cetiscape CLINICAL EDUCATION & TRAINING INSTITUTE Issue 2 December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 1 Allied Health Clinical Education and Training Division to be establishedPatricia 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 ServiceProfessor Boyages, CETI Chief Executive, announcedthat three positions will be created to form the Allied In this issueHealth Clinical Education and Training Division within Nursing and Midwifery building a collaborativeCETI, including an Allied Health Divisional Head partnership with CETI 2position. The Area Directors of Allied Health and theChief Allied Health Officer warmly welcomed this news Farewell Marie-Louise Stokes 3during their second meeting with Professor Boyages Award: Improving cardiac care for Aboriginaland CETI General Manager Dr Heading. communities 3The new division will provide support and expertise for an allied 2010 CETI Awards: Dr Steve May, Dr Matt Stanowski 4health education program in line with the aims and functionsof CETI. It will lead the design, development, implementation Racing to the Future: the 15th National Prevocational Medical Education Forum 2010 5and evaluation of state-wide clinical education and trainingstrategies in collaboration with allied health clinicians. This will Superguide: coming soon to a supervisor near you 6 Thesupport safe and sustainable high quality allied health practiceacross NSW Health. Watch this space for further news about Tribute to Professor Annemarie Hennessy, welcome to Professor Iven Young 7recruitment to these exciting new positions.Other topics discussed at the meeting included identifying NSW Health Expo and Awards 7existing resources within CETI that might be adapted for use Training Support Unit for Aboriginal mothers, Ruralin allied health, developing networks to increase capacity babies and children 7within allied health and strategies to improve communication 2010 NSW Rural and Remote Health Conference 8and collaboration in education and training across the rangeof allied health professions. Spring symposium: e-learning in medical education 10 E-learning resources: iNvestigate 11Clinical supervision resource Setting up safe handover 12One of the first resources within CETI to be adapted for allied International medical graduates get ready forhealth clinicians will be The Superguide: a handbook for supervised training in NSW 13supervising doctors in training. The Allied Health Directors havecommenced a review of this practical guide for supervisors of Coming events 13junior medical officers. The guide includes many of the core Progress in hospital skills 14elements common to sound, evidence-based supervision ofhealth professionals in a clinical setting. To ensure that examples Leading the way: CETI’s leadership programs 15provided in the handbook are relevant, the Allied Health National audit of medical internship acceptances 16Directors will be seeking volunteers from allied health disciplinesto help develop clinical scenarios for use within the allied health Forum 2010 JMO 17Superguide. Please contact your Area Director/Advisor of Allied Leading ideas 18Health if you are interested in being part of the working party todevelop these clinical examples. NSW ranked against Australia and 10 countries 18 è... 2 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 December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 2 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTEAllied health educators been expanded from GESCHN to state-wide and are being coordinated by the CHN allied health educators.Allied health educators, both general and discipline-specific,are a critical part of the allied health workforce that is only just More recently, the CHN allied health educators have calleddeveloping. To support existing allied health educators and for expressions of interest from allied health practitioners whopromote development of these roles, it was agreed to explore wish to be involved in writing clinical practice guidelines onthe feasibility of an allied health educator network. cerebral palsy and paediatric feeding. This project will provide an opportunity for allied health professionals to work closelyThe value of allied health educators is already being with their nursing colleagues to enhance multidisciplinarydemonstrated within the three paediatric child health networks care. The CHN allied health educators are also developing(CHNs). Dr Maree Doble, Greater Eastern Southern Child paediatric allied health webpages and a discharge/referralHealth Network (GESCHN), Sonia Hughes, Northern Child form for children being referred back to local centres from theHealth Network (NCHN) and Emma Geor, Western Child tertiary children’s hospitals. This form is currently being trialedHealth Network (WCHN) have been collaborating over the before being made available to all allied health professionalspast five months to coordinate and facilitate clinical education working with children across NSW.for NSW Health allied health professionals who work withchildren. Their appointments were the outcome of two fundedprojects by the NSW CHNs which assessed and implemented Allied health learning and education planrecommendations in relation to the clinical support andeducation needs for allied health professionals working with To ensure that the Allied Health Clinical Education and Trainingchildren across NSW. Division is able to manage the professional development, education and training needs of the 23 allied health professionsThe highly successful GESCHN allied health TeleHealth and associated assistant and technician workforce, work on aprogram has resulted in a comprehensive allied health TeleHealth clinical education and training plan for allied health will continue.calendar being made available to paediatric allied health The plan will provide a framework for future development ofprofessionals for 2011. The CHN allied health educators are also allied health learning resources, a consultation mechanismworking with clinicians from the three NSW tertiary children’s for identifying priorities, and clinician networks to support thehospitals to provide educational workshops in 2011 on various work of the division. It is envisaged that the division will developtopics, including cerebral palsy and paediatric feeding. resources and strategies to support in-house clinical educationAllied to Kids, a monthly