cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 1 New leadership in clinical education and training Steven Boyages New names for old friends Chief Executive, CETI The NSW Institute of Medical Education Welcome to cetiscape, the ﬁrst newsletter and Training (IMET) is now of the Clinical Education and Training Institute of the Medical Division of CETI. New South Wales (CETI). Establishing CETI was one of the key recommendations of the Garling The NSW Institute of Rural ClinicalInquiry and was adopted by the government in its Services and Teaching (IRCST) is now“Caring Together” Health Action Plan for NSW. the Rural Division of CETI.CETI is a Statutory Health Corporation under the HealthServices Act 1997. Its principal functions, as determined bythe Minister for Health, are listed in this newsletter, but in shortCETI is to provide leadership which: supports safe, high quality, multi-disciplinary team-based, In this issue patient-centred care Closing the gap in the Aboriginal medical meets service delivery needs and operational requirements workforce 2 enhances workforce skills, ﬂexibility and productivity. Medical education and training in Australia:Health is a knowledge-centred enterprise. Those working in what does the future hold? 3health are involved in the business of generating new knowledge Supervision Superguide 4(research and evaluation), imparting knowledge to a future workforce(education and training) and applying knowledge for the betterment Exciting opportunity for allied health and CETI 5of health and healthcare (service delivery). 2011 internship campaign places record numberCETI’s vision is to facilitate and build competency and of interns in NSW hospitals 6sustainable capacity to achieve better health through education, Hospital Skills Program update 6training and development of a clinical workforce that will meetthe healthcare needs of the people of NSW. Surgical Science Intensive Course 7CETI will do its work through investment in new programs; Junior doctors drive positive change in their work and training 8by collaborating with other key stakeholder groups such asuniversities, colleges, clinical leaders, hospitals, health services and sustainable way to provide community-based Athe community; and through innovation to improve communication, training 10capacity and competency by using blended learning approaches, Psychiatry training update 11including face-to-face teaching, simulation and e-learning. Centralised recruitment works well for PaediatricsCETI has a huge responsibility in working with others to ensure that Program 12we have a future health workforce that is responsive and available inappropriate numbers to meet the growing challenges. The Accreditation Surveyor Training Day 12newsletter name ‘cetiscape’ reﬂects the importance of stakeholder you or someone you know need help? Do 12involvement and the role that the newsletter will play in presentingdifferent perspectives, including those of stakeholders and staff. Prevocational review 13In a short time CETI has been able to build on the excellent work Oncology training 13of its foundation divisions, the Institute of Medical Education and Emergency medicine network directors appointed 13 Building 12, Gladesville Hospital, Victoria Road, Gladesville NSW, 2111 Editor: Craig Bingham Locked Bag 5022, Gladesville NSW 1675 02 9844 6511 CLINICAL EDUCATION & TRAINING INSTITUTE p: (02) 9844 6551 f: (02) 9844 6544 e: firstname.lastname@example.org email@example.com
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 2 Training (IMET) and the Institute of Rural Clinical Services and Teaching(IRCST). Our stakeholders have a strong desire to maintain discipline-speciﬁc divisions as well as creating cross-linking inter-professional units. CETI valuesCETI will establish several new divisions, including education, e-learning,allied health and nursing, as well as an interprofessional practice division. C CollaborationCETI’s top three priorities are to: We work together in partnership and in identify solutions to training challenges posed by the increased supply of teams for common goals. We engage medical graduates (interns) stakeholders and bring together and respect people with different develop and implement an interprofessional team program for new starters knowledge, skills and experience. in the health system Our culture encourages cooperation, adopt common standards and platforms for a learning management system. respect and sharing.I look forward to hearing your views and perspectives as to how CETI cancontinue to add value to education for future generations. Please write to me: E Excellenceceo@ceti.nsw.gov.au. We use best practice to develop and deliver quality services and learning opportunities. We ensure effectiveness in the way we use resources. We review andClosing the gap in the Aboriginal medical evaluate what we do. We are committedworkforce to professional development, competency, capacity and being proactive.Jacqueline DominishNetwork Coordinator, CETI T TransparencyCETI Medical Division (IMET), in partnership with the Australian Indigenous We are dedicated to accuracy,Doctors Association (AIDA) and NSW Department of Health, has developed a pilot consistency, and clear and regularprogram aimed at building capacity of the Aboriginal medical workforce in NSW. communication. We work in accordance with organisational and professionalThe pilot aims to support the national strategy of “Closing the Gap” in codes of conduct.Indigenous health care outcomes. Increasing the number of Aboriginal doctorsimproves access to culturally safe services for Aboriginal and Torres StraitIslander peoples. The program supports the transition of Aboriginal medical I Innovation We use emerging technologies andgraduates to internship positions in NSW. Aboriginal medical students were new ideas. We support and respectable to apply for the program in their ﬁnal year. creativity and inspiration while buildingUnder the program, Aboriginal medical graduates are appointed to a training the evidence base.network where they can show that they have one or more of the followingsupports: Family in the area relationship with the community A connection to country A pre-existing mentor A Training opportunities in line with the graduate’s career aspirations history of favourable experience during their undergraduate A training.Applications were assessed by a panel with signiﬁcant Aboriginalrepresentation, including Dr Marlene Kong (Member of the Board,Australian Indigenous Doctors Association) and Mr Charles Davison(Manager, Aboriginal Workforce Development Unit, NSW Department ofHealth). Successful applicants have been allocated to their prevocationaltraining network of ﬁrst choice in order to maximise their chance of Left to right: Dr Marlene Kong, Australian Indigenous Doctorssuccessfully completing prevocational training. The ﬁrst cohort of trainees Association; Ms Jacqueline Dominish, CETI Medical Divisionunder the program will commence their internship in January 2011. (IMET); and Mr Charles Davison, Manager, Aboriginal Workforce Development, NSW Health.More information: Network Coordinator Ms Jacqueline Dominish(02 9844 6558, firstname.lastname@example.org).
