cetiscape 1 october 2010

Steven BoyagesChief Executive, CETI

Welcome to cetiscape, the fi rst newsletter of the Clinical Education and Training Institute of New South Wales (CETI). Establishing CETI was one of the key recommendations of the Garling

Inquiry and was adopted by the government in its “Caring Together” Health Action Plan for NSW.

CETI is a Statutory Health Corporation under the Health Services Act 1997. Its principal functions, as determined by the Minister for Health, are listed in this newsletter, but in short CETI is to provide leadership which:

supports safe, high quality, multi-disciplinary team-based, patient-centred care

meets service delivery needs and operational requirements

enhances workforce skills, fl exibility and productivity.

Health is a knowledge-centred enterprise. Those working in health are involved in the business of generating new knowledge (research and evaluation), imparting knowledge to a future workforce (education and training) and applying knowledge for the betterment of health and healthcare (service delivery).

CETI’s vision is to facilitate and build competency and sustainable capacity to achieve better health through education, training and development of a clinical workforce that will meet the healthcare needs of the people of NSW.

CETI will do its work through investment in new programs; by collaborating with other key stakeholder groups such as universities, colleges, clinical leaders, hospitals, health services and the community; and through innovation to improve communication, capacity and competency by using blended learning approaches, including face-to-face teaching, simulation and e-learning.

CETI has a huge responsibility in working with others to ensure that we have a future health workforce that is responsive and available in appropriate numbers to meet the growing challenges. The newsletter name ‘cetiscape’ refl ects the importance of stakeholder involvement and the role that the newsletter will play in presenting different perspectives, including those of stakeholders and staff.

In a short time CETI has been able to build on the excellent work of its foundation divisions, the Institute of Medical Education and

CLINICAL EDUCATION& TRAINING INSTITUTE

Building 12, Gladesville Hospital, Victoria Road, Gladesville NSW, 2111 Editor: Craig Bingham

Locked Bag 5022, Gladesville NSW 1675 02 9844 6511

p: (02) 9844 6551 f: (02) 9844 6544 e: [email protected] [email protected]

cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 1

New leadership in clinical education and training

In this issue Closing the gap in the Aboriginal medical

workforce 2

Medical education and training in Australia: what does the future hold? 3

Supervision Superguide 4

Exciting opportunity for allied health and CETI 5

2011 internship campaign places record number of interns in NSW hospitals 6

Hospital Skills Program update 6

Surgical Science Intensive Course 7

Junior doctors drive positive change in their work and training 8

A sustainable way to provide community-based training 10

Psychiatry training update 11

Centralised recruitment works well for Paediatrics Program 12

Accreditation Surveyor Training Day 12

Do you or someone you know need help? 12

Prevocational review 13

Oncology training 13

Emergency medicine network directors appointed 13

New names for old friends

The NSW Institute of Medical Education and Training (IMET) is now the Medical Division of CETI.

The NSW Institute of Rural Clinical Services and Teaching (IRCST) is now the Rural Division of CETI.

Training (IMET) and the Institute of Rural Clinical Services and Teaching (IRCST). Our stakeholders have a strong desire to maintain discipline-specifi c divisions as well as creating cross-linking inter-professional units. CETI will establish several new divisions, including education, e-learning, allied health and nursing, as well as an interprofessional practice division.

CETI’s top three priorities are to:

identify solutions to training challenges posed by the increased supply of medical graduates (interns)

develop and implement an interprofessional team program for new starters in the health system

adopt common standards and platforms for a learning management system.

I look forward to hearing your views and perspectives as to how CETI can continue to add value to education for future generations. Please write to me: [email protected].

Closing the gap in the Aboriginal medical workforce

Jacqueline DominishNetwork Coordinator, CETI

CETI Medical Division (IMET), in partnership with the Australian Indigenous Doctors Association (AIDA) and NSW Department of Health, has developed a pilot program aimed at building capacity of the Aboriginal medical workforce in NSW.

The pilot aims to support the national strategy of “Closing the Gap” in Indigenous health care outcomes. Increasing the number of Aboriginal doctors improves access to culturally safe services for Aboriginal and Torres Strait Islander peoples. The program supports the transition of Aboriginal medical graduates to internship positions in NSW. Aboriginal medical students were able to apply for the program in their fi nal year.

Under the program, Aboriginal medical graduates are appointed to a training network where they can show that they have one or more of the following supports:

Family in the area

A relationship with the community

A connection to country

A pre-existing mentor

Training opportunities in line with the graduate’s career aspirations

A history of favourable experience during their undergraduate training.

Applications were assessed by a panel with signifi cant Aboriginal representation, including Dr Marlene Kong (Member of the Board, Australian Indigenous Doctors Association) and Mr Charles Davison (Manager, Aboriginal Workforce Development Unit, NSW Department of Health). Successful applicants have been allocated to their prevocational training network of fi rst choice in order to maximise their chance of successfully completing prevocational training. The fi rst cohort of trainees under the program will commence their internship in January 2011.

More information: Network Coordinator Ms Jacqueline Dominish (02 9844 6558, [email protected]).