e-newsletter for allied health and professional development and supervision, training andprofessionals, is produced by the CHN allied health education by allied health clinicians in the field.educators, with contributions from clinicians across NSW.Secondments to the three children’s hospitals and specialty This is an exciting time for allied health and the support ofclinics for allied health professionals needing to up-skill in allied health clinicians will be critical to our success as thethe clinical management of tertiary diagnoses have also division develops.Nursing and Midwifery building a collaborative partnership with CETIMardi DaddoPrincipal Adviser Nursing Strategy and Innovation, Nursing and Midwifery OfficeNursing and Midwifery have an exciting opportunity to developing e-learning modules to support the professionalwork with CETI to identify areas for collaboration, as well development of the nursing and midwifery workforceas building a relationship that fosters an inter-professional developing modules that build the knowledge and skillsapproach to clinical education and training. required to support a team approach to patient care.The Chief Nursing and Midwifery Officer, Adjunct Professor Nursing and Midwifery looks forward to building a partnershipDebra Thoms has met with CETI’s Chief Executive, Professor with CETI that supports and builds the education and trainingBoyages, to discuss possibilities for collaboration. provided within and by the Nursing and Midwifery workforceOpportunities to be explored in the immediate future include: and the opportunity to engage with other professions on inter-professional education and training strategies in the supervision abilities of the Nursing and Midwifery the future. workforce and the development of tools to support the workforce into the future More information: Mardi Daddo, Principal Adviser Nursing implementation of the transition to ED practice the Strategy and Innovation, Nursing and Midwifery Office, NSW resource manual Health (firstname.lastname@example.org).
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 3 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTEFarewell Marie-Louise StokesThe team at CETI will farewell Dr Marie-Louise the first Medical Advisor for the NSW MedicalStokes at the end of January. We are delighted to Education and Training Council (MTEC) when itsee her talents recognised in her new position as was established in 2004, and carried on in thisDirector of Education for the Royal Australasian role when MTEC merged with the NSW PMCCollege of Physicians, but sad to lose a great in 2006 to form the NSW Institute of Medicalfriend and colleague from our workplace. Education and Training.Marie-Louise has been a committed advocate for At a national level, Marie-Louise has been apostgraduate medical education for more than a member of Australian Health Ministers’ Advisorydecade. She was the NSW Health Department Council working parties on specialist trainingrepresentative on the NSW Postgraduate outside public hospitals and general practiceMedical Council from 2000 to 2004. As Chair workforce. She has participated in medicalof the Education and Resource Development school accreditation for the Medical Board ofSubcommittee in 2003–2004, she supported the establishment Australia and, as a member of the Australasian Faculty of Publicof the NSW JMO Forum, the first JMO Forum in Australia and Health Medicine, serves on its Education Committee and NSWa body that has continued to thrive, contributing significantly to Regional Committee.enhancing prevocational training. Throughout her career, Marie-Louise has shaped educationMarie-Louise also made major policy contributions to the with a collaborative spirit. Her combination of expertise,development of network-based specialist medical training. commitment, and an extraordinarily compassionate andShe played a leading role in a significant research project, The supportive approach to the business of medical educationDelivery of Postgraduate Medical Training in NSW Health will be missed by all at CETI, but are a gift to those luckyServices. This paper provided a framework to change and enough to work with her in the future.enhance the delivery of medical education. Marie-Louise was — The CETI teamAward: Improving cardiac care for Aboriginal communitiesIn 2010 the Institute of Rural Clinical Service and Teaching to local Aboriginals and a range of resources which highlight key(now the Rural Division of CETI) helped fund a new cardiac program messages.care Aboriginal education initiative designed by the AmbulanceService of NSW. This funding enabled the Ambulance The project won an Excellence Award in the ManagementService to develop a targeted cardiac health care message Practice Category at the 2010 Council of Ambulancefor Aboriginal community members in rural and remote Authorities (CAA) Ambulance Awards. The CAA Ambulancelocations. The initiative supported the evidence-based Awards were developed to acknowledge and encourageproposition that clinical intervention should be provided as innovations from Ambulance Services throughout Australia, Newsoon as possible after the onset of symptoms. The significant Zealand and Papua New Guinea. These awards also provideadverse outcomes attributed to the platform for the industry todelay between symptom onset learn from each other and reduceand treatment, particularly in the duplication of effort.Aboriginal community, supported There are four broad categories inthe introduction of this project. which individuals or groups/unitsThe project educated the can enter their project, and fourcommunity about “THE 3 R’s” awards given for each category,of a heart attack: ranging from the Excellence Recognising acute cardiac Award to a Commendation. The symptoms Management Practice Category Ringing triple zero encompasses any project which Responding to the Ambulance involves management culture, operator’s advice. open communication, diversity of staff and treatment, accountability,Interested paramedics apply toreceive the Cardiac Care Aboriginal management development,Education Package which includes professional standards, or Paul Stewart, Cardiac Care Manager, Ambulance Servicea paramedic education refresher, NSW (right) accepting an award from Tony Ahern, Chair of community education.tips on disseminating information the Council of Ambulance Authorities.