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 3 Medical education and training in Australia: What does the future hold? Simon Willcock Director, CETI Medical Division The purpose of medical education and training is to provide a highly skilled medical workforce capable of delivering high quality CETI functionshealth services to the entire population. In 2010 such trainingshould also equip the medical workforce to adapt to the As deternined by the NSW Minister for Health:changing health care needs of the Australian population and 1 To provide leadership, and work closely with area healthshould be economically sustainable. service and other public health organisations and clinical training providers, to ensure the development and deliveryOne of the outcomes of the 2008 “2020 Summit” was of clinical education and training across the NSW publican ambition that Australia should have an “integrated health system which:infrastructure for the health and education system”.1 The a Supports safe, high quality, multi-disciplinary teamincoming Commonwealth Labor government committed itself based, patient centred careto developing an integrated health service delivery system that b meets service delivery needs and operationalis ﬁscally sustainable, ﬂexible and designed around identiﬁed requirementscommunity health care needs rather than jurisdictional, c enhances workforce skills, ﬂexibility and productivity.institutional or current program boundaries. 2 To design, commission, conduct, coordinate, supportThe achievement of this goal requires a national approach and evaluate a clinical education and training programto health sector education and training (including medical for all new graduate clinical and clinical support staffeducation and training), with a focus on deﬁning the skills in the public health system, which supports their rolesrequired and the number of practitioners needed to deliver in providing safe, high quality, multi-disciplinary team-this outcome. The National Health and Hospitals Reform based, patient-centred care.Commission and the Preventive Care Taskforce each 3 To design, commission, conduct, coordinate, support andidentiﬁed the need to develop incentive arrangements evaluate such other postgraduate clinical education andand ﬁnancial consequences for performance against training programs as the Director - General may direct frombenchmarks,2 including a quantum of funds that is “at risk” time to time.and tied to achievement of targets.3 Inevitably these incentive 4 To design, commission, conduct, coordinate and supportarrangements will also be applied to the education and professional development programs to enable clinicianstraining component of the health sector. to become skilled teachers, clinical leaders, trainers and supervisors.For the past 50 years medical workforce training in Australiahas delivered highly skilled workers, but within an increasingly 5 To develop and oversee performance evaluation programs for post graduate clinical education and training in thesilo-based model of training and service delivery. This model NSW public health system.has also inﬂuenced training in the nursing and allied healthprofessions, resulting in a health system that generally delivers 6 To set standards for prevocational medical training andexcellent care, but that can be expensive and poorly integrated. accredit institutions for prevocational education and supervision.Health economists have clearly documented the increased 7 To institute, coordinate and evaluate clinical trainingcosts associated with highly specialised and uncoordinated networks, including postgraduate medical trainingmodels of care. The new Commonwealth focus on integrated networks, and ensure they support service delivery needs,service delivery models therefore has implications for training meet operational requirements and are, as far as possible,at all stages of medical training, including the undergraduate, consistent with, clinical service network;early postgraduate and vocational training sectors. 8 In undertaking its functions, to consult and liaise withCOAG has established Health Workforce Australia (HWA) as patients and their carers, clinical and clinical support staff,a national entity tasked with developing effective models for the Department of Health other public health organisationspredicting future workforce need and for identifying and funding and providers of clinical education and training.gaps in undergraduate training resources. Most gaps relate 9 To provide advice to the Department of Health, Director-to clinical training opportunities for students training in health General and Minister on matters relevant to its functions.careers, along with supervisory and educational resources.