CETI values

C Collaboration

We work together in partnership and in teams for common goals. We engage stakeholders and bring together and respect people with different knowledge, skills and experience. Our culture encourages cooperation, respect and sharing.

E Excellence

We use best practice to develop and deliver quality services and learning opportunities. We ensure effectiveness in the way we use resources. We review and evaluate what we do. We are committed to professional development, competency, capacity and being proactive.

T Transparency

We are dedicated to accuracy, consistency, and clear and regular communication. We work in accordance with organisational and professional codes of conduct.

I Innovation

We use emerging technologies and new ideas. We support and respect creativity and inspiration while building the evidence base.

Left to right: Dr Marlene Kong, Australian Indigenous Doctors Association; Ms Jacqueline Dominish, CETI Medical Division (IMET); and Mr Charles Davison, Manager, Aboriginal Workforce Development, NSW Health.


The purpose of medical education and training is to provide a highly skilled medical workforce capable of delivering high quality

health services to the entire population. In 2010 such training should also equip the medical workforce to adapt to the changing health care needs of the Australian population and should be economically sustainable.

One of the outcomes of the 2008 “2020 Summit” was an ambition that Australia should have an “integrated infrastructure for the health and education system”.1 The incoming Commonwealth Labor government committed itself to developing an integrated health service delivery system that is fi scally sustainable, fl exible and designed around identifi ed community health care needs rather than jurisdictional, institutional or current program boundaries.

The achievement of this goal requires a national approach to health sector education and training (including medical education and training), with a focus on defi ning the skills required and the number of practitioners needed to deliver this outcome. The National Health and Hospitals Reform Commission and the Preventive Care Taskforce each identifi ed the need to develop incentive arrangements and fi nancial consequences for performance against benchmarks,2 including a quantum of funds that is “at risk” and tied to achievement of targets.3 Inevitably these incentive arrangements will also be applied to the education and training component of the health sector.

For the past 50 years medical workforce training in Australia has delivered highly skilled workers, but within an increasingly silo-based model of training and service delivery. This model has also infl uenced training in the nursing and allied health professions, resulting in a health system that generally delivers excellent care, but that can be expensive and poorly integrated.

Health economists have clearly documented the increased costs associated with highly specialised and uncoordinated models of care. The new Commonwealth focus on integrated service delivery models therefore has implications for training at all stages of medical training, including the undergraduate, early postgraduate and vocational training sectors.

COAG has established Health Workforce Australia (HWA) as a national entity tasked with developing effective models for predicting future workforce need and for identifying and funding gaps in undergraduate training resources. Most gaps relate to clinical training opportunities for students training in health careers, along with supervisory and educational resources.

CETI functions As deternined by the NSW Minister for Health:

1 To provide leadership, and work closely with area health service and other public health organisations and clinical training providers, to ensure the development and delivery of clinical education and training across the NSW public health system which:a Supports safe, high quality, multi-disciplinary team

based, patient centred care b meets service delivery needs and operational

requirementsc enhances workforce skills, fl exibility and productivity.

2 To design, commission, conduct, coordinate, support and evaluate a clinical education and training program for all new graduate clinical and clinical support staff in the public health system, which supports their roles in providing safe, high quality, multi-disciplinary team-based, patient-centred care.

3 To design, commission, conduct, coordinate, support and evaluate such other postgraduate clinical education and training programs as the Director - General may direct from time to time.

4 To design, commission, conduct, coordinate and support professional development programs to enable clinicians to become skilled teachers, clinical leaders, trainers and supervisors.

5 To develop and oversee performance evaluation programs for post graduate clinical education and training in the NSW public health system.

6 To set standards for prevocational medical training and accredit institutions for prevocational education and supervision.

7 To institute, coordinate and evaluate clinical training networks, including postgraduate medical training networks, and ensure they support service delivery needs, meet operational requirements and are, as far as possible, consistent with, clinical service network;

8 In undertaking its functions, to consult and liaise with patients and their carers, clinical and clinical support staff, the Department of Health other public health organisations and providers of clinical education and training.

9 To provide advice to the Department of Health, Director-General and Minister on matters relevant to its functions.

Medical education and training in Australia:What does the future hold?

Simon WillcockDirector, CETI Medical Division


HWA therefore has a specifi c brief to fund new clinical training places across a broad range of health disciplines, to defi ne and support the role of simulated learning in clinical training, and to develop parameters for training, credentialing and support of clinical supervisors. There also exists a great opportunity (indeed a critical need) to identify domains in which students can learn collaboratively, thereby developing the skills associated with team-based care that are so crucial to effective health service delivery. New graduates must not only be competent in acute medical care skills, but just as importantly must have skills in preventive health and the management of chronic and complex co-morbidities.

While HWA’s initial focus is on undergraduate training,4 the intent is to align these initiatives with postgraduate training at both prevocational and vocational level. The postgraduate environment is also changing, with the traditional public hospital-based internship and vocational training programs evolving in recognition of the need to train graduates in a variety of settings, including community and private hospital locations.

In summary, Australia needs a skilled, fl exible and integrated health workforce to meet the needs of a diverse and ageing population. CETI, with its interprofessional training capacity, is perfectly positioned to work with HWA, universities, colleges and other professional groups to develop a vertically integrated model for postgraduate education and training.