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 4 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTE 2010 CETI Awards Dr Steve May wins NSW Geoff Marel Award The Geoff Marel Award is an annual prize awarded by CETI, named in honour of Clinical Associate Professor Geoff Marel, a committed contributor to prevocational medical training and an advocate for trainee welfare who is remembered for his vision, creativity, insight and humanity The award recognises the work of an individual who has made a substantial contribution to the education and support of prevocational trainees. Dr Steve May, Director of Prevocational Education and Training at Tamworth Rural Referral Hospital, is the winner of the Geoff Marel Award in 2010 in recognition of his outstanding contribution over many years to the education and welfare of junior doctors in New South Wales. Dr Steve May, a great teacher Dr May is well known at Tamworth for his work on behalf of junior doctors. His contributions and advocate for the welfare of to their education program, willingness to make himself available to them at all hours for his trainees, has been Director advice and support, continuing enthusiasm and involvement in hospital committees and of Prevocational Education concern for the needs of each individual doctor have earned him the respect and admiration and Training at Tamworth of his fellow staff at Tamworth and his fellow directors of training across NSW. Hospital for nine years. Dr Matt Stanowski wins NSW Junior Doctor of the Year Award The NSW Junior Doctor of the Year Award is an annual prize awarded by CETI to a junior doctor who has made a substantial contribution to the education and support of prevocational trainees. Dr Matt Stanowski, Resident Medical Officer at Nepean Hospital, is the winner of the 2010 NSW Junior Doctor of the Year Award in recognition of his outstanding contribution to the education and welfare of his fellow junior doctors. Dr Stanowski’s work on JMO welfare, in particular the peer mentoring program at Nepean and the pilot of similar programs at other sites, has been a valuable innovation and a real benefit to new interns. He has taken an enthusiastic role as a JMO representative Dr Matt Stanowski, shown here at the graduation night in hospital committees and the NSW JMO Forum, where he chaired of CETI’s leadership program. Among his other activities the welfare working group. this year, Dr Stanowski completed the LEAP course and was a member of the team that presented the winning presentation at the course, with a proposal for “CAPS: CETI congratulates Dr May and Dr Stanowski, who will be Clinical acquisition of procedural skills”. formally presented with their awards at the NSW Prevocational Forum on Friday 12 August 2011. Recommended reading: transforming medical education“ Glaring gaps andinfectious, environmental, and behavioural risks, at a countries ... New inequities in health persist both within and between qualitative imbalances in the professional labour market; and weak leadership ... time of rapid demographic and epidemiological transitions, threaten We regard transformative learning as the highest of three health security of all. Health systems worldwide are struggling to successive levels ... Informative learning is about acquiring keep up, as they become more complex and costly, placing additional knowledge and skills; its purpose is to produce experts. Formative demands on health workers. learning is about socialising students around values; its purpose Professional education has not kept pace with these challenges, is to produce professionals. Transformative learning is about largely because of fragmented, outdated, and static curricula ... developing leadership attributes; its purpose is to produce mismatch of competencies to patient and population needs; poor enlightened change ...” teamwork; persistent gender stratification of professional status; — Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new narrow technical focus without broader contextual understanding; century: transforming education to strengthen health systems in episodic encounters rather than continuous care; predominant an interdependent world. The Lancet 2010; 376: 1923–1958. hospital orientation at the expense of primary care; quantitative and www.thelancet.com
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 5 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTERacing to the futureCraig BinghamPrevocational Program Coordinator, CETI“Innovation, Integration and Transformation” werethe three themes of this year’s conference, an eventattended by over 400 delegates from Australia, New Health Workforce Australia has a significant budget forZealand and other countries. developing expanded settings of training, supervisor training, simulation training and other initiatives; on the other hand, the Confederation of Postgraduate Medical EducationInnovation Councils reported that funding for the Australian CurriculumWith the pressure of increasing numbers of prevocational Framework for Junior Doctors project had run out and thatmedical trainees and ever-expanding domains of medical further development was suspended pending renewedknowledge, innovation, especially the use of technology to support from the federal government.augment the educational capabilities of clinician educators,is the essential oil of prevocational training. Several speakerspresented innovations in e-learning. Keynote