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 4 HWA therefore has a speciﬁc brief to fund new clinical 1 Australia 2020 Summit – Final Report, April 2008, p128.training places across a broad range of health disciplines, to 2 Beyond the Blame Game: Accountability and performancedeﬁne and support the role of simulated learning in clinical benchmarks in next Australian Health Care Agreements, Apriltraining, and to develop parameters for training, credentialing 2008, p4.and support of clinical supervisors. There also exists a great 3 Australia: The Healthiest Country by 2020, October 2008, p50.opportunity (indeed a critical need) to identify domains in 4 Also known as “pre-workforce-entry training”, given that somewhich students can learn collaboratively, thereby developing medical training courses enroll graduate students.the skills associated with team-based care that are so crucialto effective health service delivery. New graduates mustnot only be competent in acute medical care skills, but justas importantly must have skills in preventive health and themanagement of chronic and complex co-morbidities. CETI’s seven CsWhile HWA’s initial focus is on undergraduate training,4 theintent is to align these initiatives with postgraduate training Capacityat both prevocational and vocational level. The postgraduate Communicationenvironment is also changing, with the traditional public hospital-based internship and vocational training programs evolving in Collaborationrecognition of the need to train graduates in a variety of settings,including community and private hospital locations. CoordinationIn summary, Australia needs a skilled, ﬂexible and integrated Competencyhealth workforce to meet the needs of a diverse and ageing Care modelspopulation. CETI, with its interprofessional training capacity,is perfectly positioned to work with HWA, universities, Culturecolleges and other professional groups to develop a verticallyintegrated model for postgraduate education and training.Supervision SuperguideA new practical guide for supervisors and motivating,” Dr Crampton said.of junior medical ofﬁcers will soon “Successful supervision uses thebe available to all term supervisors in The Superguide necessities of clinical oversight as theNew South Wales. The guide is being a handbook for opportunity for training and education,developed in consultation with clinicians supervising doctors in training so that safe supervision todayacross the State by CETI’s Medical becomes the foundation for safeDivision (IMET). August 2010 CONSULTATION DRAFT independent practice by the trainee in IMET | RESOURCE the future.”An advanced consultation draft ofThe Superguide: a handbook for The consultation draft is availablesupervising doctors in training was at www.imet.health.nsw.gov.au/launched at the NSW Prevocational prevocational. Comments receivedForum on 6 August by the Chair of from many stakeholders throughoutthe Prevocational Training Council, Dr NSW are being used to ﬁnaliseRoslyn Crampton. the ﬁrst edition for publication in November, ready for use in the 2011“There is good evidence about what training year.makes good clinical supervision, butthe literature is diffuse and not readily More information: Prevocationalaccessible to busy supervisors. We IMET NSW Institute of Medical Program Coordinator Craig Bingham Education and Trainingwanted to publish a short guide based — a division of CETI (02 9844 6511,on the evidence that was practical email@example.com).
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 5 Exciting opportunity for allied health and CETIPatricia Bradd1, Brenda McLeod2 and Richard Cheney31 SESIAHS Area Allied Health Director and Chair of the Area Allied Health Directors Group, 2 Chief Allied Health Ofﬁcer,NSW Health, 3 Allied Health Advisor, Greater Western Area Health ServiceThe creation of CETI is an important initiative that provides positions for education to particular allied health specialties,an opportunity for Allied Health to support and improve the a project to determine the impact of the new NSW Healthongoing supervision, training and development needs of the Service Health Professional (State) Award may identifyallied health workforce. opportunities to build on this foundation of allied health student supervisors and allied health profession educators inRecently the Area Directors and Advisors of Allied Health each of the local health networks.and Chief Allied Health Ofﬁcer had a positive and productivemeeting with CETI’s Chief Executive, Professor Steven 3 Exploring opportunities to develop and evaluate newBoyages, and General Manager, Dr Gaynor Heading. In line models of clinical supervision in allied healthwith CETI’s role to develop and coordinate clinical training As identiﬁed in Caring Together Action 45, one of theand professional development programs, we discussed the challenges recognised across NSW Health is the need forimportant contribution of allied health in multidisciplinary patient consistent access to quality clinical supervision as a vitalcare and interprofessional learning, with a focus on identifying part of efﬁcient and effective health care. Allied health hascommon aims and opportunities for future collaboration. to improve access to training for clinical supervisors andWith a commitment from Professor Boyages to explore the increase support for the different clinical supervision needs ofdevelopment of a dedicated suite of clinical training and the allied health professional and assistant workforce.professional development activities for allied health, a further By working in partnership with CETI, we have an opportunityplanning meeting will be organised to discuss issues important to identify models of clinical supervision that best meet theto allied health. various needs of the allied health workforce and identify costProvisional priorities identiﬁed during the meeting for further effective and efﬁcient ways of delivering essential trainingdiscussion include: to allied health professionals who provide supervision. There is also an opportunity through collaboration between1 Developing a business case for the feasibility of “new the Directors of Allied Health and CETI to develop joint starter” programs in allied health professions proposals for future funding opportunities.Several allied health professions have identiﬁed the needto improve professional development and support for new 4 Training allied health assistantsgraduates during the ﬁrst year of employment. CETI will be exploring registered training organisation access and has expressed an interest in general training for alliedThe discipline of physiotherapy has a new graduate allocation health assistants. Establishing training for Certiﬁcate IV inprogram which involves recruitment of new graduate Allied Health Assistance is a key initiative to support thephysiotherapists into positions across NSW Health facilities. growing demand for allied health professional services. As anThe program provides structured clinical supervision and emerging qualiﬁed workforce within allied health, there is aopportunities for practical clinical skills training, and supports need to ensure quality of care and safety of patients throughthe transition of new graduates to practising clinicians. clinical governance of training and supervision.This type of “new starter” program would be an important We have an opportunity to establish a project ofﬁcer positionmechanism for improving recruitment and retention within the within CETI to link with local health networks and directorsallied health workforce. It is proposed that existing models of allied health to ensure consistency in training, identifywithin allied health, nursing and medicine will be reviewed to innovative training delivery options and explore supervisiondetermine applicability of other allied health disciplines. training needs for allied health professionals and assistants.2 A project ofﬁcer to investigate options for strengthening The Area Directors of Allied Health look forward to working allied health clinical placement coordinator and in partnership with CETI to promote collaborative links with educator roles allied health professionals. Outcomes from the planningTo date, there have been limited allied health clinical meeting will be detailed in a future article.placement coordinator and allied health profession educator More information: Patricia Bradd, SESIAHS Area Alliedpositions created across NSW. Some growth has occurred Health Director and Chair of the Area Allied Health Directorsas part of Caring Together initiatives with the appointment Group (firstname.lastname@example.org),of pharmacy educator positions. In line with Caring Together or Dr Gaynor Heading, CETI General ManagerAction 35b to consider cost effective creation of speciﬁc (email@example.com).