1 Australia 2020 Summit – Final Report, April 2008, p128.

2 Beyond the Blame Game: Accountability and performance

benchmarks in next Australian Health Care Agreements, April

2008, p4.

3 Australia: The Healthiest Country by 2020, October 2008, p50.

4 Also known as “pre-workforce-entry training”, given that some

medical training courses enroll graduate students.


CETI’s seven Cs

Capacity

Communication

Collaboration

Coordination

Competency

Care models

Culture

Supervision SuperguideA new practical guide for supervisors of junior medical offi cers will soon be available to all term supervisors in New South Wales. The guide is being developed in consultation with clinicians across the State by CETI’s Medical Division (IMET).

An advanced consultation draft of The Superguide: a handbook for supervising doctors in training was launched at the NSW Prevocational Forum on 6 August by the Chair of the Prevocational Training Council, Dr Roslyn Crampton.

“There is good evidence about what makes good clinical supervision, but the literature is diffuse and not readily accessible to busy supervisors. We wanted to publish a short guide based on the evidence that was practical

and motivating,” Dr Crampton said. “Successful supervision uses the necessities of clinical oversight as the opportunity for training and education, so that safe supervision today becomes the foundation for safe independent practice by the trainee in the future.”

The consultation draft is available at www.imet.health.nsw.gov.au/prevocational. Comments received from many stakeholders throughout NSW are being used to fi nalise the fi rst edition for publication in November, ready for use in the 2011 training year.

More information: Prevocational Program Coordinator Craig Bingham (02 9844 6511, [email protected]).

The Superguidea handbook for supervising doctors in training

August 2010CONSULTATION DRAFT

IMET | RESOURCE

IMETNSW Institute of Medical Education and Training— a division of CETI

The creation of CETI is an important initiative that provides an opportunity for Allied Health to support and improve the ongoing supervision, training and development needs of the allied health workforce.

Recently the Area Directors and Advisors of Allied Health and Chief Allied Health Offi cer had a positive and productive meeting with CETI’s Chief Executive, Professor Steven Boyages, and General Manager, Dr Gaynor Heading. In line with CETI’s role to develop and coordinate clinical training and professional development programs, we discussed the important contribution of allied health in multidisciplinary patient care and interprofessional learning, with a focus on identifying common aims and opportunities for future collaboration.

With a commitment from Professor Boyages to explore the development of a dedicated suite of clinical training and professional development activities for allied health, a further planning meeting will be organised to discuss issues important to allied health.

Provisional priorities identifi ed during the meeting for further discussion include:

1 Developing a business case for the feasibility of “new starter” programs in allied health professions

Several allied health professions have identifi ed the need to improve professional development and support for new graduates during the fi rst year of employment.

The discipline of physiotherapy has a new graduate allocation program which involves recruitment of new graduate physiotherapists into positions across NSW Health facilities. The program provides structured clinical supervision and opportunities for practical clinical skills training, and supports the transition of new graduates to practising clinicians.

This type of “new starter” program would be an important mechanism for improving recruitment and retention within the allied health workforce. It is proposed that existing models within allied health, nursing and medicine will be reviewed to determine applicability of other allied health disciplines.

2 A project offi cer to investigate options for strengthening allied health clinical placement coordinator and educator roles

To date, there have been limited allied health clinical placement coordinator and allied health profession educator positions created across NSW. Some growth has occurred as part of Caring Together initiatives with the appointment of pharmacy educator positions. In line with Caring Together Action 35b to consider cost effective creation of specifi c

positions for education to particular allied health specialties, a project to determine the impact of the new NSW Health Service Health Professional (State) Award may identify opportunities to build on this foundation of allied health student supervisors and allied health profession educators in each of the local health networks.

3 Exploring opportunities to develop and evaluate new models of clinical supervision in allied health

As identifi ed in Caring Together Action 45, one of the challenges recognised across NSW Health is the need for consistent access to quality clinical supervision as a vital part of effi cient and effective health care. Allied health has to improve access to training for clinical supervisors and increase support for the different clinical supervision needs of the allied health professional and assistant workforce.

By working in partnership with CETI, we have an opportunity to identify models of clinical supervision that best meet the various needs of the allied health workforce and identify cost effective and effi cient ways of delivering essential training to allied health professionals who provide supervision. There is also an opportunity through collaboration between the Directors of Allied Health and CETI to develop joint proposals for future funding opportunities.

4 Training allied health assistants

CETI will be exploring registered training organisation access and has expressed an interest in general training for allied health assistants. Establishing training for Certifi cate IV in Allied Health Assistance is a key initiative to support the growing demand for allied health professional services. As an emerging qualifi ed workforce within allied health, there is a need to ensure quality of care and safety of patients through clinical governance of training and supervision.

We have an opportunity to establish a project offi cer position within CETI to link with local health networks and directors of allied health to ensure consistency in training, identify innovative training delivery options and explore supervision training needs for allied health professionals and assistants.

