News and Views of Medical Training in NSW ISSUE NUMBER 9, December 2009 > Printer friendly format (pdf) > Last newsletter (#8 October 2009)   REFLECTIONS ON 2009 > A big year for IMET WHAT'S NEW? > And the winner is… > New version of the Australian Curriculum Framework for Junior Doctors > Congratulations to Hornsby Ku-ring-gai Health Service on NSW Health Award > National registration and the internship update > Guides for new interns EVENTS > Coasting to Gold – 14th National Prevocational Medical Education Conference FEATURES > National Hand Hygiene Initiative IMET PROGRAM UPDATES > Future Leaders Development Program > Surgical skills > Prevocational training in 2010: how are we shaping up? > Internship FAQs for 2011 > Hospital Skills Program > Psychiatry > Oncology training TALKING POINT > The importance of handover RESOURCE > Trainee in difficulty: a handbook for Directors of Prevocational Education and Training   REFLECTIONS ON 2009 A big year for IMET Dr Marie-Louise Stokes, Acting General Manager Another year has passed. Well, not just another year, because in 2009: We welcomed 668 interns into the NSW Health system – the largest commencing intern group on record in Australia. The NSW Government’s response to the Garling commission confirmed that the Clinical Education and Training Institute (CETI) will be established and that IMET will be incorporated within it. A priority listing system for intern allocation that gave priority to domestic NSW graduates (and those who completed Year 12 in NSW) over other applicants was implemented for the first time, which caused some initial concern. In the end, all applicants were offered positions for 2010. A major project on managing increasing graduate numbers was completed. The report considers ways in which increasing graduate numbers can be accommodated, such as developing innovative terms and expanding postgraduate medical training into community-based settings. Twenty doctors-in-training enrolled in the inaugural IMET Future Leaders program and participated with great enthusiasm despite their busy work and study schedules. The Hon Andrew Macdonald MP (>>) presented the graduates with certificates in November and gave an inspiring talk on what it means to be a clinical leader. IMET welcomed two new Clinical Chairs: Dr Noel Young as Chair of the Radiology Training Implementation Group (RTIG) and Dr Jon Hayman as the Clinical Chair of the Emergency Medicine Training Implementation Group (EMTIG). The RTIG is piloting training networks in 2010. The EMTIG completed a survey of emergency medicine trainees and supervisors and commenced planning for network-based education in 2010. External reviews of the Cardiology and Paediatric Network programs took place in July and December. IMET will be responding to the recommendations in 2010. IMET and participating networks delivered two pre-employment programs for international medical graduates who were commencing a year of supervised training. The programs were popular and well received by participants. IMET completed a review of oncology-related specialist training in partnership with the Cancer Institute NSW. The review has recommended that training networks in medical oncology, palliative care and radiation oncology be established in 2010. The Hospital Skills Program became a reality with the first enrolments in South Eastern Sydney Illawarra Health Service after a successful Emergency Skills Education Day hosted by the University of Wollongong Medical School. Twenty-seven accreditation surveys and focus visits were undertaken by our fantastic volunteer surveyor workforce and dedicated accreditation committee members. The long-awaited Trainee in difficulty handbook was published and distributed to Directors of Prevocational Education and Training, JMO Managers and others involved in managing JMOs. (See it on the web: http://www.imet.health.nsw.gov.au/prevocational) We are looking forward to a period of R & R from 18 December when we close the IMET office for two weeks. We will reopen on Monday 4 January 2010 in time to welcome the 2010 interns. On behalf of the IMET directors, staff and management committee, I would like to thank all of you who contribute in so many ways to the education, supervision and support of our postgraduate medical trainees in NSW. We wish you a very Happy Christmas and New Year. WHAT'S NEW? And the winner is… Dr Annette Britton (>>) was awarded the highly esteemed Geoff Marel Award at the IMET End of Year Award Ceremony on Friday 13 November 2009. Annette has made an outstanding contribution to prevocational training in NSW and the ACT in her role as Chair of IMET’s Prevocational Accreditation Committee, her participation on state-wide and local committees, and through local support of JMOs in her role as a geriatrician at Royal Prince Alfred Hospital. Annette’s dedication and commitment to advocating for prevocational trainees has ensured that prevocational trainees