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 6 2011 internship campaign places record number of interns inNSW hospitalsVanessa EvansActing Head, Systems Support and Operations, CETISeven hundred and seventy medical graduates, more than Regional Preferential Allocation aims to build a sustainableever before, have been allocated to internship positions workforce in three regional areas (the Central Coast,in New South Wales after CETI Medical Division (IMET) the Illawarra/South Coast and Hunter/New England) bysuccessfully facilitated another internship allocation and providing an opportunity for medical graduates of regionalrecruitment process for the 2011 clinical year. We also universities to continue their training in their region.ﬁlled a record number of positions (56) through the RuralPreferential Recruitment process. The pilot program to build capacity of the Aboriginal medical workforce supports the transition of Aboriginal medicalIn fact the allocation process is continuing, with weekly offer graduates to internship positions in NSW, and is describedrounds scheduled up to January (if required) to ensure that in an article on page 2.all intern positions for 2011 are ﬁlled. The intern allocation and recruitment process for 2011 willFor the ﬁrst time, NSW is participating in the National Audit be reviewed, and a report will be prepared by the end of theof Internship Acceptances, a process which will give all year.jurisdictions a clearer idea of how interstate applications andallocations are proceeding. Two other initiatives implemented For the latest updates on offer rounds and internshipthis year are Regional Preferential Allocation and the news: visit the CETI Medical Division (IMET) website:pilot program to build capacity of the Aboriginal medical www.imet.health.nsw.gov.au.workforce in NSW.Hospital Skills Program updateAlpana SinghHSP Coordinator, CETIHealth service implementation activities SESIAHS has also been organising airway/intubation training for interested HSP participants in the Shoalhaven andHunter New England Area Health Service held a successful Shellharbour operating theatres. Other activities for 2010HSP Emergency Medicine Education Day on Thursday 3 include central lines training in late August and SeptemberJune 2010. The day included skills workshops on airways 2010 as well as a dental trauma workshop in Novembermanagement and arrhythmia management in the emergency 2010. SESIAHS will also be holding their annual HSPdepartment, non-invasive ventilation and venous access. This Forum on 7 December 2010 which will focus on paediatricworkshop was attended by 34 doctors from across the Area emergencies.who all provided positive feedback on the skills workshops. SESIAHS mental health doctors have been invited toHNEAHS will be holding an HSP Paediatric Emergency participate in the Hunter New England Area Health ServiceDepartment Education Day in late October 2010. Psychiatry Training Program via videoconference onSouth East Sydney Illawarra Area Health Service conducted Wednesday afternoons from 1445 until 1630.an Emergency Medicine Workshop at Sutherland Hospitalon Tuesday 11 May 2010. The workshop was attended by21 doctors from across the Area who participated in skills Enrolmentsdevelopment workshops on venous access using ultrasoundguidance, advanced facial suturing, ECG interpretation and More than 200 doctors have been enrolled in the program toan aged care module on falls and advanced life directives in date. All Area Health Services have received HSP modulesthe emergency department. The feedback received was very and enrolment forms. Areas have been asked to enrol allpositive. interested doctors in the program.
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 7 Module development and quality care is paramount and that the professional development of non-specialist doctors is a core businessThe completed modules in Emergency Department, Aged Care, activity of health services.Mental Health and HSP Core Skills have been distributedto Area Health Services and are also available via the CETI CETI is also developing a HSP Strategic Plan 2010–2013,Medical Division (IMET) website (www.imet.health.nsw.gov.au). which will give the health services, the HSP State TrainingModules are being developed in Hospital Medicine (including Council and CETI some goals and key performanceperioperative surgical care, hospital therapeutics and trauma), indicators. The document provides a work plan for theChild and Adolescent Health and Women’s Health, and are on Hospital Skills Program over the next three years.track for completion by end of 2010.Following an internal analysis of workforce data on current HSP assessment resourcesroles of non specialist doctors working in NSW hospitals,funding for further module development has been requested CETI submitted a request for funding under the Caringunder the NSW Government’s Caring Together response Together initiative proposed by Workforce Development andto the Special Commission of Inquiry. The funding received Innovation Branch to provide statewide assistance in the formincludes supporting the delivery of medical education activities of a “train the trainer” package to support trainee assessmentto non-specialist doctors in four modules: Sexual Health, Drug in the program. This funding has been provided and work hasand Alcohol Medicine, Indigenous Health and Rural Medicine. commenced on developing DVDs as part of the package for HSP assessment. Workshops will be run within all the AreaCETI has received funding to identify and develop Health Services for HSP assessment by the end of the currentonline learning resources and activities that will promote ﬁnancial year. Some of these workshops will be videotaped soparticipants’ achievement of HSP workplace competencies/ that this can be provided as an online resource for review bycapabilities. This may involve: assessors at a later date. creating properly conﬁgured online courses and tutorials converting content provided by the HSP curriculum developer into ﬁnished online tutorials. This will involve HSP Education Strategy Forum editing video, graphics, photographs for use in online HSP Education Strategy Forums provide an opportunity pages, formatting text, and creating the instructional ﬂow for HSP Area Directors and Education Support Ofﬁcers of tutorials and question pages to meet, network and help CETI develop sustainable and linking and uploading ancillary resources, such as pdf effective educational strategies. ﬁles and other documents, html pages and websites creating other online activities, such as forums, calendars The forums will be held three times a year, with two one-day and coordinating the development of assessment items. meetings and one two-day meeting. Each forum will include all the HSP Area Directors and Education Support Ofﬁcers as well as two HSP participants from each area healthPrinciples for implementing the HSP service, CETI staff and co-opted members, as required.CETI is developing principles to guide HSP implementation The ﬁrst Education Strategy Forum will be held duringacross health services. These principles are being developed the third week of November 2010, with a ﬁrm date to bewith the overarching goal of recognising that patient safety conﬁrmed shortly.Surgical Science Intensive CourseCETI will be delivering the next Surgical Science Intensive and Training (SET) program prepare for examinations, theCourse from 24 January to 4 February 2011 at the University course is open to prevocational, surgical skills and otherof Western Sydney. specialty trainees to enhance their surgical knowledge and competencies.The course teaches basic sciences (pathology,pharmacology, physiology, microbiology and anatomy) Contact Jay Jacinto, Program Coordinator on 02 9844 6545to junior doctors. Primarily assisting trainees in the Royal or firstname.lastname@example.org to register.Australasian College of Surgeons Surgical Education Hurry, places are limited.