The Area Directors of Allied Health look forward to working in partnership with CETI to promote collaborative links with allied health professionals. Outcomes from the planning meeting will be detailed in a future article.

More information: Patricia Bradd, SESIAHS Area Allied Health Director and Chair of the Area Allied Health Directors Group ([email protected]), or Dr Gaynor Heading, CETI General Manager ([email protected]).


Exciting opportunity for allied health and CETI

Patricia Bradd1, Brenda McLeod2 and Richard Cheney31 SESIAHS Area Allied Health Director and Chair of the Area Allied Health Directors Group, 2 Chief Allied Health Offi cer, NSW Health, 3 Allied Health Advisor, Greater Western Area Health Service


Seven hundred and seventy medical graduates, more than ever before, have been allocated to internship positions in New South Wales after CETI Medical Division (IMET) successfully facilitated another internship allocation and recruitment process for the 2011 clinical year. We also fi lled a record number of positions (56) through the Rural Preferential Recruitment process.

In fact the allocation process is continuing, with weekly offer rounds scheduled up to January (if required) to ensure that all intern positions for 2011 are fi lled.

For the fi rst time, NSW is participating in the National Audit of Internship Acceptances, a process which will give all jurisdictions a clearer idea of how interstate applications and allocations are proceeding. Two other initiatives implemented this year are Regional Preferential Allocation and the pilot program to build capacity of the Aboriginal medical workforce in NSW.

Regional Preferential Allocation aims to build a sustainable workforce in three regional areas (the Central Coast, the Illawarra/South Coast and Hunter/New England) by providing an opportunity for medical graduates of regional universities to continue their training in their region.

The pilot program to build capacity of the Aboriginal medical workforce supports the transition of Aboriginal medical graduates to internship positions in NSW, and is described in an article on page 2.

The intern allocation and recruitment process for 2011 will be reviewed, and a report will be prepared by the end of the year.

For the latest updates on offer rounds and internship news: visit the CETI Medical Division (IMET) website: www.imet.health.nsw.gov.au.

2011 internship campaign places record number of interns in NSW hospitalsVanessa EvansActing Head, Systems Support and Operations, CETI

Health service implementation activities

Hunter New England Area Health Service held a successful HSP Emergency Medicine Education Day on Thursday 3 June 2010. The day included skills workshops on airways management and arrhythmia management in the emergency department, non-invasive ventilation and venous access. This workshop was attended by 34 doctors from across the Area who all provided positive feedback on the skills workshops.

HNEAHS will be holding an HSP Paediatric Emergency Department Education Day in late October 2010.

South East Sydney Illawarra Area Health Service conducted an Emergency Medicine Workshop at Sutherland Hospital on Tuesday 11 May 2010. The workshop was attended by 21 doctors from across the Area who participated in skills development workshops on venous access using ultrasound guidance, advanced facial suturing, ECG interpretation and an aged care module on falls and advanced life directives in the emergency department. The feedback received was very positive.

SESIAHS has also been organising airway/intubation training for interested HSP participants in the Shoalhaven and Shellharbour operating theatres. Other activities for 2010 include central lines training in late August and September 2010 as well as a dental trauma workshop in November 2010. SESIAHS will also be holding their annual HSP Forum on 7 December 2010 which will focus on paediatric emergencies.

SESIAHS mental health doctors have been invited to participate in the Hunter New England Area Health Service Psychiatry Training Program via videoconference on Wednesday afternoons from 1445 until 1630.

Enrolments

More than 200 doctors have been enrolled in the program to date. All Area Health Services have received HSP modules and enrolment forms. Areas have been asked to enrol all interested doctors in the program.

Hospital Skills Program updateAlpana SinghHSP Coordinator, CETI

Module development

The completed modules in Emergency Department, Aged Care, Mental Health and HSP Core Skills have been distributed to Area Health Services and are also available via the CETI Medical Division (IMET) website (www.imet.health.nsw.gov.au). Modules are being developed in Hospital Medicine (including perioperative surgical care, hospital therapeutics and trauma), Child and Adolescent Health and Women’s Health, and are on track for completion by end of 2010.

Following an internal analysis of workforce data on current roles of non specialist doctors working in NSW hospitals, funding for further module development has been requested under the NSW Government’s Caring Together response to the Special Commission of Inquiry. The funding received includes supporting the delivery of medical education activities to non-specialist doctors in four modules: Sexual Health, Drug and Alcohol Medicine, Indigenous Health and Rural Medicine.

CETI has received funding to identify and develop online learning resources and activities that will promote participants’ achievement of HSP workplace competencies/capabilities. This may involve:

creating properly confi gured online courses and tutorials

converting content provided by the HSP curriculum developer into fi nished online tutorials. This will involve editing video, graphics, photographs for use in online pages, formatting text, and creating the instructional fl ow of tutorials and question pages

linking and uploading ancillary resources, such as pdf fi les and other documents, html pages and websites

creating other online activities, such as forums, calendars and coordinating the development of assessment items.

Principles for implementing the HSP

CETI is developing principles to guide HSP implementation across health services. These principles are being developed with the overarching goal of recognising that patient safety

and quality care is paramount and that the professional development of non-specialist doctors is a core business activity of health services.

