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WHAT'S NEW?
New look for the newsletter and results from a reader survey
We hope you like the design and layout of the new IMET newsletter which matches the new look IMET website. We have added a section on IMET Program Updates which will now include regular sections on medical education and training, accreditation and workforce issues. These changes have been introduced in response to our June reader survey which was sent out to IMET’s Newsletter distribution list. In all, 88 responses were received from a cross section of readers.
Here are a few of the key findings:
- 69% of responses indicated that the newsletter is about right length, with 16% indicating they are not sure. Some feedback indicated that the overall length of the newsletter should remain the same and not be increased.
- 84%, 64% and 60% of responses indicated high or very high interest in the WHAT’S NEW, TALKING POINT and TRAINEE FORUM sections respectively.
- The survey also asked readers whether they would like to see any of the following included as regular content: Editorials -39% said yes; updates of IMET programs (including accreditation and workforce) - 79% said yes and articles and links to national/international MET - 69% said yes.
- Other topics/areas suggested for inclusion include: policy changes; surveyor updates; International conferences on medical education & training; working in other areas of Australia; information from the Coroner; education/training for International Medical Graduates; Innovative education delivery models
In response to the survey feedback, we will endeavour to publish one article in each newsletter issue highlighting good practices and some common issues identified through accreditation surveys. <top>
Upcoming Events
Surgical Sciences Preparation Courses
> Anatomy Limb and Pelvis 30 August 2008
> Pathology and Pharmacology 12-14 September 2008
> Anatomy prosection course 27-28 September 2008
Hospital Skills Program Forum 26 August 2008
DPET Forum 28 November 2008
For more event dates are available on the NSW IMET website. <top>
FEATURE
Preparing for the Next Generation of Medical Graduates – July Forum Report.
The number of NSW medical graduates will double over the next five years providing a unique opportunity to develop new models of clinical training and address medical workforce issues.
On 15th July, around 140 stakeholders in medical education and training including medical students, postgraduate trainees, medical administrators, clinician trainers, medical deans and representatives of state health departments, specialty colleges and postgraduate medical councils participated in the NSW IMET forum “Preparing for the Next Generation of Medical Graduates”.
The goals of the forum were to raise awareness of the issues around the increase in medical graduates in NSW and stimulate discussion and action.
The key note speakers were Professor Mark Brown Director NSW IMET, Professor John Horvath, Australian Government Chief Medical Officer, Ms Susanne Le Boutillier, Acting Director Medical Workforce Advice and Coordination, Workforce Planning and Coordination Branch, Queensland Health and Professor Lou Landau of the Western Australian Postgraduate Medical Council and WA Health. There were also short presentations from Mr Michael Bonning, President of the Australian Medical Student Association and Mr David Dixon, Acting Director of NSW Health Workforce and Leadership Development Branch. A/Prof Simon Willcock facilitated a lively and thought provoking panel discussion.
NSW IMET thanks all those who participated and looks forward to continuing to work with all involved in medical training in NSW to prepare for the incoming generation of doctors. A summary of the forum discussion and copies of speaker presentations are available on the IMET website. <top>
Reflections on the evolution of the JMO Manager in NSW
Judy Muller is well known to many currently or previously involved in prevocational training and workforce as a passionate advocate for junior doctors within the hospital system.
Judy had worked in the Information Technology sector prior to joining the health system as assistant to the Deputy Director of Medical Services at Westmead Hospital in 1992. As part of her role she became involved in assisting with trainee queries and rostering. From there Judy was involved in the development of the first JMO Manager’s position in NSW, and she commenced work in this new role in 1993. In 2002 Judy moved to Hornsby Hospital, where she continues in the role of JMO Manager. 
Left: Judy Muller, JMO Manager Hornsby Hospital
Since 1993, more JMO Managers have been appointed and the role has grown in responsibility and complexity. There are now around 50 JMO Managers throughout NSW and ACT who meet every month to provide a forum for peer support and discussion.
When asked what was essential for doing the role well, Judy replied ‘passion’. “You have to love being involved in a young person’s personal and professional development”. Judy goes out of her way to balance the trainees’ personal and training needs and the hospital’s workforce requirements.
One of the significant changes since the origins of the role has been the change in organisational culture around work/life balance. When Judy started in her role, many senior doctors believed a 40 hour shift for trainees was appropriate because ‘that’s what I did in my training’. Today, things have changed and 40 hour shifts are no longer part of prevocational training. The JMO Manager plays a pivotal role in ensuring safe rostering practices and a sustainable work/life balance.