speaker TransformationProfessor John Sandars made some important points about What is the future of prevocational training?the deep objectives of e-learning: Workplace-based assessment: Dr Julian Archer reported Education is about enquiry and collaboration, and about on experience in the UK Foundation Program, which life. It is not about preparing for life. We should not suggests that 360o assessment and greater use of separate clinical education from the clinical immersion structured assessment tasks can provide more valid and experience any more than we have to. reliable workplace-based assessment of junior doctors. clinicians as teachers, it is better to be the “guide For However, Dr Archer sounded a cautionary note: assessors on the side” than the “sage on the stage”: no longer the need training and a substantial level of commitment for these changes to work. He hinted that Australia could dispenser of wisdom but instead a navigator through seas benefit from examining the UK experience with a sceptical of electronic information. eye on the evidence before adopting change. Ubiquitous technology leads to ubiquitous learning. This is not of itself a bad thing, but does mean that you can’t attention to supervisor training and support will be More required, or a dwindling resource of senior clinicians will be fully control the learning environment. If you want to swamped by rising numbers of trainees. ensure core curriculum coverage, you need to provide appropriate focused education. ownership of their own training: The National JMO JMO Forum and participation by JMOs in the conference Medical education in the next were highlights of the meeting. Several JMO-initiated generation will require a mixture of innovations and surveys were presented. There is learner enquiry yet more potential for JMOs to play a leading role in learner participation transforming JMO education. learner digital literacy production of appropriate training in general practice and community settings. More resources. This is where the majority of doctors will work after training, so training in these settings is appropriate and Dr John Sandars, University of Leeds. becoming more common.Integration Simulation: Health Workforce Australia is promisingNational integration of medical training was high on the agenda significant funding, and the National JMO Forum has thethis year. The establishment of the Medical Board of Australia widespread availability of high-fidelity simulation on itsand Health Workforce Australia has created an expectation that wishlist for the future.training accreditation, internship standards, trainee assessmentand perhaps even workforce allocation will eventually move toa national model, although keynote presentations by Dr Joanna CETI at the conferenceFlynn (Chair, Medical Board of Australia) and Mr Mark Cormack Staff from CETI played an active role. David Lochhead attracted(Chief Executive Officer, Health Workforce Australia) reminded plenty of interest from other States when he presented CETI’sus that there was a long way to go. online solution for administering the prevocational training
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 6 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTE application and allocation processes. Jackie O’Callaghan presented a streamlined solution for accrediting general practice training positions. Craig Bingham presented one of the largest studies at the conference: an evaluation of 3390 prevocational trainee assessments which raised serious questions about the effectiveness of current processes. Next year: The conference will be held for the first time in New Zealand, with the theme of “bridging the gap” between undergraduate and vocational medical education.CETI team members presented six posters at the National Prevocational 16th Australasian Prevocational Medical Education ForumMedical Education Forum, three of which were selected as finalists in 6-9 November 2011 Auckland, New Zealandthe conference poster competition.The Superguide: coming soon to a supervisor near you CETI’s new guide for supervisors of junior medical officers is now being distributed via training sites to all term supervisors in New South Wales. The Superguide a handbook for The guide was developed in consultation with clinicians across the State by supervising doctors in training CETI’s Medical Division (IMET), and has been well received by its intended audience. Dr David Lester-Smith, Associate Director of Clinical Education, August 2010 CONSULTATION DRAFT IMET | RESOURCE The Children’s Hospital at Westmead, writes: There is truly something here for all clinical supervisors, whatever their level of previous experience. We all recognise good clinical supervision as key to sound clinical education and training, but know many colleagues find the role challenging. For most, without any formal guidance or training, supervision is an assumed skill. This is the first document I have read that usefully defines what supervision actually is and how to best supervise trainees, including hints on managing the trainee in difficulty. I am sure many colleagues will find valuable guidance and advice here. The book is available at www.ceti.nsw.gov.au/prevocational. For more information, or to order printed copies, contact: IMET NSW Institute of Medical Prevocational Program Coordinator Craig Bingham (02 9844 6511, Education and Training — a division of CETI email@example.com).
