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News and Views of Medical Training in NSW
ISSUE NUMBER 6, February 2009
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> Last newsletter (#5 August 2008)
WHAT'S NEW?
> A changing of the guard at IMET
> IMET commended in the 2008 Premier’s Public Sector Awards
> Awards for three high achievers in medical education and training
> Oncology Training Review
> 13th National Prevocational Medical Education Forum, Hobart
UPCOMING EVENTS
> NSW Future Medical Training and Workforce Forum
FEATURES
> Professor Mark Brown reflects on key issues in medical education and training
IMET PROGRAM UPDATES
Medical Education and Training
> New standards in Prevocational Progress Review
> Surgical Science Examination preparation courses
> Future Leaders Development Program
> Paediatrics Supervisors’ Appraisal Evening
> Advanced Cardiology Statewide Lecture Series
> Psychiatry Training Program
> Hospital Skills Program
Accreditation
> Would you like to be part of NSW IMET’s accreditation program?
Workforce
> Basic Physician Training recruitment report
TALKING POINT
> Developing new terms for JMOs — the Drug and Alcohol experience
WHAT'S NEW?
 A changing of the guard at IMET
Professor Mark Brown stepped down from the role of Director of IMET on 31 October 2008, after more than two decades of daily commitment to the training of junior doctors in his hospital, Area Health Service and the NSW Health system. Professor Brown was the founding Director of IMET when it was set up in 2005.
IMET’s new Director is Associate Professor Simon Willcock. Associate Professor Willcock is a general practitioner and Head of the Discipline of General Practice at the Northern Clinical School of the University of Sydney Medical Program. He is also chair of the board of General Practice Education and Training (GPET), which oversees the management of general practice training in Australia. He brings long experience in medical education and advocacy for training to his new role at IMET. 
<< Dr Simon Willcock.
IMET commended in the 2008 Premier’s Public Sector Awards
IMET is committed to achieving equity of training opportunities throughout New South Wales. So we were particularly pleased to receive a commendation in the ‘Delivering the plan – workforce’ section of the 2008 Premier’s Public Sector Awards for our success in increasing rural and regional training for medical graduates.
Dr Simon Willcock, Director NSW IMET (centre), and Mr Evan Rawstron, then IMET General Manager (right), receive the commendation from Mr John Lee, Director-General of the NSW Department of Premier and Cabinet (left).
Awards for three high achievers in medical education and training  
Dr Scott Fortey, Director of Prevocational Education and Training at Gosford Hospital, has been awarded the 2008 Geoff Marel Award for his outstanding contribution to the welfare and training of junior doctors. The Award was presented to Dr Fortey by the Minister for Health, The Honourable John Della Bosca, and by Mrs Merrilyn Marel. Dr Fortey is well known for his good humour, his enthusiasm and his dedication to the interests of junior doctors. He is a member of the NSW Prevocational Training Council and also a leading proponent in NSW of the Teaching on the Run training program for trainers.
<< Dr Scott Fortey. The Honourable John Della Bosca, NSW Minister for Health >>
Dr Greg Keogh, Deputy Director of NSW IMET and General Surgeon at Prince of Wales Hospital, Sydney is the proud recipient of the 2008 Geoffrey Marel Medal awarded by the Confederation of Postgraduate Medical Education Councils (CPMEC) in recognition of his outstanding contribution to medical education and training over 20 years. In particular, the Medal recognises Dr Keogh’s pivotal role in the inception, development and leadership of the Australian Curriculum Framework for Junior Doctors. Dr Keogh was presented with the Medal by Mrs Merrilyn Marel at the official dinner of the 13th National Prevocational Forum in Hobart.
Also recognised at this event was Dr Stephanie Arnold, who received the CPMEC’s Inaugural National Junior Doctor of the Year Award at the National Prevocational Forum in Hobart. Dr Arnold has played a huge role in the development of the NSW JMO Forum, which she chaired in 2007, and as a member of the NSW Prevocational Training Council. Now a dermatology registrar at Royal Prince Alfred Hospital, Sydney, Dr Arnold continues to advocate for the needs, safety and welfare of junior doctors.