For Judy, the main challenge over the years has been to obtain recognition for the role of the JMO Managers. Many JMO Managers take on multiple responsibilities within their hospitals which makes keeping trainee needs on the top of their priority list a constant juggling act; a feat that Judy says she manages with an open-door policy and good forward planning. <top>
TRAINEE NEWS
Paediatric RMOs' Retreat - “Working together to become better doctors”
The first ever Paediatric RMOs' Retreat involving trainees from the three paediatric training networks, was held on the 4-6 April at the picturesque Cypress Lakes Resort in the Hunter Valley. The goal of the retreat was to provide an opportunity for trainees to develop their professional skills such as preparation for job interviews, teaching skills, self-awareness and leadership skills.
NSW IMET supported one of the two days of the professional development program. The second day was run by each network.
Session facilitators included: Dr Emma McCahon, IMET State Chair Paediatrics,; Tim Laporte, Management Consultant; Dr Hala Katf, IMET Stream Coordinator General and Community Medicine; and, Dr Paul Craven, IMET Stream Coordinator Neonatal Medicine and Teaching on the Run facilitator.
The retreat facilitated relationship building between trainees and senior medical staff and helped to strengthen workplace relationships whilst building trainees’ professional skills. The program evaluation will be used by NSW IMET to develop a model professional development program for that can be used in all IMET training networks. <top>
NSW IMET information evening on leadership for trainees
NSW IMET hosted an information evening for trainees at Australia Technology Park on 30 June 2008. The purpose of the evening was to update doctors-in-training on NSW IMET’s proposed Trainee Leadership program and to provide a ‘taste’ of leadership skills through a group exercise.
Prof. Mark Brown - NSW IMET Director; welcomed trainees and spoke of the significance of three key leadership qualities of vibrancy, connectedness and depth. Dr Rowan Gillies, an advanced surgical trainee gave some personal insights of the leadership styles he encountered and admired during his time as International President of Medecins sans Frontieres.
Mr Tim Laporte and Dr Emma McCahon co-facilitated an activity where trainees were required to work in groups to build the longest suspension bridge with the materials provided (see photo below). Each group had a leader with a different leadership style – democratic, dictator and abdicator. The activity challenged trainees to step outside their comfort zones and reflect on the different approaches to leadership that may operate in a given situation.
Above: Trainees making a suspension bridge
Participating trainees came from a broad range of disciplines and stages of training. The evaluation was positive with trainees indicating that they valued the experience offered and would be keen to develop their leadership skills with likeminded peers, have access to training with other trainees outside of their specialty and meet with clinicians/experts. <top>
IMET PROGRAM UPDATES
Medical Education and Training
Postgraduate Anatomy Courses
For many years junior medical officers working towards surgical and emergency medicine Fellowship have bemoaned the lack of postgraduate teaching in anatomy available in New South Wales. In response to trainee demand, the NSW IMET Clinical Surgical Training Council (CSTC) has worked with NSW medical schools with Departments of Anatomy and surgeons with a long history of participation in the delivery of anatomy courses to coordinate a series of weekend courses providing hands on anatomy teaching using prosections.
For the first time in the recent history of surgical education in NSW, anatomy courses targeted at postgraduate surgical trainees will be delivered in NSW. The Universities of Newcastle, New South Wales and Western Sydney, and the orthopaedic surgeon Mr James Powell FRACS have used the Royal Australasian College of Surgeons’ (RACS) anatomy curriculum for the generic component of the Surgical Sciences Exam to design a series of three courses covering:
1. Head & Neck and Neuroanatomy;
2. Lower & Upper Limb and Pelvis; and
3. Abdomen and Thorax.
The first course, covering Head & Neck and Neuroanatomy was held at the University of New South Wales over the weekend of 2 and 3 August. Otolaryngology Head and Neck Surgeons and Neurosurgeons were an integral part of the course, acting as demonstrators, and providing surgical insight to complement the anatomical theory. Five neurosurgeons from the Prince of Wales Hospital provided invaluable support and expertise on the morning of Sunday 3 August, and Otolaryngology Head and Neck Fellows from Prince of Wales Hospital were part of the Saturday and Sunday afternoon sessions.
 Below: Dr Charlie Teo with students in the neuroanatomy course
Nineteen trainees from surgical and emergency medicine programs attended the course, and have given it the “thumbs-up”. Word is rapidly spreading about these new anatomy courses, and the there are more than twenty trainees enrolled for the one day session in Lower & Upper Limb and Pelvis set for Saturday 30 August at the University of Newcastle.