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 7 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTEFrom strength to strengthMarie-Louise StokesSenior Medical Advisor, CETITribute to Professor Annemarie Hennessy“If you want something done, ask a busy person.”On 17 November, Professor Annemarie Hennessy completedher term as Clinical Chair of the NSW Basic Physician TrainingCouncil after four years in the role. During this time, Annemarieled CETI Medical Division’s (IMET’s) flagship networkedtraining program with great flair, passion and a commitment tothe values of excellence and equity that underpin the networks. Professor Iven Young, the incoming Clinical Chair of the BasicAnyone who knows Annemarie will tell you that they can’t Physicians Training Program, with the past Program Coordinator Ellensee how she fits everything in: research and supervision of Rawstron and outgoing ClinicalChair, Professor Annemarie Hennessy.multiple PhD students, teaching (students, junior doctors, basicand advanced trainees), academic leadership as FoundationProfessor of Medicine at the University of Western Sydney, Welcome to Professor Iven Youngclinical service work, work for the Royal Australasian College CETI is delighted to welcome Iven Young as the incomingof Physicians and, fortunately for us, the Clinical Chair role. Clinical Chair of the NSW Basic Physician Training Council.Somehow Annemarie manages to do all this and more. Professor Young is a well known and respected seniorDuring her time as Clinical Chair, Annemarie developed closer respiratory physician and physician educator at the Royallinks with the networks and the College, negotiated changes Prince Alfred Hospital. He is Clinical Professor of Medicine atto network structures (always a tricky undertaking) and Central Clinical School, the University of Sydney, was Head ofsteered the program towards a greater focus on education. Respiratory Medicine at the Royal Prince Alfred Hospital forAnnemarie’s personable and straightforward approach earned 17 years and was foundation Chair of the Royal Prince Alfredgreat respect and appreciation among trainees, network Basic Physician Training Network Governance Committee.directors, education support officers, directors of physician Professor Young has first hand experience of implementing thetraining and staff from CETI and NSW Health. network system and seeing its benefits and challenges. WeThank you Annemarie. warmly welcome him to the Clinical Chair role.NSW Health Expo and Awards Training Support Unit for AboriginalThe Rural Division of CETI supported 39 delegates to mothers, babies and childrenattend the 2010 Health Expo and Awards. This program wasintroduced in 2006 in recognition of the difficulties faced by The Training Support Unit will support Aboriginal Maternalrural and remote health workers in attending such an event. Infant Health Service staff in improving primary and community health services for Aboriginal people, particularly mothers andOver the years, several delegates have introduced programs their babies.or methods observed at the Expo, and others have beenfinalists in their own area health service quality awards. The inaugural meeting of the implementation group wasThis year it was exciting to see 2008 delegate Rosanna held at NSW Department of Health on 11 November. TheRobertson of Shoalhaven presenting as a finalist. membership of this group was reviewed and some new faces are invited to the December meeting.Afterwards, Roseanna said “I was so inspired when I camehere two years ago, that I decided I’d work on my own project Jennifer Wannan manages the unit within CETI’s Rural— and here I am!”. Division. Recruitment is under way for the remaining 11 positions in the Training Support Unit, and it is anticipatedRoseanna’s project was titled “Shouldering Education;Enhancing Skills and Outcomes”. Roseanna analysed the that the successful applicants will commence in the new year.use of electrical stimulation in occupational therapy stroke Planning has commenced for the biennial forum. Inputservices in the Southern Hospital Network, then developed and ideas are welcome, and can be forwarded to: Jenniferclinical guidelines and an education program. This led to the Wannan (firstname.lastname@example.org). Theincorporation of electrical stimulation in all Southern Hospital forum will be held in the first half of 2011 and will giveNetwork occupational therapy stroke services. service providers an opportunity to showcase their excellentCongratulations to Roseanna and the team. work.
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 8 CLINICAL EDUCATION Issue 2& TRAINING INSTITUTE RURAL DIVISION 2010 NSW Rural and Remote Health Conference “Many paths to follow” The second NSW Rural and Remote Health Conference was held at Albury on 4th and 5th November. Delegates were treated to a range of excellent speakers who supported the conference themes: • The path to a healthier community • The path to “closing the gap” • The path to a stronger workforce, and • The path to improving the quality of our services. The Hon. Carmel Tebbutt, Deputy Premier and Minister for Health, ad- dressed the conference and reinforced her commitment to rural and remote health. The conference was enhanced by a series of workshops provided by highly regarded academics and health and business professionals. www.ircst.health.nsw.gov.au
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 9 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTE RURAL DIVISION Conference DinnerThe Italian themed conference dinner was held on the banks of the lovely Murray River, which was inflood at the time.The evening commenced with delegates designing their own pizzas, made in the city’s communitywood fired pizza oven. This was followed by a very entertaining evening, which included the pianoaccordion, opera and some fabulous dancing (yes, there was even a conga line).We were delighted to share the evening with some of our keynote speakers, including Prof. StefanGrzybowski (pictured right with Dr Vahid Saberi), Dr Juanita Sherwood and Assoc. Prof. Sabina Knight(pictured below left). Rural Research Capacity Building GraduationOne of the highlights of the conference dinner was the graduation ceremony for 11 research A special congratulations goes to Kerith Dun-candidates, who have completed their projects: Tod Adams, SESIAHS; Cath Bateman, GSAHS; canson, who won the “Best Report” awardJenni Devine, GSAHS; Kerith Duncanson, HNEAHS; Barbara Fetherston, GSAHS; Michelle for her project: “Feeding Healthy Food toMurray, HNEAHS; Rachael O’Brien, HNEAHS; Rachel O’Loughlin, GSAHS; Judy Reinhardt, Kids randomized control trial: three monthNCAHS; David Schmidt, GSAHS; Christian Tremblay, NCAHS. These graduates are pictured analysis”. This award includes sponsorshipbelow with Linda Cutler and Dr Austin Curtin. for attendance at a national or internationalAdditional information about this program can be obtained by contacting Dr Emma Webster, conference where she has had an abstractRural Research Project Officer at email@example.com accepted. Kerith is pictured above with Dr Austin Curtin and Linda Cutler. www.ircst.health.nsw.gov.au