CETI is also developing a HSP Strategic Plan 2010–2013, which will give the health services, the HSP State Training Council and CETI some goals and key performance indicators. The document provides a work plan for the Hospital Skills Program over the next three years.

HSP assessment resources

CETI submitted a request for funding under the Caring Together initiative proposed by Workforce Development and Innovation Branch to provide statewide assistance in the form of a “train the trainer” package to support trainee assessment in the program. This funding has been provided and work has commenced on developing DVDs as part of the package for HSP assessment. Workshops will be run within all the Area Health Services for HSP assessment by the end of the current fi nancial year. Some of these workshops will be videotaped so that this can be provided as an online resource for review by assessors at a later date.

HSP Education Strategy Forum

HSP Education Strategy Forums provide an opportunity for HSP Area Directors and Education Support Offi cers to meet, network and help CETI develop sustainable and effective educational strategies.

The forums will be held three times a year, with two one-day meetings and one two-day meeting. Each forum will include all the HSP Area Directors and Education Support Offi cers as well as two HSP participants from each area health service, CETI staff and co-opted members, as required.

The fi rst Education Strategy Forum will be held during the third week of November 2010, with a fi rm date to be confi rmed shortly.


CETI will be delivering the next Surgical Science Intensive Course from 24 January to 4 February 2011 at the University of Western Sydney.

The course teaches basic sciences (pathology, pharmacology, physiology, microbiology and anatomy) to junior doctors. Primarily assisting trainees in the Royal Australasian College of Surgeons Surgical Education

and Training (SET) program prepare for examinations, the course is open to prevocational, surgical skills and other specialty trainees to enhance their surgical knowledge and competencies.

Contact Jay Jacinto, Program Coordinator on 02 9844 6545 or [email protected] to register. Hurry, places are limited.

Surgical Science Intensive Course

A peer-to-peer mentoring scheme to support interns in their fi rst months of hospital service

A standard approach to shift handover designed to improve patient care and training opportunities for junior doctors

A coordinated approach to lectures to reduce redundancy and improve the relevance of education sessions

— These are just some of the initiatives being developed this year with the leadership or creative input of junior doctors in the NSW JMO Forum.

The forum is an elected representative body of JMOs (PGY1 and PGY2) from each of the training networks. It is an advisory subcommittee of the NSW Prevocational Training Council and provides CETI and other statewide institutions with JMO input into projects to improve clinical supervision

and training. This year the JMO Forum organised itself into ‘portfolio’ groups to take action on fi ve important areas: welfare, supervision, handover, education and assessment.

HandoverThe handover group has played a major role in the Acute Care Taskforce’s JMO Shift-to-Shift Handover Project. The proposed reforms to handover procedures are being piloted at six sites.

“The project has benefi ted greatly by having JMOs from a range of networks representing their peers in all phases of the project,” says Ian Richards, Principal Project Offi cer. “Their hard work and creative input gives us confi dence that the project is relevant to and meets the needs of newly graduated medical offi cers.”

JMO representatives involved at the pilot sites report that the reforms represent a huge cultural change, as they require more involvement of senior staff and a fi xed time for handover, conducted formally with compulsory attendance by all JMOs on duty. A formal evaluation of the pilot is in progress, with members of the handover group conducting interviews of participants at each pilot site.

Participants so far have reported benefi ts in patient safety, learning opportunities for JMOs, and clinical team-building.

All Safe Clinical Handover resources are available freely at: <http://www.archi.net.au/e-library/safety/clinical/nswhandover>.

WelfareExpanding on a mentoring program initiated at Westmead Hospital in 2009 by Dr Farzan Fahrtash, the welfare group is working with DPETs and JMO management units at four sites to pilot peer-to-peer mentoring. In this voluntary scheme, new interns are mentored by a more experienced junior doctor (PGY2 or above), with the aim of accelerating the transition from student to doctor in a supportive working environment.

“Mentoring transfers institutional knowledge between JMO groups from year to year, and has the potential to improve JMO wellbeing and patient care,” says Dr Matt Stanowski, RMO at Nepean Hospital and chair of the welfare group. “We’ve learned a lot from the pilot and hope to expand the scheme in 2011 to more hospitals. We’re also working on a better advisory package for potential mentors, to equip them for the job.”

SupervisionThe supervision group is gathering data on the supervision of JMOs across the state. “We have a lot of ideas about supervision and how it might be improved, but thought it important to gather an evidence base before making any recommendations,” says Dr Daniel Sumpton, chair of the supervision group.

Dr Roslyn Crampton, Chair of the Prevocational Training Council, welcomes the data-gathering exercise. “There is evidence that clinical supervision of JMOs is not always as close or effective as it should be. Health Workforce Australia, the Clinical Excellence Commission and CETI are all examining the supervision of JMOs. Information from the JMOs themselves about their experience of supervision will be valuable in shaping the future direction of reform.”

The supervision group invites all NSW and ACT JMOs to participate in a short online survey at: http://www.surveymonkey.com/s/HB3GJLK


Junior doctors drive positive change in their work and training

Craig BinghamPrevocational Program Coordinator, CETI

JMO FORUM

NEW SOUTH WALES

Chair of the JMO Forum’s handover group, Dr Hamish Dunn, RMO at Hornsby Hospital.