across the state are working in a culture that promotes professional development and JMO support. Annette has provided enormous support to IMET staff to ensure the ongoing implementation of accreditation standards, and makes herself readily available to resolve any issues that may arise. Her commitment goes beyond the scope of the Chair of the Prevocational Accreditation Committee. Annette was a popular winner among her colleagues and peers. Her presence and contribution will be sorely missed as she steps down from chairing the Prevocational Accreditation Committee and takes a well deserved break. Dr Farzan Fahrtash (<<) was awarded the 2009 NSW Junior Doctor Award for his contributions to JMO education and welfare. Dr Fahrtash is a Resident Medical Officer at Westmead Hospital. Speaking at the Awards ceremony, Dr Crampton said: "Dr Fahrtash was instrumental in setting up a mentorship program at Westmead Hospital in which PGY1 trainees were supported by their PGY2 colleagues. Farzan has been a tireless participant in clinical meetings, GCTC, NCPT, and the JMO Forum. He has been involved in a medical handover project for Sydney West AHS, worked towards implementing electronic discharge systems, improved communications between JMOs on shifts and rosters, helped arrange the multimedia recording of education sessions for JMOs, and helped the DPET set up Teaching on the Run programs. He’s made a huge contribution for the improvement of patient care." New version of the Australian Curriculum Framework for Junior Doctors One highlight of the National Prevocational Forum (see report below) was the release by the Confederation of Postgraduate Medical Education Councils of version 2.2 of the Australian Curriculum Framework for Junior Doctors (ACF). The new ACF comes in a greatly improved reader-friendly format. IMET will be distributing copies to all new interns during Orientation Week. Digital copies can be downloaded from http://www.cpmec.org.au/Page/acfjd-project, where you can also find a range of support materials for implementing the ACF. Congratulations to Hornsby Ku-ring-gai Health Service on NSW Health Award Hornsby Ku-ring-gai Health Service (prevocational training network 6) won this year’s NSW Health Award in the category "Building the health workforce" for their work on A practical peer oriented approach to intern orientation. IMET would like to congratulate the Director of Prevocational Training, Dr Auriel Jameson, and the JMO Manager, Ms Judy Muller, for their innovation and enthusiasm. The Hornsby orientation runs more like a team sport than a lecture series. It’s fun! For more information, see http://www.awards-expo.health.nsw.gov.au/winners/category_6 National registration and the internship update The discussion paper from the Confederation of Postgraduate Medical Education Councils (CPMEC) working party is now available from http://www.cpmec.org.au. The paper has been forwarded to the Medical Board of Australia for consideration and is being circulated to a broad range of interested parties, including medical schools, Departments of Health, State Medical Boards, the Australian Medical Council, the Australian Medical Students Association and medical colleges. Broadly the paper covers the following issues: The nature, purpose and location of the internship The mix of clinical experience, including any compulsory ‘core’ terms, to be included Competence vs. time based approaches to assessing internship A national process for sign off of satisfactory completion of the internship, incorporating achievement of educational objectives Accreditation of prevocational training Mechanisms for referring interns to the Medical Board for unsatisfactory performance.   Guides for new interns The Doctor’s Compass: a guide to prevocational training in NSW developed by the JMO Forum The new edition of The Doctor’s Compass is a starter-guide to life as an intern in New South Wales, written by junior doctors themselves. IMET will distribute printed copies to all new interns during Orientation Week, and it is also available online: http://www.imet.health.nsw.gov.au/jmoforum Prevocational Training Directory 2010 The directory provides information for current and prospective trainees about the training system and networks in New South Wales. Available online at: http://www.imet.health.nsw.gov.au/prevocational   EVENTS Coasting to Gold – 14th National Prevocational Medical Education Conference Craig Bingham, IMET Prevocational Program Coordinator, reports: The National Prevocational Forum was a fascinating get together, held very successfully in the relaxed and comfortable surrounds of the Sheraton Mirage on the Gold Coast. There was strong attendance and vocal participation by junior doctors themselves. Whether inspired by the imminent approach of national medical registration or perhaps by the Rudd government’s interest in health reform, a persistent theme of the conference was the opportunities