Dr Stephanie Arnold, Dr Greg Keogh and Mrs Merrilyn Marel,
at the dinner of the 13th National Prevocational Forum, Hobart.
Oncology Training Review
NSW IMET has been commissioned by the Cancer Institute NSW to develop a model for a sustainable training network for oncology based specialties, focusing specifically on Medical Oncology, Radiation Oncology, and Palliative Care. The primary purpose of this project is to support NSW area health services in the delivery of high quality oncology training. The desired outcome of the review is a prospectively designed and approved networked training program.
During the review, IMET will be consulting with a broad range of relevant groups and individuals including trainees, trainers and area health service administrators. The final recommendations will be completed in mid 2009. The program will be implemented according to the model agreed by IMET and the Cancer Institute NSW.
If you would like to know more about the Oncology Training Review, please contact:
Jennifer Chapman, Acting Deputy Department Head Medical Education and Training Division, IMET (email: jchapman@imet.health.nsw.gov.au; phone: 9844 6541), or
Jennie McGhie, Oncology Review Project Officer (email: jmcghie@imet.health.nsw.gov.au phone: 9844 6521).
Riding the Wave
13th National Prevocational Medical Education Forum, Hobart
How will the rising wave of new medical graduates affect the quality of training in our hospitals? This was one of the questions debated at the National Prevocational Medical Forum in Hobart, 9-12 November 2008. The rising number of trainees will be needed to meet the workforce requirements of the future. One of the chief pressure points identified at the meeting was the increasing lack of qualified supervisors.
Junior doctors held the annual meeting of the National JMO Forum. Looking forward to the national registration of doctors, the JMO Forum called for a nationally established benchmark for training standards, not acceptance of the ‘lowest common denominator’ among existing State standards.
A similar focus on national standards was evident in the resolutions of the forum of Directors of Clinical Training (which called for a national framework for training) and the forum of the Confederation of Postgraduate Medical Councils (which called for national accreditation of PMCs and national calculation of the required number of medical trainees).
More information about the conference is available from the Postgraduate Medical Education Council of Tasmania.
UPCOMING EVENTS
NSW Future Medical Training and Workforce Forum
The NSW Department of Health and NSW IMET are holding the NSW Future Medical Training and Workforce Forum to discuss NSW Health’s strategic plan to manage an increasing number of medical graduates on 7 April 2009. Enquiries: Mr Rohan Keys, 9844 6551, or email info@imet.health.nsw.gov.au.
FEATURE
High quality training for all trainees, wherever they are working 
Mark Brown recently completed his term as Director of IMET and has over 20 years experience in postgraduate medical training. Here he comments on postgraduate medical education and training in NSW.
IMET recognises the need to have well-trained and motivated trainees (JMOs and registrars) not only in city-based teaching hospitals but also in outer metropolitan and rural sites. Traditionally, trainees had concerns that if they were not working in a large city hospital they were unlikely to receive the training required to progress through their career. IMET has aimed to balance the requirement to have good trainees treating patients at many different hospitals with their need to receive excellent medical training wherever they work.
This aim underpinned the formation of networks of training in prevocational, basic physician, basic surgery (now pre-surgical), paediatrics, cardiology, psychiatry and hospital skills training for Career Medical Officers. Other networks such as anaesthetics, radiology and emergency medicine are in development.
Have training networks been a success? We now have far more trainees, more equitably distributed across the state, in prevocational, basic physician, cardiology, paediatrics and mental health training, with great benefits for patients. Each of these programs, with the exception of mental health, is almost fully filled with College registered trainees. Undoubtedly there have been improvements in physician training, prevocational training and paediatrics, but it will take time before all concerned (trainees, clinicians, supervisors of training and health service managers) become used to the principles of networked training where all hospitals and trainees have an equal voice.