Education

“There is concern among JMOs about the lack of a unifi ed statewide education process for NSW JMOs, because the quantity and quality of teaching across the 15 prevocational training networks varies,” says Dr Helen Boyd, who shares the chair of the education group with Dr Sarah Sasson.

The education group knows that there is some great teaching going on, but wanted to suggest ways of ensuring that all JMOs, particularly interns, receive the teaching that they need in a timely and effi cient manner.

“At the moment, lecture series are coordinated by individual hospitals, but trainees are rotated through networks. So you might miss an important lecture topic while on rotation, or receive two lectures on the same topic, says Dr Sarah Sasson. “Another problem is that lectures are not necessarily organised so that the most important topics are covered fi rst.”

The education group has drafted a lecture series proposal for the intern year, in which critical topics are covered in term 1, then other topics in a logical order. DPETs were consulted closely in developing the lecture series, and many have embraced the concept enthusiastically, at least as an aspirational target. As all DPETs and JMO Managers are aware, organising lectures for JMOs is a logistical challenge, and the education group does not envisage that the proposed series will be implemented exactly as shown.

The group is now working on outlines of the lecture content that JMOs most need in relation to each topic. Helen Boyd: “Some sites have world experts giving lectures, and these people don’t need any guidance from us. But in other cases, the lecture may be given by somebody with relatively little experience of training JMOs, and they could use an outline indicating what level of knowledge the JMO already has, what clinical points are most important to cover and what subject matter is too advanced or specialised to be relevant.”

The Prevocational Training Council has endorsed the concept of the unifi ed lecture series and CETI will be working with networks to provide online resources to support implementation.

Proposed lecture series for interns

As proposed by the JMO Forum education group (see article for details)

Term 1 Term 2 Term 3 Term 4 Term 5

Advanced cardiac life support

Chest pain, acute coronary syndrome, heart failure

Assessing shortness of breath

Assessing syncope and loss of consciousness

Diabetes management

Fluids and electrolyte management

Assessing abdominal pain

Assessing and managing delirium

The deteriorating patient

Blood pressure management

Analgesia and pain management

Interpreting chest and abdominal x-rays

Gastrointestinal bleeding

ECG interpretation and management of arrhythmias

Perioperative assessment and management

Antibiotics and their use

Pathology tests: ordering and interpretation

Death certifi cation, breaking bad news, communicating with diffi cult patients and families

Pleural and ascitic taps and drains

Geriatric medicine

Recognition of the sick child

Introduction to trauma

Anticoagulants and their use

Looking after the junior medical offi cer

Psychiatry 101: depression, anxiety and the Mental Health Act

Medicolegal issues: privacy and confi dentiality, informed consent and open disclosure

Introduction to ear, nose and throat medicine

Fundamental orthopaedics

Intracerebral events

Psychiatry 102: the psychotic patient, drug overdose and withdrawal syndromes

Basic anaesthesiology

Obstetric and gynaecological emergencies

Introduction to ophthalmology

Wounds, dressing and suturing

Vascular surgery

Urology

Introduction to oxygen, delivery systems and intensive care medicine

Oncology and palliative care

Advanced lines

Radiology essentials

Neonatal and paediatric resuscitation

JMO FORUM

NEW SOUTH WALES


Co-chairs of the JMO Forum’s education group: Dr Sarah Sasson, RMO at Prince of Wales Hospital, and Dr Helen Boyd, RMO at Port Macquarie Base Hospital.

Assessment

At the recent NSW Prevocational Forum (6 August 2010), CETI reported a study of over 3000 progress review forms used in assessing prevocational trainees, which suggested that the forms are not supporting formative assessment as effectively as intended and are not being used to document underperformance when it occurs. The study raises questions about the current approach to assessment. Similar questions were raised by Dr Robert Russo, Director of Medical Education at Concord Hospital, who conducted a qualitative study of JMO assessment at Concord, and by Dr Farah Noaman, chair of the JMO Forum assessment group.

“The assessment group would like to see a separation of formative feedback from summative assessment, and assessment based on term-specifi c aims that assessed specifi c outcomes,” Dr Noaman says. “The assessment process should encourage regular meetings between the

JMO and supervisor. We need to think about incentives for engaging supervisors.”

The assessment group would like to increase the objectivity of assessment and decrease the amount of unnecessary information sent to different stakeholders. The group is working with the Prevocational Training Council and CETI to develop better approaches to assessing JMO performance.

New federal government funding will give more junior doctors in NSW a chance to train in general practice and provide extra training terms for the increasing number of medical graduates.

The federal government has increased funding to the Prevocational General Practice Placement Program (PGPPP). The funding will result in approximately 50 general practices providing training in 2011 in NSW. As part of the partnership between practices, regional training providers and hospitals, funding is available to back-fi ll the trainee while they are placed in general practice. This provides hospitals with a strategy to increase their rotation options and better manage the increasing numbers of medical graduates expected in the next few years.