for and advantages of national cooperation in matters of medical education. The difficult issues facing each of the States are quite similar: budgetary constraint, increasing numbers of trainees, and "the grey tsunami" of senior clinician-supervisors approaching retirement age. New educational technologies (particularly online learning) offer one line of solutions, and there are small initiatives being explored all over the country, such as the Paediatric OnLine Interactive Education (POLIE) project in Queensland, the Moodle development at Queen Elizabeth Hospital in Adelaide or IMET’s own Moodle development. However, several speakers cautioned against a piecemeal approach. According to Dr Ian Graham, from the Postgraduate Medical Council of Victoria, the real benefits of internet-based learning arise from connectedness, and the lack of an overarching plan might lead to waste, redundancy and a plethora of independent systems that do not communicate with each other. Anyone of us who has trouble remembering all their usernames and passwords and is tired of learning new interfaces will relate to the problem. Professor Laurie Geffen gave a closing address that in many ways summed up the drive towards integration. He proposed that there is nothing prevocational about being employed as a doctor and training in hospital. The training pathway should be considered vocational from the intern year onwards. The first two years of training should be general, with more involvement of medical schools in providing education. Certification of general training at the end of two years might be by exam, analogous to the College exams that finalise stages of training. Colleges would be involved in training towards specialisation from PGY3 onwards. All specialist programs should be built on the two generalist years, shortening the period of specialist training. Professor Geffen said that he thought the NSW Hospital Skills Program was an example of the training that should be available for those who are not proceeding with specialist training. There were murmurs in the hall from junior doctors who were wary of a proposal that sounded like a two-year internship, but there was also much interest in a proposal that might shorten the overall length of training. More information: PMCQ website: http://www.pmcq.com.au/     FEATURE National Hand Hygiene Initiative Dr Annette Pantle, Director of Clinical Practice Improvement at the Clinical Excellence Commission, provides an update on a continuing campaign. Healthcare-associated infections are a significant problem in healthcare systems worldwide. Improving hand hygiene among healthcare workers is the single most effective intervention to reduce the risk. In 2006/071 the Clinical Excellence Commission (CEC) coordinated the successful Clean Hands Save Lives Campaign in all NSW public hospitals, improving hand hygiene compliance from 47.1% to 62.2%, with a 377% improvement in the amount of alcohol-based hand rub available in near patient locations. However, a reaudit in July 2008 showed that those results have not been sustained. Hand hygiene compliance among doctors in particular remained lower than for other healthcare worker groups throughout the campaign. Doctors averaged 30% compliance before the campaign, rising to 58% at the peak of the campaign and then falling to 39% 12 months after campaign activities ceased. The goal of the WHO Global Patient Safety Challenge Clean Care is Safer Care is to make hand hygiene "core business" for all healthcare workers. In keeping with this challenge the Australian Commission on Safety and Quality in Health Care is promoting a National Hand Hygiene Initiative for implementation across all public and private hospitals in Australia until 31 December 2010. The Commission has retained a team from the Austin Hospital in Victoria under the auspices of Hand Hygiene Australia to implement the program and the CEC is leading the implementation of the National Hand Hygiene Initiative in NSW. The Initiative offers NSW the opportunity to build on the work of the Clean Hands Save Lives Campaign and achieve sustained improvement in hand hygiene. The program introduces the WHO concept of the five moments for hand hygiene: 1. Before patient contact 2. Before a procedure 3. After a procedure 4. After patient contact 5. On leaving the patient’s environment Key features of the National Hand Hygiene Initiative: 1. Auditing hand hygiene compliance Regular audits of hand hygiene compliance will be undertaken. A rigorous, standardised training program for auditors has been developed to ensure appropriate reliability and validity of the data. Some Area Health Services are encouraging medical staff to take on this role in addition to infection control professionals and nurse educators. All participants are required to achieve a pass mark of 90%. As this is part of a national program, this credential is transferable and is considered a significant achievement. The CEC and Hand Hygiene Australia provide the training to credential "Gold Standard" auditors who then train clinicians to undertake audits on the wards. Audit data will contribute to the national data collection and enable benchmarking against other jurisdictions and nations. 