Some exciting things have come out of the development of these training programs. Postgraduate medical training is now high on the agenda of the most senior people in New South Wales Health, including the Director General and Minister, both of whom are very supportive. A key role for IMET now is to turn this goodwill into well funded and well-managed systems of training that are innovative and fair to all involved. IMET has so far secured funding for many supervisors of training, assisted by education support officers; this has been a great advance but is still a process somewhat in its infancy. New trainee positions have been created in the rural sector and the training there has increased considerably, with feedback suggesting a highly motivated senior staff who enjoy having dedicated College trainees.
Some key issues remain to be addressed. There have been some wonderful examples, particularly in the surgical program, where IMET has been able to facilitate the delivery of training to overcome gaps identified by trainees. This process is fundamental to the continued success of IMET and it requires trainees at every level to become involved in their networked training programs and in the IMET training committees. Secondly, at a time when the health system is strapped for cash, we must ensure that the money intended for training in the Area Health Services is actually spent in that fashion. Thirdly, we need better systems that reward those who demonstrate excellence in medical training.
Perhaps our most pressing issue is what will happen to the increasing number of medical graduates. This has to be the golden opportunity to reduce, if not remove, the emerging medical workforce shortage in Australia. It remains a mystery how there could be funding for increased medical school places at undergraduate level without dedicated funding for these graduates to work through their prevocational and vocational training years in the public hospital system. Hopefully, both Federal and State Governments will provide dedicated funding for additional JMOs, CMOs and registrars very soon.
My term as Director of IMET has been a wonderful time. I have met many highly engaged and thoughtful people whose primary concern has been the improvement of postgraduate medical training. The negotiations around this can be difficult, particularly where change is required, but I have been heartened by the goodwill in the system towards the training of registrars, residents and interns. I'm excited about the prospect that with the Hospital Skills Program we are at last developing formal and improved training opportunities for Career Medical Officers.
On a practical note, I'd urge all of you reading this newsletter to continue to advocate at your local hospital for the importance of good medical training. We are fortunate in New South Wales that we have so many excellent trainees and a host of altruistic dedicated supervisors of training. Spare a thought too for the many health service managers who are keen to help improve training but find they are given little incentive to do so in the midst of a financially difficult job. Nevertheless, as long as we stay enthusiastic about medical training, remain connected in a practical sense with all those we need to work with to improve training, and negotiate respectfully with one another, then the system will continue to improve.
At the end of the day I believe that IMET got it right when it developed its motto:
excellent medical training …
excellent patient care.
IMET PROGRAM UPDATES
Medical Education and Training
New standards in Prevocational Progress Review
New prevocational progress review forms have been introduced for the assessment of prevocational trainees. The new forms provide more information for trainees, Term Supervisors and hospital Directors of Prevocational Education and Training (DPETs). The forms are designed to measure training outcomes in terms of the Australian Curriculum Framework for Junior Doctors (ACF), ensuring that prevocational trainees are meeting the standard required for registration with the NSW Medical Board.
There are now two forms, one for mid-term formative appraisal of trainees and one for end of term assessment. Both forms begin with the trainee’s self-assessment, which is then discussed with the term supervisor. This assessment process was developed in extensive consultation with trainers and trainees and is intended to facilitate better planning of individual training.
Surgical Science Examination preparation courses 
Pre-specialist surgical training network activities: a limbs and hip education session at Newcastle University.
IMET and the Clinical Surgical Training Council (CSTC) have been facilitating examination preparation courses for surgical trainees and prevocational trainees interested in a career in Surgery. In 2008, as a result of feedback from trainees and agreement by the CSTC, IMET delivered the first set of Anatomy Courses aimed to assist SET 1 trainees.
The new Anatomy courses not only attracted SET 1 trainees, but also trainees from Emergency, Prevocational years 1 & 2, PreSET trainees and trainees from other disciplines. Feedback from trainees showed that there is a definite need for these preparation courses and that it was a positive experience. The Anatomy courses are being delivered again this year. There has already been an overwhelmingly positive response to the 2009 courses, with places filling within a few days.