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 8 Junior doctors drive positive change in their work and trainingCraig BinghamPrevocational Program Coordinator, CETI peer-to-peer mentoring scheme to support interns in A All Safe Clinical Handover resources are available freely their ﬁrst months of hospital service at: <http://www.archi.net.au/e-library/safety/clinical/ standard approach to shift handover designed to improve A nswhandover>. patient care and training opportunities for junior doctors coordinated approach to lectures to reduce redundancy A Welfare and improve the relevance of education sessions Expanding on a mentoring program initiated at Westmead — These are just some of the initiatives Hospital in 2009 by Dr Farzan Fahrtash, the welfare group isbeing developed this year with the leadership or creative working with DPETs and JMO management units at four sitesinput of junior doctors in the NSW JMO Forum. to pilot peer-to-peer mentoring. In this voluntary scheme, new interns are mentored by a more experienced junior doctor The forum is an elected representative (PGY2 or above), with the aim of accelerating the transition M body of the training networks. It is an of JMOs (PGY1 and PGY2) from from student to doctor in a supportive working environment. F ORU each JMO advisory subcommittee of the NSW “Mentoring transfers institutional knowledge between JMO Prevocational Training Council and groups from year to year, and has the potential to improve JMO provides CETI and other statewide wellbeing and patient care,” says Dr Matt Stanowski, RMO at NEW SOU TH WALES institutions with JMO input into Nepean Hospital and chair of the welfare group. “We’ve learned projects to improve clinical supervision a lot from the pilot and hope to expand the scheme in 2011and training. This year the JMO Forum organised itself into to more hospitals. We’re also working on a better advisory‘portfolio’ groups to take action on ﬁve important areas: package for potential mentors, to equip them for the job.”welfare, supervision, handover, education and assessment. SupervisionHandover The supervision group is gathering data on the supervisionThe handover group has played a major role in the Acute Care of JMOs across the state. “We have a lot of ideas aboutTaskforce’s JMO Shift-to-Shift Handover Project. The proposed supervision and how it might be improved, but thought itreforms to handover procedures are being piloted at six sites. important to gather an evidence base before making any recommendations,” says Dr Daniel Sumpton, chair of the“The project has beneﬁted greatly by having JMOs from a supervision group.range of networks representing their peers in all phases ofthe project,” says Ian Richards, Principal Dr Roslyn Crampton, Chair of theProject Ofﬁcer. “Their hard work and creative Prevocational Training Council,input gives us conﬁdence that the project welcomes the data-gathering exercise.is relevant to and meets the needs of newly “There is evidence that clinicalgraduated medical ofﬁcers.” supervision of JMOs is not alwaysJMO representatives involved at the pilot as close or effective as it should be.sites report that the reforms represent a Health Workforce Australia, the Clinicalhuge cultural change, as they require more Excellence Commission and CETI areinvolvement of senior staff and a ﬁxed time for all examining the supervision of JMOs.handover, conducted formally with compulsory Information from the JMOs themselvesattendance by all JMOs on duty. A formal about their experience of supervisionevaluation of the pilot is in progress, with will be valuable in shaping the futuremembers of the handover group conducting direction of reform.”interviews of participants at each pilot site. Chair of the JMO Forum’s The supervision group invites all NSW and handover group, Dr HamishParticipants so far have reported beneﬁts Dunn, RMO at Hornsby ACT JMOs to participate in a short onlinein patient safety, learning opportunities for Hospital. survey at:JMOs, and clinical team-building. http://www.surveymonkey.com/s/HB3GJLK
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 9 Education“There is concern among JMOs about the lack of a uniﬁedstatewide education process for NSW JMOs, because thequantity and quality of teaching across the 15 prevocationaltraining networks varies,” says Dr Helen Boyd, who sharesthe chair of the education group with Dr Sarah Sasson.The education group knows that there is some great teachinggoing on, but wanted to suggest ways of ensuring that allJMOs, particularly interns, receive the teaching that theyneed in a timely and efﬁcient manner. Co-chairs of the JMO Forum’s education group: Dr Sarah Sasson,“At the moment, lecture series are coordinated by individual RMO at Prince of Wales Hospital, and Dr Helen Boyd, RMO at Port Macquarie Base Hospital.hospitals, but trainees are rotated through networks. So youmight miss an important lecture topic while on rotation, orreceive two lectures on the same topic, says Dr Sarah Sasson. The group is now working on outlines of the lecture content that“Another problem is that lectures are not necessarily organised JMOs most need in relation to each topic. Helen Boyd: “Someso that the most important topics are covered ﬁrst.” sites have world experts giving lectures, and these people don’t need any guidance from us. But in other cases, the lecture mayThe education group has drafted a lecture series proposal be given by somebody with relatively little experience of trainingfor the intern year, in which critical topics are covered in JMOs, and they could use an outline indicating what level ofterm 1, then other topics in a logical order. DPETs were knowledge the JMO already has, what clinical points are mostconsulted closely in developing the lecture series, and many important to cover and what subject matter is too advanced orhave embraced the