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 10 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTESpring symposium: e-learning in medical educationHosted by South Australian Institute of Medical Education and Training (SAIMET) and Clinical Education and Training Queensland(ClinEdQ), Adelaide October 2010Peter DavyCurriculum Developer, Medical Education and Training Team, CETIHow best can we support e-learning in medical establishing relationships which allow the sharing ofeducation and training? How can we increase access learning resources and the intellectual property to developfor clinicians and trainees to high quality e-learning learning resources.resources? These are two important questions asked at On the other hand, delegates acknowledged a numbera recent national symposium. of challenges that needed to be addressed by their own organisations before collaboration could succeed, including:The symposium brought together practitioners and decision-makers in medical education and e-learning to share ideas difficulties with stakeholder engagement and agreementand to propose solutions to challenges such as collaboration varying compliance requirementsand sharing of resources, integration of e-learning intomedical curricula, and identifying attributes of best practice rotation of technical staff to maintain and sustain a highin e-learning design. There were delegates from state consistent effective approach to e-learning designgovernment clinical education and training organisations potential costs involved in developing high quality the(CETI, SAIMET, ClinEdQ, PMCV, PMCT), universities e-learning resources (estimated to be between 15 and 20(Flinders, Melbourne, Griffith and the University of Western hours for each hour of e-learning resource).Sydney), hospitals and specialist colleges (ACEM, RACMA,RANZCOG, ANZCA). Integrating e-learning into curricula e-Learning is just one part of the learning design to supportWhy e-learning? educational activities in medical education and training.Symposium delegates acknowledged that e-learning covers a There was consensus that blended learning is the favouredwide set of applications and processes, such as web-based approach for curriculum development and learning design.learning, computer-based learning, virtual classrooms andclinics, and online collaboration. With careful targeting of appropriate learning outcomes, integrating e-learning into the curriculum can enhanceThe advantages of e-learning include: learning. Delegates identified the following strategies to potential savings compared with conventional training support this integration: capacity to communicate consistent educational the educators acting as curators of learning guides, resources messages to learners and teachers across locations and and other materials for learners at any time educators assembling learning resources in content potential for enhanced learning effectiveness with well repositories and allowing content sharing and and designed e-learning programs. appraisal across organisations and jurisdictions enhancing the sharing of e-learning resources by clearly stating learning outcomes and specifically linking them toWhy collaborate? important components of curricula (such as core clinicalCollaboration between government clinical education and skills and patient safety).training institutes, universities, hospitals and specialistcolleges will enhance the sustainability, integration andeffectiveness of learning across clinical disciplines and for e-Learning best practicedifferent levels of learners. Delegates identified attributes of best practice in e-learningOther reasons for collaboration identified by delegates design for clinical education. Discussion centred on three mainincluded: aspects of e-learning design: scope to provide economies of scale to fund the the understanding the characteristics and needs of learners design of learning resources who will be using e-learning tools opportunity to reduce costs for software licensing and the design based on core effective principles of learning development opportunities for building learner communities.
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 11 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTEDelegates identified specific attributes of best practice E-learning best practicedesign based on these three points (see Box). Their list is notexhaustive, but does give important points to consider. Understanding the learner analysis of learning requirementsWhere to now? catering to the experience and maturity of learner, learning styles, and capacity and willingness toDelegates were enthusiastic about advancing the participate in e-learningdiscussions of this symposium. A webinar in six months was well-defined learning outcomesproposed. control of screen informationOne agenda item suggested for the webinar is to identify capacity for self assessment and quizzespossible sources of e-learning project sponsorship and content integrationfunding support. document management facilities helpConclusions simple user interfacee-Learning provides a valuable set of tools to support communication interactivityclinician and trainee education, but it is just one part of the calendar to assist learner time management.learning design to support medical education and training.The consensus at the symposium was that blended learning Core principles of learningis the favoured strategy. stimulating and meaningful learning activitySustainable e-learning will involve sharing of learning motivation of learners and rewards for participationmaterials and collaboration between education organisations transferability of skills/knowledgeand jurisdictions. quality of learning environment, including opportunity for prompt feedback and formative assessmentDevelopment of e-learning content needs to be measured; learner-centred focus of teachers.taking on too much all at once can result in expectations notbeing met and projects being disbanded or downgraded. Communities of learningTargeting important learning