Demand for the third and final session, covering abdomen and thorax and scheduled for the weekend of 27 and 28 September at the University of Western Sydney has also been strong. For more information on how to enrol in these anatomy courses, refer to the IMET website. <top>
NSW IMET begins working towards Radiology Training Networks
NSW IMET is moving towards implementing the Recommendations for the Delivery of Radiology Training in NSW. Watch this space as the Radiology Training Implementation Group (RTIG) is formed and begins work towards the implementation of training networks for Radiology. Representation for the RTIG is being sought from NSW Health, radiology departments, the College (RANZCR), GMCT and current trainees. There is still much work and consultation to be completed before these networks can start and we will keep everyone advised of the progress on the IMET website. <top>
Psychiatry Training News
Recruitment time is on us again and information can be accessed via the RANZCP website.
We say goodbye to Dr Catherine Hickie as our Network Director for the Sydney South East Illawarra (SESI) Network and thank her for her amazing work in creating a great training program. I am sure you join us in wishing her well in her next role. Thanks also to Ms Helen Stavrou who has work tirelessly for SESI as their Psychiatry Education Support Officer. Helen is moving on to another role in SESI.
Congratulations to the trainees who passed their recent exams. We all realise the huge effort you have put into your training and look forward to you moving successfully into Advanced Training.
Our thanks go to the NOC Trainee Sub-Committee for its submission on expanding the variety of training opportunities into private and community settings. Good news is how well this has been reflected in the record 20 applications to the Commonwealth for new psychiatry training positions, many as part of the Expanded Settings for Specialist Training Program. We await the final decision on these applications and thanks to the Network teams for composing such quality applications.
The NOC is reviewing the next round of Education Support Fund applications and there are some enticing proposals to consider that will greatly benefit trainees.
We are also arranging a repeat of the Dementia Lecture Series with Professors Henry Brodaty and Sue Kurrle. These are a joint initiative with the Dementia Training and Study Centre. Dates for the four lecture series are 12 and 19 August, 2 and 20 October. The lectures are open to all trainees and interested doctors. You can register for one or more and will receive a discount if you register for all sessions. Register now via the IMET website or call Jay Jacinto on (02) 9844 6566. <top>
External Review of NSW Psychiatry Training Networks
The Psychiatry Training Network system commenced in 2006 and is now undergoing an external review led by an independent panel of experts. The review panel met with trainees, clinicians, health service managers and representatives of the NSW Health Department during an intensive week of visits commencing 18 August 2008. Contact Ms Christina Harlamb on 9844 6551 for more information. <top>
Accreditation
Supervision of junior doctors – when is on-site supervision needed?
In each edition of the newsletter we will aim to include a brief article highlighting good practices and some common issues identified through the accreditation survey process. By sharing this information training facilities can learn from each other, resulting in fewer provisos being issued. More importantly however, the process will result in improved trainee safety and patient care.
NSW IMET surveys approximately 20 hospitals each year. One of the most common provisos resulting from hospital accreditation surveys concerns prevocational trainee supervision. Supervision provisos relate to standard 1.3 -Supervision which states: The hospital provides prevocational trainees with adequate and appropriate supervision.
The standard for supervision consists of six criteria. Each criterion has a list of guidelines on how training facilities can meet the compulsory specific requirements. For example, the standard requires trainees in their first year (PGY1s) to have on-site supervision at all times and the supervisor must be awake. Trainees in their second year (PGY2s) must have on-site supervision at all time however the supervisor may be asleep e.g. on-call but in the hospital. The supervisor must have a minimum of two years experience. It is important that all training facilities apply the standards consistently.
Further information regarding NSW IMET’s accreditation standards is available on the website. <top>
Workforce
Rural Preferential Recruitment – a win-win for graduates and rural hospitals
The Rural Preferential Recruitment Program (RPR) was established in 2006 by NSW IMET in response to increasing demand from trainees, clinicians and health service managers for rural based internships for medical graduates. Until then, access to a rural internship in a specific location was generally through ‘secondment’ from a city hospital.
In brief, graduates with an interest in rural training now apply directly to a range of rural hospitals accredited by IMET for prevocational training. This occurs before the main centralised intern allocation process, a computerised system which allocates each graduate to one of fifteen training networks across NSW and the ACT based on his/her ranked preferences.
By comparison, the rural preferential recruitment process is merit-based, requiring trainees to submit a written application and attend an interview. The process is carefully timed to be completed before the main allocation process so that unsuccessful applicants are still allocated to an intern placement in NSW through the main allocation process. Rural hospitals with unfilled positions continue to receive other trainees on rotation within their training network.
Since the Rural Preferential Recruitment Program was introduced in 2006 (for the 2007 clinical year), there has been a significant increase in: the total number of applicants for RPR; the number of hospitals participating in the RPR; and, the number of intern positions filled through RPR (see Table below).