concept enthusiastically, at least as an specialised to be relevant.”aspirational target. As all DPETs and JMO Managers areaware, organising lectures for JMOs is a logistical challenge, The Prevocational Training Council has endorsed the conceptand the education group does not envisage that the of the uniﬁed lecture series and CETI will be working withproposed series will be implemented exactly as shown. networks to provide online resources to support implementation. JMO FOR UM Proposed lecture series for interns N E W S O U T H WA L E S 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 Analgesia and pain Pleural and ascitic taps Introduction to ear, nose and Vascular surgery support management and drains throat medicine Urology Chest pain, acute Interpreting chest and Geriatric medicine Fundamental orthopaedics coronary syndrome, Introduction to oxygen, abdominal x-rays heart failure Recognition of the sick Intracerebral events delivery systems and Gastrointestinal bleeding child intensive care medicine Assessing shortness of Psychiatry 102: the psychotic breath ECG interpretation Introduction to trauma patient, drug overdose and Oncology and palliative and management of withdrawal syndromes care Assessing syncope and Anticoagulants and arrhythmias loss of consciousness their use Basic anaesthesiology Advanced lines Perioperative assessment Diabetes management Looking after the junior Obstetric and gynaecological Radiology essentials and management medical ofﬁcer emergencies Fluids and electrolyte Neonatal and paediatric Antibiotics and their use management Psychiatry 101: Introduction to resuscitation Pathology tests: ordering depression, anxiety and ophthalmology Assessing abdominal and interpretation the Mental Health Act pain Wounds, dressing and Death certiﬁcation, Medicolegal suturing Assessing and breaking bad news, issues: privacy and managing delirium communicating with conﬁdentiality, informed The deteriorating patient difﬁcult patients and consent and open families disclosure Blood pressure management
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 10 Assessment JMO and supervisor. We need to think about incentives for engaging supervisors.”At the recent NSW Prevocational Forum (6 August 2010),CETI reported a study of over 3000 progress review forms The assessment group would like to increase the objectivityused in assessing prevocational trainees, which suggested of assessment and decrease the amount of unnecessarythat the forms are not supporting formative assessment as information sent to different stakeholders. The group iseffectively as intended and are not being used to document working with the Prevocational Training Council and CETI tounderperformance when it occurs. The study raises questions develop better approaches to assessing JMO performance.about the current approach to assessment. Similar questionswere raised by Dr Robert Russo, Director of MedicalEducation at Concord Hospital, who conducted a qualitativestudy of JMO assessment at Concord, and by Dr Farah UM Need the advice, support or creative FORNoaman, chair of the JMO Forum assessment group. JMO thinking of a representative group N E W SO UTH WA L E S of junior doctors?“The assessment group would like to see a separationof formative feedback from summative assessment, and Contact the JMO Forum via CETI’s Prevocationalassessment based on term-speciﬁc aims that assessed Program Coordinator: Craig Binghamspeciﬁc outcomes,” Dr Noaman says. “The assessment (email@example.com, 9844 6511).process should encourage regular meetings between theA sustainable way to provide community-based trainingJackie O’CallaghanDeputy Head, Systems Support and Operations, CETINew federal government funding will give more junior CETI supports this trainee initiative and has revampeddoctors in NSW a chance to train in general practice and its accreditation program to facilitate its rapid expansion.provide extra training terms for the increasing number of Prevocational general practice training will be organisedmedical graduates. through regional training providers accredited by the Royal Australian College of General Practitioners andThe federal government has increased funding to the the Australian College of Rural and Remote MedicinePrevocational General Practice Placement Program for the training of general practice registrars. CETI has(PGPPP). The funding will result in approximately 50 general recognised the regional training providers as the leaders andpractices providing training in 2011 in NSW. As part of the coordinators of general practice training, introduced newpartnership between practices, regional training providers streamlined standards, deﬁned the responsibilities of feederand hospitals, funding is available to back-ﬁll the trainee hospitals and developed an accreditation process thatwhile they are placed in general practice. This provides recognises the training provider and practices’ accreditationhospitals with a strategy to increase their rotation options by the general practice colleges.and better manage the increasing numbers of medicalgraduates expected in the next few General practices can be provisionally Gyears. accredited for prevocational training by a sending CETI a completed application. sFor the ﬁrst time in NSW both PGY1 More details about the program, Mand PGY2 doctors will participate in accreditation model and requirements ageneral practice training. The program a available on the CETI Medical areprovides a real life experience in general Division website (www.imet.health.nsw. Dpractice for prevocational trainees gov.au). gin metropolitan, regional and ruralareas. The direct patient care enables More information: Deputy Head, Mtrainees to develop their medical skills General practice training can provide trainees Systems Support and Operations, S with close patient interactions and a real sensein a different context and gain greater Jackie O’Callaghan (02 9844 6546, J of managing patient care.conﬁdence and independence. firstname.lastname@example.org). j