IMET also facilitated the continuing delivery of the Microbiology and Physiology course and the Pathology and Pharmacology course throughout the year. These courses have been in operation for a number of years and are seen as an important part of Surgical Science Preparation.
The courses delivered by IMET for 2009 in preparation for the Surgical Sciences Examination include:
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Course
Limbs and Pelvis
Head, Neck and Neuroanatomy
Physiology and Microbiology
Pathology/Pharmacology
Abdomen and Thorax |
University
Newcastle
New South Wales
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Western Sydney |
Date
21 February
7–8 March
13–15 March
3–5 April
2–3 May |
Future Leaders Development Program
IMET is sponsoring a comprehensive leadership program for doctors in training who have an interest in further developing their leadership skills. The program targets medical trainees in NSW (PGY2 through to fellow) with the aim of developing leaders at all stages of training.
The program is based on five weekend training workshops across the year. Participants will also be given the opportunity to take part in various committees and projects where they can take a leading role, and will be matched with a mentor in an effort to expose them to and equip them for higher levels of leadership and responsibility in their current roles. 
The first workshop was held this month in Sydney and included 21 participants from various specialties. The participants experienced a very intense and enjoyable three days filled with leadership activities. The lecturers spoke on “Looking Inward”, inviting the participants to focus on understanding their own personality attributes and leadership styles and how their personal style interacts with others.
Workshop participants work blindfolded to create a square from a piece of string — one of a series of group exercises to strengthen leadership and communication skills.
Paediatrics Supervisors’ appraisal evening
One of the recommendations of the Paediatric Planning Day in May 2008 was for an event aimed at supporting training supervisors. On 30 October 2008, IMET and the NSW Paediatric Physician Training Council (PPTC) supported a Supervisors’ Appraisal Evening that focused on:
- providing feedback and appraisal to trainees, and
- managing a trainee in difficulty.
The session was attended by supervisors from the three Paediatrics Networks and was facilitated by Dr Paul Craven. Our thanks go to Dr Craven for his effort and time in making this event possible.
Advanced Cardiology Statewide Lecture Series
In 2008, the NSW Advanced Cardiology Trainees’ Committee, together with IMET and the NSW Cardiology Training Committee launched the Cardiology Statewide Lecture Series. The Trainees’ Committee designed the lecture program and sought feedback on topics and presenters from advanced cardiology trainees in NSW. The inaugural lecture was held in July.
The lectures in 2008 included:
- Coronary Artery Disease and Angiography – Dr Martin Ng
- Cardiac Transplantation – A/Prof Peter Macdonald
- Grown Up Congenital Heart Disease – A/Prof Drew Fitzpatrick
- Electrophysiological Studies – Dr Mark Cooper
The lecture series allows trainees to interact with a range of different presenters. Lectures are held at a central venue and videoconferencing access is provided for regional and rural trainees. The Statewide Lecture Series is managed by the Trainees’ Committee and the Cardiology Education Support Officer.
The series recommenced in February 2009.
Psychiatry Training Program
The Dementia Lecture Series was very successful and well attended by trainees from a number of different programs. Professors Brodaty and Kurrle were very informative and we thank them for their efforts and time. Trainees from rural locations have received recordings of the sessions.
Trainees from the Advanced Training in Old Age Program have benefitted from a sponsored training day held at Maddison House. They joined Advanced Trainees from the Generalist stream to learn about topics in late life Psychiatry. The day was a trial and was very well received by all involved. Thank you to Dr Clare Jones for arranging the day.
Psychiatry was very successful in the last Commonwealth funded Expanded Specialist Training Program. Twenty applications were received from NSW and 14 were successful. Of particular interest are a number of new positions for trainees in community settings. We look forward to hearing the feedback from these new terms.
The IMET External Review into Psychiatry Training in NSW has submitted its report to the NSW Department of Health. The Psychiatry Network Oversight Committee has been tasked responding to the report's recommendations.