2. Use of alcohol-based hand rub The program encourages and measures placement of alcohol-based hand rub at the point of care, ideally at the foot of the patient bed. 3. Collection of SAB data The rate of Staphylococcus aureus bacteraemia is the key outcome measure of the initiative. 4. Education All healthcare workers should participate in an education program to improve knowledge about infection prevention and control. An e-learning package has been developed by Hand Hygiene Australia for this purpose and the CEC is working with Hand Hygiene Australia and an e-learning provider to improve this resource to make it suitable for all clinicians. It is suggested that the education program be incorporated into orientation and mandatory training for existing staff A variety of materials to support the initiative has been developed and is available at the Hand Hygiene Australia website (www.hha.org.au). Further information from: Dr Annette Pantle, Director of Clinical Practice Improvement on (02) 9382 7605 or annette.pantle@cec.health.nsw.gov.au 1 Grayson ML, Russo PL. The national hand hygiene initiative. Med J Aust 2009; 191: 420-421. McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. Improvements in hand hygiene across New South Wales public hospitals: clean hands save lives, part III. Med J Aust 2009; 191(8 Suppl): S18-S24. McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. Improvements in hand hygiene across New South Wales public hospitals: clean hands save lives, part IV. Med J Aust 2009; 191(8 Suppl): S26-S31.   IMET PROGRAM UPDATES Future Leaders Development Program NSW IMET leadership development programs are for current and future leaders in Medical Education and Training. LEAP- The Future LEAders Development Program will be running again in 2010. LEAP will ensure the preparation of doctors in training for leadership roles within the NSW public health system. No other program exists in NSW that is focused on the needs of doctors in training in relation to medical education and development of leadership skills. LEAD- LEAdership Development Program in Medical Education and Training is a new program for consultant medical practitioners in NSW. Dr Chaminda Wijeratne graduated from the first Future Leaders Development Program in November 2009. What did it mean to him? As a relatively inexperienced medical professional, it is easy to get lost in the daily grind of clinical work, wondering how you can possibly make a difference — yet making a difference was the reason most of us decided to pursue a a career in medicine. This is certainly how I felt towards the end of my second year of working in the NSW Health system. It was with much eagerness that I applied for the FLDP after having a brief read of the program outline. I was thrilled to be selected, and now I know why. The program certainly broadened my horizons and culminated in a workshop where we presented our final group projects on issues facing postgraduate medical education today such as standardising clinical handover, improving access to research opportunities, improving quality and safety, creating terms for our increasing medical graduates and bridging the gap between clinicians and administrators. Each group pitched its ideas with passion and energy. It was amazing to see how far we had come within a year. We felt we had the power to make a difference. The program provided me the opportunity to get on the metaphoric helicopter, and look at what I do everday from a whole new perspective. I started to see, not just the effect I had on each patient, but on everyone around me, and how I contributed to our health care system and society as a whole. In particular, I glimpsed the very complicated nature of postgraduate education in health. The program provided an opportunity to ask my deepest questions about my career. And it was a privilege to create friendships with the course facilitators and participants. I am pleased that the program will continue into the future, and would recommend it to any colleague.   Surgical skills Surgical Science Course NSW IMET and the NSW Clinical Surgical Training Council (CSTC) will be piloting a two week surgical science residential course to help trainees prepare for the Royal Australasian College of Surgeons Surgical Education and Training primary surgical science examinations. This two week course will be delivered from 27 January to 6 February 2010 at UWS Campbelltown leading up to the February 2010 surgical science examinations. There are limited places available Register for the course via the IMET website: http://www.imet.health.nsw.gov.au/secure/downloadfile.asp?fileid=1005767 For more information about the surgical science course, please contact Jay Jacinto (jjacinto@imet.health.nsw.gov.au, 02 9844 6545). Trainee Sub Committee The NSW CSTC Trainee Sub Committee has voted Dr Rewena Shaw and Dr Chaminda Wijeratne to be the Chairs for 2010. The Committee will also be welcoming sixteen new positions to the committee for 2010. Each IMET Surgical Network will be represented by junior (PGY 1 or 2) and senior (PGY3+) trainees.   