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 11 Psychiatry training update are currently ﬁnalising 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. TheJan Veitch algorithm can be downloaded from IMET moodle sitePsychiatry Program Coordinator, CETI <www.imet.moodle.com.au>.Psychiatry Supervisors’ Forum CBT skills“Supervisors need to get to know their trainees early,” Dr Lisa Lampe has completed CBT Skills in Action, a DVD/CDsaid Christine Senediak, a Clinical Psychologist from the resource pack for supervisors, which is being distributed via theNSW Institute of Psychiatry, at the Waterview Convention training networks and will shortly be uploaded in e-Psych.Centre on 10 August. “Effective supervision is a partnershipbetween supervisors and trainees for the purpose of Being launched in September is “The Psychotherapies”optimising the professional development of the trainee. The website. This much anticipated site will support all traineesapproach has to be individualised.” learning in this specialty area. Dr Jeff Streimer, Dr Margot Phillips and team have spent many hours developing thisChristine was addressing an audience of psychiatry resource with psychiatry ESF funding. Link to the site can besupervisors who had come from across the state for a train- found on the IMET Psychiatry www.psychotherapies.org.authe-trainer afternoon of presentations and case discussions,with feedback from an expert panel synthesised by our New Psychotherapy Educators Group (PEG) has continued withZealand guest, Professor Pete Ellis, Head of Psychological its popular Saturday Workshop series. In May, 70 traineesMedicine at the University of Otago. Our thanks to all and Psychology students from University of Sydney attendedinvolved in organising the day; to the facilitators, Murray a personality Workshop with guest presenter Dr NancyWright and Ros Montague; presenters and panel members, Williams. In July, last workshop for 2010 on Formulation forChristine, Cath Hickie and Pete Kelly. Integrated Care was very well received.At the Forum CETI launched new resources for supervisorsand trainees. The E-IMET learning platform has a developing Hot newse-Psych chapter where we are uploading education The Psychiatry Education Support Fund for 2011 isresources. Go to www.imet.moodle.com.au to enrol, and supporting some more great workshops and resources.check it out regularly for new resources, such as those Watch this space.described below. More information: Since writing this article, Jan has left CETI to pursue other interests. For further information on theMetabolic management workshop Psychiatry Program, contact Louise Rice, Head of MedicalThe “Metabolic management for patients with mental health Education and Training Programs (email@example.com,issues” workshop developed a management algorithm and 02 9844 6535). Obesity Polycystic Smoking Lifestyle Blood Fasting Blood Fasting Pressure Glucose Blood Lipids ovary Weight Waist syndrome Current Poor diet BMI (kg/m2) Male≥94cm* >140 systolic > 5.6 mmol/L >6.5 TChol No periods > 25 for 3 Smoker AND/OR Female≥80cm AND/OR (>5.5 TChol if months^ AND/OR diabetic) diabet ) diabetic) betic) S dentary Sedent y Sedentary Sedentary t AND/OR /O AND/OR >90 diastolic 90 diastolic diastolic astoli t li Acne Ac Acne lifestyle lifesty lifestyle estyle Weight W ight Weight ↑> 5kg 5kg 5k kg Hirsutism Hirsutism Hi s tism suti Waist Waist ↑> 5cm 5cm >2.0 Trig >2 0 Trig 2 igCheck out the whole algorithm at www.imet.moodle.com.au
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 12 Centralised recruitment works well Accreditation Surveyor Training Dayfor Paediatrics Program Pamela BloomﬁeldNeha Broota Network Coordinator, CETIProgram Coordinator, Paediatrics and Basic Physicians A surveyor training day on 30 July 2010 provided anTraining, CETI opportunity for both new and experienced accreditationHenry Ford, the American industrialist and founder of the surveyors to develop their surveying skills and network withFord Motor Company, once said that “Coming together is a other clinicians, administrators and trainees. The day wasbeginning. Keeping together is progress. Working together hosted by CETI Medical Division (IMET) and the Prevocationalis success.” A new centralised recruitment system for the Accreditation Committee at the Harbourview Hotel NorthPaediatrics and Basic Physicians Training networks has Sydney. Over 40 surveyors attended for training in applicationproved the truth of this aphorism. of the accreditation standards, surveying processes, working in teams, communication, interviewing and report writing.Recruitment can be a nerve-wracking time for applicants, butit’s also a busy time behind the scenes as Medical Support Surveyors are vital to the accreditation process, ensuringOfﬁcers, Network Directors, NSW Health and CETI work to that there are high standards for prevocational trainees andensure a successful outcome. that amenities, supervision and training continue to improve. Because of the expansion of prevocational training in NSW,For the ﬁrst time since inception of the paediatric networks, with increasing numbers of trainees and a wider range ofprovisional fellows in the paediatrics stream were recruited training sites, CETI expects that the number of surveys willthrough a centralised process. Interviews across the general, increase. CETI Medical Division is keen to extend its pool ofcommunity and neonatal streams took place at CETI. Apart surveyors.from a few teething issues, the centralised process greatlybeneﬁted all three networks and applicants and should work Being a surveyor can have several beneﬁts for the volunteer.even more smoothly next year. It’s a good professional development