outcomes which are well alignedwith e-learning delivery would be a good start to planning clearly stated purpose for learning within communitiese-learning projects. experienced teachers to guide learning in this context appropriate use of synchronous and asynchonous tools opportunities for group problem solving maximising the level of interaction.E-learning resourcesiNvestigate is an interactive website designed for use iNvestigate allows trainees to role-play ordering tests andby prevocational medical trainees which focuses on interpreting results based upon given case histories. Thethe appropriate and cost-effective use of diagnostic tool shows the cost of investigations, and allows users toinvestigations. The project was funded by the Australian compare their choices with those of an expert.Government under the Quality Use of Pathology Program, Three new cases by Dr Kate Webber have been added toand developed by a team led by Professor Rakesh Kumar, iNvestigate, replacing the case used in the pilot version ofProfessor of Pathology and Director of Academic Projects for the program.the Faculty of Medicine, University of New South Wales. See iNvestigate at https://investigate.med.unsw.edu.au
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 12 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTESetting up safe handoverShireen Martin, Ian Richards and James DunneHealth Service Performance Improvement Branch, NSW HealthHandover is the transfer of patient care from one clinician to Dubbo Base, Campbelltown, Sutherland, Prince of Walesanother. It is a crucial moment when information about the and John Hunter. Each site chose the scope for the localpatient must be communicated effectively if patient care is to implementation based on their specific needs.continue safely. Representatives from CETI’s JMO Forum contributed to theIn 2008 the Special Commission of Inquiry into Acute piloting and evaluation process, attended each of the sitesServices in NSW Public Hospitals (Garling Report) and conducted a qualitative review of the pilot based onrecommended that each facility in NSW Health should have interviews with local JMOs. The Acute Care Taskforce wasa mandated clinical handover policy within 18 months. This impressed by the eager engagement to effect change andrecommendation was supported in the government response improve patient safety shown by this team of junior doctors,to the report, Caring Together. Improving clinical handover is who gave a great deal of their own time to the project.also a high priority at a national level (Australian Commission The importance of the program is highlighted through the keyon Safety and Quality in Health Care, National Clinical messages that have come directly from the JMOs:Handover Initiative). Senior leadership is critical: executive and clinicalIn 2009, the Acute Care Taskforce commenced the NSW leaders must model and reinforce the value of shiftSafe Clinical Handover Program and developed key handover by leading handover, policy, training andprinciples for clinical handover that have been mandated aligning of rosters.for state-wide implementation. NSW is the first Australianjurisdiction to tackle system-wide improvement in clinical Involve JMOs in change: involving JMOs ensureshandover. that new processes meet their needs and gain their commitment.During implementation, many junior and senior clinicians Senior nursing involvement: significant value wasreported that processes for handover at shift change were reported by clinicians in all models where senior nursesad hoc or absent, and requested a specific focus on junior were integrated into the handover.medical officers (JMOs). The literature has shown thatfailures of clinical handover are most likely when clinical Relationships = communication: an environmentstaff are inexperienced, communication quality and content where all doctors feel comfortable to call and discussis suboptimal, there is a lack of standardised protocols and clinical care develops a good culture for communicationclinicians are fatigued. during and between shifts. Education: doctors place high valueIn response, the Acute Care Taskforce on the teaching they can receivebegan the JMO Clinical Handover Project RemembeR IsBar at handover, led by consultants.in 2010. In some cases, education = IntroductIon IThrough early engagement of junior and Identify yourself (name/role/location) sustainability.senior clinicians from both metropolitan and and give a reason for calling Undergraduate education: junior “I am calling because…”rural facilities, the project developed three and senior doctors have called for sItuatIon skey elements for effective shift handover: elements of JMO handover and Give the patients age/gender and status1 A standard communication framework a: Stable (at risk of deterioration) ISBAR to be universally taught in b: Unstable for JMOs (ISBAR). undergraduate education. Background B2 Senior leadership determining who and Give the relevant details: Documentation not duplication: what should be handed over. Presenting problems...? it is important to ensure that clinical Clinical history...3 Standard key principles for locally documentation in the medical record assessment a appropriate implementation (so that is effective and not replaced by Put it all together. the handover process is consistent, but Current condition/risks/needs handover documentation. “My assessment is….” locally appropriate). recommendatIon ISBAR: junior and senior clinicians r see value in ISBAR. They report thatThese elements were tested through Be clear about what you are requesting Transfer/review/treatment? it should be used as a framework,a consultative process across NSW When should it happen? not a rigid structure, to help effectiveand then pilot implementation at Hunter New England Health is acknowledged for developing this resource communication.six hospitals: Wagga Wagga Base,