Prevocational training in 2010: how are we shaping up? IMET has concluded the prevocational training allocation and recruitment process for 2010. Following seven rounds of offers, all applicants for internship commencing in 2010 received an offer. Each year IMET reviews the allocation process. This year a number of recommendations have been made to NSW Health to enhance the allocation and recruitment process for 2011. In September this year IMET wrote to each of the NSW and ACT Medical Schools to request a University Allocation Liaison person. We hope the presence of the liaison person will enhance the communication channels between universities, students and IMET regarding the NSW allocation and recruitment process. The nominees are: Associate Professor Tessa Ho, University of Sydney Ms Michelle Brackbank, University of New South Wales Ms Peta Bernisconi, University of Newcastle and University of New England Ms Jodie Douglas, University of Wollongong Ms Lyndal McCulloch, University of Western Sydney Associate Professor Mavis Duncanson, University of Notre Dame Professor Frank Bowden, Australian National University   Internship FAQs for 2011 For the latest information on the 2011 allocation process please refer to the following link: http://www.imet.health.nsw.gov.au/www/472/1001127/displayarticle/1005500.html   Hospital Skills Program Module development Four education modules have now been completed (Emergency Department, Aged Care, Mental Health and Core Skills). The modules have also been mapped into Moodle to provide a state-wide hub of learning resources and to undertake a resource gap analysis. Areas have been requested to review medical education and identify relevant educational resources which are suitable for HSP doctors or which could be modified for the program. Three new HSP Module Development Groups have been established and held their first meeting in October 2009: Hospital Medicine (including pre-, peri- and post-operative surgical care and hospital therapeutics) Paediatrics Obstetrics and Gynaecology. It is anticipated that development will be completed by March 2010. If there is anyone interested in participating in either the Paediatrics or Obstetrics and Gynaecology HSP Module Development Groups, please contact Ms Alpana Singh (asingh@imet.health.nsw.gov.au, (02) 9844 6560). Enrolment into the HSP The official Hospital Skills Program enrolment form will be ready to distribute to Area Health Services together with the four completed education modules in December 2009. HSP Assessment Update The following resources were approved by the HSP State Training Council members at their meeting on 27 October 2009. Self Appraisal Templates. Workplace Based Assessment Tool Kit (mini-CEX, direct observation of procedural skills form, case-based discussion, 360° assessment). Area Health Service Certification Policy. The resources are currently being finalised and will be available from mid December 2009. Want to know more? Contact us! Mr Graeme Still, Program Coordinator (gstill@imet.health.nsw.gov.au, (02) 9844 6542) Ms Alpana Singh, Project Officer (asingh@imet.health.nsw.go.au, (02) 9844 6560) Mr Peter Davy, Curriculum Developer (pdavy@imet.health.nsw.gov.au, (02) 9844 6578)   Psychiatry The second workshop in the Saturday Psychotherapy series, The Therapist as a Person, was held in November at the Liverpool Hospital’s new mental health facility. Twenty-six trainees benefitted from presentations from Judy Hyde ("The personality of the psychotherapist and its impact on psychotherapy"), Carolyn Quadrio ("Boundary violations in psychotherapy") and Joan Hailburn ("Responding to transference and countertransference in psychotherapy"). Our thanks to Jason Fowler from Sydney South West – North Coast Training network and the Psychotherapy Educators Group for arranging another excellent workshop. The next workshop in the series will be held in March 2010. The Psychiatry Education Support Officers joined IMET staff for a forum in November. The group discussed network issues and strategies to improve the delivery of the training program. Of particular interest was the discussion on ways to share resource across the networks. We look forward to seeing how the ideas are progressed. Psychiatry Education Support Officers and the IMET Psychiatry Program Coordinator: Jean Melvin (HNEAHS), Philippa Ditton-Phare (HNEAHS), Paula Britten (NSCCAHS), Jan Veitch (IMET), Leanne McKechnie (SSWAHS), Angela Bennett (SESIAHS). The Psychiatry Network Oversight Committee (NOC) held its annual planning meeting at the Vibe Hotel. The NOC invited all Directors of Basic and Advanced Training, Psychotherapy Educators and Education Support Officers to join them in their consideration of the revised strategic plan. The meeting commenced with short presentations from Simon Willcock (IMET Director), Ros Montague (Director NSW Institute of Psychiatry), Stephen Jurd (RANZCP), John Allan (Mental Health and Drug and Alcohol Office) and Olivia Chan (Trainee Sub-Committee) on their organisation’s priorities. The meeting then progressed with table discussions providing valuable direction for the NOC for 2010. We appreciate that so many people were able to attend on the day. A report on the discussion will be tabled at the next NOC meeting.   Oncology training The Review into Oncology Training in NSW is now complete and the report is in process. We hope to have further information in the new year. The administration of the Basic Sciences in Oncology Course (BSOC) has moved from Cancer Institute NSW (CINSW) to IMET. We look forward to working with the many people involved in this important training and education series in 2010. Information on the course for 2010 will be available early in 2010. IMET will work closely with CINSW in this period of transition to ensure all participating organisations and staff are keep well informed. Please contact IMET on (02) 9844 6551 or oncology@imet.health.nsw.gov.au if you have any questions about this transition.   TALKING POINT The importance of handover Dr Farzan Fahrtash, winner of the 2009 NSW Junior Doctor Award, was also awarded the prize for best poster display at the National Prevocational Forum on the Gold Coast. His topic was clinical handover. It would be hard to deny the importance of effective handover, particularly for the deteriorating and complex patient. The typical scenario that confronts the junior doctor is the need to attend a PACE call, knowing very little about the patient and having a file that’s too heavy to lift. The patient is suddenly deteriorating, but the resuscitation ceiling or what treatment the medical team would have instituted are unclear. After-hours medical staffing is usually reduced to the bare minimum. With residents and registrars who may not be familiar with a patient’s history, hospital progress or the treating team’s protocols, there are numerous possibilities for adverse events to occur. Adverse patient outcomes have been linked in various studies to poor handover. Furthermore, I believe handover requires the exercise of effective communication skills, skills in which there is always room for improvement. Using good handover and management plans in the early years of training is likely to entrench the importance of communication as we advance in our careers. Out of these thoughts arose the drive to introduce a handover system at Westmead Hospital that would be easy to use, not too time consuming and allow the after-hours staff to have an overview of a patient’s background, resuscitation status, inpatient progress and clear management plan. So that the additional workload of handover did not compromise patient care and working hours, we identified a specific group of patients likely to benefit from structured handover. We chose patients who have been stepped down from intensive care, had PACE/ALS calls, had more than one active organ pathology, or who were considered to have a high likelihood of deterioration. The handover would be initially documented on a single page sheet to be updated weekly. Ideally the handover would be linked to a computerised patient list that allows a general overview of sick ward patients. Close cooperation with intensive care and nursing staff is required to make this an effective intervention. The plan is to evaluate the handover intervention with current practice and look at several surrogate markers of outcome. These would include adverse events, hosptial stay, number of PACE calls and level of satisfaction about communication skills among the doctors. Handover is a concept relevant to doctors at all stages of their careers. Its importance cannot be highlighted enough. I hope the handover project initiated at Westmead Hospital can be a driver for other networks to re-evaluate their current practice and consider if it can be improved. The key goals to keep in the back of our minds is safe patient care and effective communication. RESOURCE Trainee in difficulty A handbook for Directors of Prevocational Education and Training Available online: http://www.imet.health.nsw.gov.au/prevocational Contains practical advice for managing doctors in difficulty useful to all clinical supervisors.   ^To top^ > Printer friendly format (pdf) > Last newsletter (#8 October 2009)

Building 12, Gladesville Hospital Victoria Road, Gladesville NSW 2111 p: (02) 9844 6551 f: (02) 9844 6544 e: newsletter@imet.health.nsw.gov.au w: www.imet.health.nsw.gov.au Editor: Craig Bingham