opportunity: surveyors learn new skills in interviewing, evaluating and reporting,The Basic Physician Training networks have also worked discover how other hospitals are organised, and networktogether to streamline recruitment. Medical Education with a wide range of health professionals from a range ofSupport Ofﬁcers brought together common selection disciplines.criteria to be used within all nine networks, and the networksworked with the NSW Department of Health to ensure that For more information on the survey process or how toreference checks for each applicant only occur once. This become a surveyor, please contact Network Coordinatoris a signiﬁcant improvement from the previous year, where Ms Pamela Bloomﬁeld (02 9844 6555,referees were contacted by each network separately. pbloomﬁeld@ceti.nsw.gov.au). Do you or someone you know need help? The Medical Benevolent Association of NSW (MBANSW) They may be experiencing health problems, relationship is a support service for doctors difﬁculties or be struggling with balancing the demands of and their family members work, study and family life. in NSW and ACT. The Association is able to provide The Association’s social worker Meredith McVey has many ﬁnancial assistance and social years experience working with doctors work support to medical and appreciates the difﬁculty that many practitioners (including Junior doctors have asking for assistance. You Medical Ofﬁcers). can contact Meredith on 02 9987 0504 or via www.mbansw.org.au for a The service is independent, free and conﬁdential. It is run conﬁdential discussion about your “for doctors by doctors”. Those who request assistance health, work or personal life and how from the association are at various stages in their career. MBANSW may be able to assist.
cetiscape Issue 1 October 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 13 Prevocational reviewAmanda Harriss 2011Project Manager, CETI Do you know someone starting their career in Oncology? BSOC is the course for great foundationCETI’s external review of the prevocational training and knowledge in the sciences that underpin thiseducation network system is now complete. The review discipline area.panel is preparing its recommendations in a formal reportthat will be made available to CETI in the coming weeks. Information and enrolment for BSOC 2011 can be found on the CETI Medical Division websiteIMET (now the CETI Medical Division) commissioned the (www.imet.health.nsw.gov.au) orreview by an independent panel earlier this year. The panel contact firstname.lastname@example.org led by Professor Andrew Wilson, Executive Dean ofthe Faculty of Health, Queensland University. The reviewwas fortunate to have an exceptionally high calibre teamreviewing the current prevocational system. Emergency medicine networkCETI and the review panel would like to thank all the people directors appointedwho participated in the review and gave up their time to ensurea comprehensive and robust assessment was possible. The Lynny Groshinskireview process engaged with over 450 people across both Senior Program Coordinator, Emergency Medicine, CETINSW and the ACT and included everyone from JMOs to the Network directors of training have now been appointed forPrincipal Medical Advisor at ACT Health. Information regarding the ﬁve emergency medicine training networks. The newthe review including the terms of reference can be viewed at network directors had an induction meeting and an intensive<www.imet.health.nsw.gov.au/projects/w1/i1005640/>. education planning session in July. The network directors are progressing emergency medicineOncology training education initiatives, including preparation for the primary examination, preparation for the Fellowship examination andBSOC 2010 (Basic Sciences in Oncology Course) is well support for the 4.10 research project.under way, with seven teaching days completed and the ﬁnal Education support ofﬁcers have been appointed in twothree anticipated. Medical and radiation oncology trainees, networks and are actively being recruited in the other three.medical physic trainees, allied health and oncology program They will work with the network directors to provide andstaff have all reported how valuable the presentations have promote education in the networks.been and how they appreciate the interaction with the seniorclinicians and research staff contributing to the course.Participants report that BSOC events are: Survey of emergency medicine training enjoyable, with a good range of topics presented well In 2009 the survey of emergency medicine trainees and directors of emergency medicine training provided valuable practical, with material relevant to understanding clinical data and comment for the Emergency Medicine Training trials making a difﬁcult topic easy to digest Implementation Group in its planning for educational and informative, with excellent quality and quantity of training initiatives for NSW trainees. The 2010 survey is information currently taking place to update this information and provide clinically relevant new trainees with an opportunity to comment on their training experience. interactive. really More information: Emergency Medicine Senior ProgramMore information: BSOC Support Ofﬁcer Coordinator Lynny Groshinski (02 9844 6576, lgroshinski@(02 9844 6551, email@example.com). ceti.nsw.gov.au). Building 12, Gladesville Hospital Cetiscape is distributed widely in the NSW Health system. Victoria Road, Gladesville NSW, 2111 Contributions to this newsletter on all subjects related to CLINICAL EDUCATION & TRAINING INSTITUTE Locked Bag 5022 clinical education and training are invited. Gladesville NSW 1675 p: (02) 9844 6551 Please contact the editor, Craig Bingham (02 98446511, f: (02) 9844 6544 firstname.lastname@example.org), to discuss potential e: email@example.com contributions and receive guidelines for contributors.