For the fi rst time in NSW both PGY1 and PGY2 doctors will participate in general practice training. The program provides a real life experience in general practice for prevocational trainees in metropolitan, regional and rural areas. The direct patient care enables trainees to develop their medical skills in a different context and gain greater confi dence and independence.

CETI supports this trainee initiative and has revamped its accreditation program to facilitate its rapid expansion. Prevocational general practice training will be organised through regional training providers accredited by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine for the training of general practice registrars. CETI has recognised the regional training providers as the leaders and coordinators of general practice training, introduced new streamlined standards, defi ned the responsibilities of feeder hospitals and developed an accreditation process that recognises the training provider and practices’ accreditation by the general practice colleges.

General practices can be provisionally accredited for prevocational training by sending CETI a completed application. More details about the program, accreditation model and requirements are available on the CETI Medical Division website (www.imet.health.nsw.gov.au).

More information: Deputy Head, Systems Support and Operations, Jackie O’Callaghan (02 9844 6546, [email protected]).

Need the advice, support or creative thinking of a representative group of junior doctors?

Contact the JMO Forum via CETI’s Prevocational Program Coordinator: Craig Bingham ([email protected], 9844 6511).

JMO FORUM

NEW SOUTH WALES


A sustainable way to provide community-based training

Jackie O’CallaghanDeputy Head, Systems Support and Operations, CETI

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Psychiatry training update

Jan VeitchPsychiatry Program Coordinator, CETI

Psychiatry Supervisors’ Forum“Supervisors need to get to know their trainees early,” said Christine Senediak, a Clinical Psychologist from the NSW Institute of Psychiatry, at the Waterview Convention Centre on 10 August. “Effective supervision is a partnership between supervisors and trainees for the purpose of optimising the professional development of the trainee. The approach has to be individualised.”

Christine was addressing an audience of psychiatry supervisors who had come from across the state for a train-the-trainer afternoon of presentations and case discussions, with feedback from an expert panel synthesised by our New Zealand guest, Professor Pete Ellis, Head of Psychological Medicine at the University of Otago. Our thanks to all involved in organising the day; to the facilitators, Murray Wright and Ros Montague; presenters and panel members, Christine, Cath Hickie and Pete Kelly.

At the Forum CETI launched new resources for supervisors and trainees. The E-IMET learning platform has a developing e-Psych chapter where we are uploading education resources. Go to www.imet.moodle.com.au to enrol, and check it out regularly for new resources, such as those described below.

Metabolic management workshop The “Metabolic management for patients with mental health issues” workshop developed a management algorithm and

are currently fi nalising a learning package for e-Psych. Thanks to Dr Jackie Curtis, Dr Kathy Samaras and Dr Hannah Newell for their hard work on this project. The algorithm can be downloaded from IMET moodle site <www.imet.moodle.com.au>.

CBT skills Dr Lisa Lampe has completed CBT Skills in Action, a DVD/CD resource pack for supervisors, which is being distributed via the training networks and will shortly be uploaded in e-Psych.

Being launched in September is “The Psychotherapies” website. This much anticipated site will support all trainees learning in this specialty area. Dr Jeff Streimer, Dr Margot Phillips and team have spent many hours developing this resource with psychiatry ESF funding. Link to the site can be found on the IMET Psychiatry www.psychotherapies.org.au

Psychotherapy Educators Group (PEG) has continued with its popular Saturday Workshop series. In May, 70 trainees and Psychology students from University of Sydney attended a personality Workshop with guest presenter Dr Nancy Williams. In July, last workshop for 2010 on Formulation for Integrated Care was very well received.

Hot news The Psychiatry Education Support Fund for 2011 is supporting some more great workshops and resources. Watch this space.

More information: Since writing this article, Jan has left CETI to pursue other interests. For further information on the Psychiatry Program, contact Louise Rice, Head of Medical Education and Training Programs ([email protected], 02 9844 6535).

Centralised recruitment works well for Paediatrics Program

Neha BrootaProgram Coordinator, Paediatrics and Basic Physicians Training, CETI

Henry Ford, the American industrialist and founder of the Ford Motor Company, once said that “Coming together is a beginning. Keeping together is progress. Working together is success.” A new centralised recruitment system for the Paediatrics and Basic Physicians Training networks has proved the truth of this aphorism.

Recruitment can be a nerve-wracking time for applicants, but it’s also a busy time behind the scenes as Medical Support Offi cers, Network Directors, NSW Health and CETI work to ensure a successful outcome.

For the fi rst time since inception of the paediatric networks, provisional fellows in the paediatrics stream were recruited through a centralised process. Interviews across the general, community and neonatal streams took place at CETI. Apart from a few teething issues, the centralised process greatly benefi ted all three networks and applicants and should work even more smoothly next year.

The Basic Physician Training networks have also worked together to streamline recruitment. Medical Education Support Offi cers brought together common selection criteria to be used within all nine networks, and the networks worked with the NSW Department of Health to ensure that reference checks for each applicant only occur once. This is a signifi cant improvement from the previous year, where referees were contacted by each network separately.

