND TRAINING
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NSW IMET works with the health system, facilities, colleges and doctors to make sure on the job medical training is the best in Australia. NSW IMET was formed in September 2005 following the merger of the Postgraduate Medical Council (PMC) of NSW and the Medical Training and Education Council (MTEC) of NSW. NSW IMET is an independent entity within the NSW Health system and reports to the Director General of NSW Health and provides advice to the Minister for Health.
NSW IMET’S ROLE IS TO:
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Advocate for safe patient care through high quality postgraduate medical training in NSW
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Work with individuals, groups and organisations to develop and deliver strategies and programs that support and coordinate the delivery of postgraduate medical training in the NSW Health system. This includes oversight of systems that implement standards, distribute workforce and deliver education
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Lead and support changes in the delivery of medical training through innovation and engagement with trainees, clinicians, training organisations and health services
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Recognise and support the valuable roles of clinicians as trainers and trainees in the NSW Health system
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Provide advice on medical training issues including the distribution of medical training positions within NSW Health services
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Set standards and accredit institutions for prevocational medical training
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Undertake research into and evaluation of medical training systems to improve the delivery of training
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NSW IMET is governed by a Management Committee and has a number of specialised committees to advise and undertake policy and strategic development.
PREVOCATIONAL TRAINING COUNCIL (PvTC)
The purpose of the PvTC is to promote high quality Prevocational Training in NSW by ensuring the effective functioning of the Network Committees for Prevocational Training and to support the delivery of Prevocational Training as required. As a result of the review of Prevocational Training in NSW and the implementation of the new network and governance structures the NSW Prevocational Training Council refined the Terms of Reference in 2007 to include additional advisory and operational functions.
The additional functions for the Council included the requirement :- to monitor and support the prevocational training networks: to develop and review policies and the guidelines to promote the effective delivery of prevocational training; to liaise with the networks; to gain oversight of network operations; to respond to matters referred by the networks and trainees.
THE PREVOCATIONAL ACCREDITATION COMMITTEE
The purpose of the Prevocational Accreditation Committee is to:
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manage and advise NSW IMET on the accreditation of all NSW and ACT prevocational trainee terms and the facilities that provide them
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manage, oversee, evaluate and improve an on-site surveying system to accredit facilities and training terms according to the Standards for Prevocational Training
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manage, oversee, evaluate and improve the recruitment and training of surveyors and team leaders and to facilitate their continuing education
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review facility accreditation survey reports and make decisions regarding the accreditation status of facilities and terms for prevocational training.
GOALS OF THE ACCREDITATION STANDARDS
| Goal 1: |
The hospital ensures Prevocational Trainees have the appropriate knowledge, skills and supervision to provide quality patient care. |
| Goal 2: |
The facility provides a wide range of educational and training opportunities for Prevocational Trainees to ensure that they are competent and safe. |
| Goal 3: |
The facility promotes the welfare and interests of Prevocational Trainees. |
JMO FORUM
The JMO Forum has been established to provide a forum for NSW and ACT prevocational trainees to meet with their peers and discuss issues relevant to prevocational supervision and training, recruitment, accreditation of position and workforce allocation. Eight members are appointed to the Prevocational Trainees Committee who are responsible for leading and directing the work of the JMO Forum. It ensures effective prevocational trainee representation within NSW IMET and to provide advice on these issues to the Prevocational Training Council (PvTC).
The JMO Forum is responsible for:
- Promoting awareness of JMO Forum issues by providing information arising from the JMO Forum, to prevocational trainees and external organisations
- Focus on participation and involvement of prevocational trainees in the decision making and planning functions of NSW IMET
- Report to NSW IMET on relevant issues and where appropriate forward issues to the Prevocational Training Council
- Support members of NSW IMET Executive and Secretariat attending the JMO Forum as a resource on specific issues, when appropriate.
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14. Would you like to get more involved in NSW IMET?
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There are a number of opportunities to participate in NSW IMET activities beyond your work as a DPET:
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Become a member of one of the NSW IMET committees
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Become an accreditation surveyor
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Assist in the development of educational resources
For further information:
Contact NSW IMET on 02 9844 6551 or by email info@imet.health.nsw.gov.au | 