Table: Outcomes of the Rural Preferential Recruitment Process
|
Recruitment Year |
2006 |
2007 |
2008 |
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Intern Clinical Year |
2007 |
2008 |
2009 |
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Total Applications** |
Not available* |
81 |
150 |
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Eligible Individuals |
Not available* |
42 |
77 |
|
Uptake of Positions (FTE) |
15 |
35 |
54.5 |
|
Number of Participating Rural Hospitals |
4 |
11 |
10 |
*for the 2007 clinical year, applications were not coordinated through NSW IMET
** some individuals made more than one application
As these interns may stay in these hospitals for their first resident (second postgraduate) year, this has enhanced the rural medical workforce with increased continuity of rural training, and allowed rural hospitals to develop stronger relationships with junior medical staff. For more information on the Rural Preferential Recruitment Program click here. <top>
TALKING POINT
Clinical supervision – a clinical training and patient safety issue
A tenet of postgraduate medical training is that trainees learn most by working as part of a team under the guidance and supervision of senior colleagues. As a trainee becomes more skilled and knowledgeable over a multi-year training program, the level of supervision required reduces until such time as the trainee reaches competence for independent practice. The notion of “graded, progressive responsibility” is an integral part of postgraduate medical training. But it does raise questions like what is the “right” level of clinical supervision required for patient safety and for clinical training. This is not an easy question to answer in general terms because the amount of supervision required depends on the clinical context and the capability, experience and confidence of the individual trainee.
NSW IMET sets general standards for on-site supervision of junior doctors (postgraduate years 1 and 2). These standards aim to prevent junior doctors being isolated in a hospital by requiring hospitals to ensure that there is always a more senior doctor on-site.
Even when on-site supervision is available however, the seemingly simple task of a junior doctor calling for help and advice, especially after-hours, is not as straightforward as it seems.
Stewart1 has described four assumptions underpinning “calling for help and advice”. These are:
i. Junior doctors will contact a senior when they recognise the need to do so.
ii. A senior member of staff will respond when called.
iii. The senior brings additional knowledge to a situation.
iv. A junior has the “right” level of confidence.
Assuming that the junior doctor has recognised a problem in a patient, the decision to call a senior is influenced by a number of factors. For example, the junior doctor knows that the registrar is busy assessing patients in the emergency department and does not want to disrupt this work. The junior doctor reconsiders – is this something that I really need to worry the registrar about now? What about calling the consultant? There may be a reluctance to call consultants directly because there is a perception that consultants should not be contacted after hours except for emergencies or that they should not be contacted directly except by the registrar. There is also the desire on the part of junior doctors to demonstrate to the registrar and consultant that they are competent to manage on their own.
The complex interactions between a trainee and a supervisor underpin the “supervision relationship”. It is this relationship, argue Kilminster and Jolly2 that is “the single most important factor for the effectiveness of supervision, more important that the supervisory methods used”.
Over the next few editions of the newsletter, we will continue the theme of clinical supervision as our Talking Point and will be inviting people to submit their views and ideas on this topic. If you would like to contribute to the discussion please e-mail us newsletter@imet.health.nsw.gov.au <top>
References
Stewart J. ‘Don’t hesitate to call’ – the underlying assumptions. The Clinical Teacher. 2007; 4:6-9
Kilminster S and Jolly B. Effective supervision in clinical practice settings: A literature review. Medical Education. 2000; 34 (10): 827-840
POST SCRIPT
NSW IMET Staff Update
There have been a number of appointments in the last month.
Congratulations to Mathi Sakthivel and Christina Harlamb who have been appointed to the roles of Acting Head, Systems Support and Operations Division (SSOD) and Acting Head, Medical Education and Training Division (METD) while Kirsten Campbell and Louise Rice are on maternity leave. SSOD is responsible for graduate and AMC allocation, the AMC pre-employment program and the accreditation program while METD is responsible for the network training programs and the Hospital Skills Program. Congratulations also to Nicole Delaat who has been appointed to the position of Program Coordinator, Workforce within SSOD.
Thank you to Di Peers who has recently completed 10 months in the role of Acting General Manager while Evan Rawstron was on leave in the UK completing a Masters of International Health Policy at the London School of Economics. Evan returned to work in July just in time to farewell Abi Bennett (EA and Newsletter Editorial Coordinator) who has been with IMET for almost three years. We wish Abi all the best for the future.
Thank you to all of the IMET knitters who contributed to the Wrap with Love Project held last month. We received 28 squares, made by 13 knitters of different levels of experience: some knitters showed off their skills with fancy patterns and stripes, and some staff (women and men) took it up for the very first time. You can judge the results for yourself.
Below: IMET staff with the finished product <top>
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