We welcome 43 new trainees to the program. At the recent NSW Institute of Psychiatry Induction day we were able to speak with many of these trainees about IMET and how they can better participate in their training through the various opportunities for trainee representation. IMET was able to provide the new trainees with some resources to assist their learning, foremost being Acute Psychiatric Management, a new text by Dr Michael Robertson (Senior Staff Specialist and Director of Psychiatry, Royal Prince Alfred Hospital) and his team. The text was launched by Dr Murray Wright, Chair of the Psychiatry Network Oversight Committee, in the presence of our new trainees, NSWIOP staff and members of the Psychiatry training community. All new trainees and training supervisors are receiving copies of this text, and a freely available web version can be accessed via the IMET Psychiatry website. 
Dr Murray Wright, Chair Psychiatry Network Oversight Committee, and Dr Michael Bowden, Head Medical Programs, NSW Institute of Psychiatry listen to Dr Michael Robertson at the launch of Acute Psychiatric Management.
Hospital Skills Program
Career Medical Officers (CMOs), Multiskilled Medical Officers (MMOs), Senior Resident Medical Officers (SRMOs) and Hospitalists working in NSW hospitals will soon benefit from a new and innovative training program developed to improve the quality and safety of patient care — the Hospital Skills Program (HSP). The program is designed to recognise and support the knowledge, skills and other attributes of non-specialist doctors in hospital and community settings within NSW.
The HSP provides a framework for assessment and multi-level certification of skills appropriate to the various roles of medical officers in hospital settings. This includes skills acquired through the training program, recognition of prior learning and recognition of current competency. The HSP also provides effective professional development assistance to doctors in line with their career aspirations and their need to safely fulfil current and future roles. This in turn will help the NSW Area Health Services ensure that NSW doctors are highly competent and providing safe patient care to the NSW public.
A Curriculum Developer, Mr Peter Davy, is working on the HSP curricula, which will encompass 7 clinical streams – Emergency Departments, Mental Health, Aged Care, Medicine, Paediatrics, Surgery, and Obstetrics and Gynaecology. A draft curriculum for Emergency Medicine has been out for consultation since December 2008 and a Mental Health curriculum should be ready for consultation in early 2009. An Assessment and Certification Policy is under development and will be available for feedback in mid 2009.
At a Forum on 26 August 2008 many issues were discussed, including hot topics such as assessment and certification processes, on-line support programs, and engagement of rural and regional doctors. Relevant groups and individuals were invited to attend including College, Area Health Service, CMO, Department of Health and NSW IMET representatives. A report is now available on the IMET website: HospitalSkillsProgramCommunication.
NSW IMET would like to thank all the Curriculum Working Group members for their excellent input to the curricula, and the HSP State Training Council members for their invaluable support and advice around the implementation of the HSP.
Accreditation
Would you like to be part of NSW IMET’s accreditation program?
The Prevocational Accreditation Program is looking to recruit more surveyors. A NSW IMET surveyor is a clinician, medical administrator, prevocational or vocational trainee who has been trained to assess the performance of health facilities against the standards for prevocational education and training.
Surveying provides an opportunity to learn about other facilities’ innovative ideas and improvements, reflect on the training in their own facilities, and network with other surveyors with a passion for prevocational education and training.
Surveyors provide their services on a voluntary basis and contribute between two and four days a year. Travel, accommodation and survey-related expenses are met by NSW IMET. Honorariums are also available for eligible surveyors.
The prevocational accreditation program facilitates the accreditation of all facilities within NSW/ACT that are involved in prevocational education and training. There are currently 56 accredited facilities within NSW/ACT, most of which are accredited every three years.
To become a surveyor, please contact the Accreditation Program on (02) 9844 6551 or email accreditation@imet.health.nsw.gov.au. An application folder will be distributed to those interested in becoming a surveyor. Once the information in the folder is reviewed, you will be requested to complete a list of assessment questions. On approval of the assessment questions, surveyors are appointed and participate in their initial survey as a ‘trainee surveyor’.