Accreditation Surveyor Training Day

Pamela Bloomfi eldNetwork Coordinator, CETI

A surveyor training day on 30 July 2010 provided an opportunity for both new and experienced accreditation surveyors to develop their surveying skills and network with other clinicians, administrators and trainees. The day was hosted by CETI Medical Division (IMET) and the Prevocational Accreditation Committee at the Harbourview Hotel North Sydney. Over 40 surveyors attended for training in application of the accreditation standards, surveying processes, working in teams, communication, interviewing and report writing.

Surveyors are vital to the accreditation process, ensuring that there are high standards for prevocational trainees and that amenities, supervision and training continue to improve. Because of the expansion of prevocational training in NSW, with increasing numbers of trainees and a wider range of training sites, CETI expects that the number of surveys will increase. CETI Medical Division is keen to extend its pool of surveyors.

Being a surveyor can have several benefi ts for the volunteer. It’s a good professional development opportunity: surveyors learn new skills in interviewing, evaluating and reporting, discover how other hospitals are organised, and network with a wide range of health professionals from a range of disciplines.

For more information on the survey process or how to become a surveyor, please contact Network Coordinator Ms Pamela Bloomfi eld (02 9844 6555, pbloomfi [email protected]).


Do you or someone you know need help?The Medical Benevolent Association of NSW (MBANSW)

is a support service for doctors and their family members in NSW and ACT. The Association is able to provide fi nancial assistance and social work support to medical practitioners (including Junior Medical Offi cers).

The service is independent, free and confi dential. It is run “for doctors by doctors”. Those who request assistance from the association are at various stages in their career.

They may be experiencing health problems, relationship diffi culties or be struggling with balancing the demands of work, study and family life.

The Association’s social worker Meredith McVey has many years experience working with doctors and appreciates the diffi culty that many doctors have asking for assistance. You can contact Meredith on 02 9987 0504 or via www.mbansw.org.au for a confi dential discussion about your health, work or personal life and how MBANSW may be able to assist.

Prevocational review Amanda HarrissProject Manager, CETI

CETI’s external review of the prevocational training and education network system is now complete. The review panel is preparing its recommendations in a formal report that will be made available to CETI in the coming weeks.

IMET (now the CETI Medical Division) commissioned the review by an independent panel earlier this year. The panel was led by Professor Andrew Wilson, Executive Dean of the Faculty of Health, Queensland University. The review was fortunate to have an exceptionally high calibre team reviewing the current prevocational system.

CETI and the review panel would like to thank all the people who participated in the review and gave up their time to ensure a comprehensive and robust assessment was possible. The review process engaged with over 450 people across both NSW and the ACT and included everyone from JMOs to the Principal Medical Advisor at ACT Health. Information regarding the review including the terms of reference can be viewed at <www.imet.health.nsw.gov.au/projects/w1/i1005640/>.

Oncology training BSOC 2010 (Basic Sciences in Oncology Course) is well under way, with seven teaching days completed and the fi nal three anticipated. Medical and radiation oncology trainees, medical physic trainees, allied health and oncology program staff have all reported how valuable the presentations have been and how they appreciate the interaction with the senior clinicians and research staff contributing to the course. Participants report that BSOC events are:

enjoyable, with a good range of topics presented well

practical, with material relevant to understanding clinical trials making a diffi cult topic easy to digest

informative, with excellent quality and quantity of information

clinically relevant

really interactive.

More information: BSOC Support Offi cer (02 9844 6551, [email protected]).

Emergency medicine network directors appointed

Lynny GroshinskiSenior Program Coordinator, Emergency Medicine, CETI

Network directors of training have now been appointed for the fi ve emergency medicine training networks. The new network directors had an induction meeting and an intensive education planning session in July.

The network directors are progressing emergency medicine education initiatives, including preparation for the primary examination, preparation for the Fellowship examination and support for the 4.10 research project.

Education support offi cers have been appointed in two networks and are actively being recruited in the other three. They will work with the network directors to provide and promote education in the networks.

Survey of emergency medicine training In 2009 the survey of emergency medicine trainees and directors of emergency medicine training provided valuable data and comment for the Emergency Medicine Training Implementation Group in its planning for educational and training initiatives for NSW trainees. The 2010 survey is currently taking place to update this information and provide new trainees with an opportunity to comment on their training experience.

More information: Emergency Medicine Senior Program Coordinator Lynny Groshinski (02 9844 6576, [email protected]).


Do you know someone starting their career in Oncology? BSOC is the course for great foundation knowledge in the sciences that underpin this discipline area.

Information and enrolment for BSOC 2011 can be found on the CETI Medical Division website (www.imet.health.nsw.gov.au) or contact [email protected]

2011

CLINICAL EDUCATION& TRAINING INSTITUTE

Building 12, Gladesville Hospital

Victoria Road, Gladesville NSW, 2111

Locked Bag 5022

Gladesville NSW 1675

p: (02) 9844 6551

f: (02) 9844 6544

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Cetiscape is distributed widely in the NSW Health system. Contributions to this newsletter on all subjects related to clinical education and training are invited.

Please contact the editor, Craig Bingham (02 98446511, [email protected]), to discuss potential contributions and receive guidelines for contributors.

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