Workforce
Basic Physician Training recruitment for the 2009 clinical year
In 2008, the NSW Physician Training Council and the Basic Physician Training Networks introduced a preference matching system, the First Round Offer Optimisation Process. The main purpose of the optimisation process was to increase the number of applicants receiving a first round offer and reduce the number of “wasted” offers made by the networks to applicants who had already accepted an offer from a preferred network.
IMET facilitated the optimisation process on behalf of the BPT Networks. This included the dissemination of information to Networks and applicants, collecting and holding applicant preferences and completing the preference matching process.
The results of the First Round Offer Optimisation were:
- 72% of applicants received an offer from their first preference. Of the 185 BPT positions offered for 2009, 134 positions were “matched”.
- 51 applicants did not received a first preference match and therefore received multiple offers.
- Five of the nine BPT networks “matched” over 80% of their positions for the first round.
- As a result of the optimisation process, an additional 66 applicants received first round offers that otherwise would not have received an offer. Of that 66, 44 were “matched” with their first preference.
The Basic Physician Training Networks are now fully recruited for the 2009 clinical year.
TALKING POINT
Developing new terms for JMOs — the Drug and Alcohol experience
Anne Lawrance is the Principal Pharmaceutical Adviser, Opioid Treatment Program and Clinical Policy Team, Mental Health and Drug and Alcohol Office, NSW Department of Health
About three years ago NSW Health noted that while a number of NSW drug and alcohol specialists were nearing retirement, there were few young specialists entering the field. This was a cause for concern as between 10% and 20% of patients admitted to hospital have problems related to excessive drug or alcohol use as a primary or secondary issue affecting their hospital stay, and there are increasing problems in the community arising from the over prescribing of opioids for chronic pain.
State funding of around $5 million over four years was successfully sought for an addiction medicine workforce development strategy, which has a number of initiatives related to speciality recognition and associated fellowship training, as well as increased training in addiction medicine at undergraduate and postgraduate levels.
It was decided that the early postgraduate years are an important formative period in medical training when skills, knowledge, attitudes, reasoning and experience are developed, and that additional addiction medicine training opportunities could be provided in a number of NSW teaching hospitals through increased JMO positions. Addiction medicine training is included in the Australian Curriculum Framework for Junior Doctors under various headings such as comprehensive assessment, addiction, alcohol withdrawal scale and substance abuse.
Funding was provided to six Area Health Services to create extra IMET-accredited PGY1 and PGY2 positions. The Mental Health and Drug and Alcohol Office provided assistance, advice, relevant IMET forms and information to the AHSs. Progress was monitored, and ongoing advice was provided. It was hoped to capitalise on the expected increase in PGY1 and 2 graduates in NSW in 2008 and beyond.
What were the outcomes?
- Two AHSs have had a trainee for the greater part of the 2008 academic year.
- Two AHSs have not as yet had their positions accredited by IMET; one due to lack of action, the other because the proposed position was across two Networks, which proved to be a major sticking point in negotiations.
- Two AHSs have had their positions accredited, but they were unable to be filled due to the lower than anticipated numbers of interns and JMOs in 2008 (due to a 60% uptake by ANU graduates in PGY1, and a 24% attrition between PGY1 and PGY2 in NSW in 2008).
AHSs were also encouraged to join with other specialities (eg, psychiatry, gastroenterology, emergency medicine, general medicine, palliative care) to share part of a training rotation. Unfortunately no extra addiction medicine training opportunities for JMOs were able to be created in this way.
The AHSs where the JMO positions were filled appeared to be those where historically there had been strong leadership and support for drug and alcohol as an important component of general medical training. One Director of Prevocational Training expressed displeasure that consultation and debate had not occurred with Network Directors before the positions were funded or accredited. In hindsight this may have been helpful, but it would seem that the broadening of training for junior doctors may not be solely related to the availability of funding and positions.
While it is recognised that all speciality areas of clinical practice believe that their own area of expertise is most deserving of inclusion in training, from the Mental Health and Drug and Alcohol Office experience, medical workforce development is a slow and often difficult process, and despite funds being provided, there needs to considerable support and constant oversight to drive the workforce development processes to successful completion.
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