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 13 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTEThe Acute Care Taskforce and NSW Health are collaborating will be sent to all facilities in the NSW prevocational trainingwith CETI on system-wide implementation of the JMO networks shortly.clinical handover project in 2011. CETI has endorsed the All resources and project reports can also be downloadedproject’s key elements and is working towards an appropriate from the Safe Clinical Handover web page:accreditation standard. http://www.archi.net.au/e-library/safety/clinical/nsw-handoverFollowing consultation, the Acute Care Taskforce has For more information, please contact Shireen Martin,developed a package of tools to support implementation that firstname.lastname@example.orgInternational medical graduates getready for supervised training in NSW Coming eventsA new cohort of overseas-trained doctors have been National Rural Health Conference scholarships The 11th National Rural Health Conference will be held in Perth, 13–16 March 2011, and the Rural Division of CETI is funding 25 scholarships to assist health workers from rural and remote NSW to attend. Twenty-five successful applicants were selected from 74 applications after a very competitive selection process. Successful applicants have itemised comprehensive learning objectives to be gained from attendance, thepreparing for work in NSW with help from CETI. The outcomes of which will be evaluated. Applicants weregroup of 77 Australian Medical Council (AMC) graduates notified on 29th November.commence supervised training in January 2011 in hospitalsacross the state. While many of these AMC graduates haveworked in medicine overseas, the transition to the Australianhealth care system can be daunting, particularly adapting Rural Allied Health Conference,to the hospital hierarchy, patient expectations and the 10-11 November 2011Australian culture surrounding health care. Preliminary planning has commenced for the 5th RuralEach year CETI runs the AMC Pre-employment Program, Allied Health Conference, which is to be hosted bywhich includes a one-week lecture series and clinical skills the North Coast Area Health Service. It will be held inworkshop followed by an observation placement in the Port Macquarie on 10-11 November 2011. Similar tohospital where the AMC graduates will be starting their previous conferences, it is anticipated that numeroussupervised training. pre conference workshops will be held preceding theThis year the lectures and workshop were held at the Kolling conference. Additional information will be posted on theBuilding, Royal North Shore Hospital, 22–30 November. CETI Rural Division (IRCST) website early next year.The graduates learnt a range of survival essentials, includingunderstanding the hospital hierarchy, managing thedeteriorating patient, prescribing, documentation and workingin a interprofessional team. During the clinical skills workshops NSW Prevocational Forum,the graduates had an opportunity to practice skills such as 11–12 August 2011cannulation, airway management and advanced life support. If you are interested in prevocational medical educationThe program also gave the group an opportunity to network and training, keep 11–12 August 2011 free in yourwith each other and elect two of their colleagues as calendar so that you can attend this event.representatives to the NSW JMO Forum. Congratulations toDr Juan Dong and Dr MD Masum Alam who will be the AMCgraduate representatives for 2011.
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 14 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTEProgress in hospital skillsAlpana SinghActing Program Coordinator, CETIHow far has the Hospital Skills Program being achieved at Hunter New England Areacome since its launch in March 2010? Health Service. She showed other areas that providing education for both ED traineesThis was one of the topics discussed at the and HSP participants was an opportunity forinaugural HSP Education Strategy Forum HOSPITAL SKILLS PROGRAM collaboration and networking which is not(23 November). Thirty-five people (including always possible.HSP Area Directors and Education Support The Hospital Skills Program supportsOfficers, HSP participants, CETI staff and the training and professional The Royal Australian and New ZealandHSP State Training Council members) development of non-specialist doctors College of Obstetricians and Gynaecologistsattended the forum, which had a full day’s working in NSW hospitals. gave an update on the collaboration betweenprogram of presentations and a plenary CETI and RANZCOG and provideddiscussion. attendees with a picture of content within the new RANZCOG Certificate, Diploma and Diploma Advanced which wouldCollaboration has been the buzz word for the Hospital Skills articulate with the HSP Women’s Health Module. There was alsoProgram since it was developed and presentations and an excellent section on online learning and how this would bediscussions during the Forum supported this approach. incorporated into the courses provided.Dr Danielle Morris, the HSP Area Director for Greater Western Dr Alan Giles, the HSP Area Director from Sydney South WestArea Health Service, presented on education initiatives used to Area Health Service provided an entertaining session on thepromote the Hospital Skills Program within GWAHS. challenges in delivering education to CMOs in the south westGWAHS launched the Hospital Skills Program in conjunction and what he has learnt from this experience. To accommodatewith a two-day resuscitation procedures workshop on 6–7 the different learning styles of HSP participants, Dr GilesNovember. More than 30 doctors from all over GWAHS suggested that the best method for providing education andattended the workshop which included practical skills stations training was a blended learning model that included onlinefor joint relocation, emergency delivery, plastering, airway resources, lectures and face-to-face teaching.management and emergency ultrasounds. Feedback from the The plenary discussion on progress and challenges for the HSPworkshop showed overwhelming support for the program, was lively, but the day’s presentations had demonstrated that thewhich allowed participants to refresh their procedural skills in HSP has come a long way since the launch in March 2010. Areaemergency care and gave them an opportunity to network with Directors and Education Support Officers have been appointedother doctors across the greater western area. in all Area Health Services, which has provided an impetusProfessor Graham Reece spoke on the Oasis Simulation Centre which had been lacking, but the main achievement has been thebased in Blacktown and how HSP participants from Sydney engagement of doctors in the HSP. Most HSP participants haveWest Area Health Service are able to access training provided been receiving an enhanced level of education and training andthere. The cost for training and education sessions is very have developed good communication networks, and there hasreasonable and there is certification for any training provided. been increasing engagement from doctors who will be providingProfessor Reece has indicated that training is available for all the education and training as well as supervising and assessingHSP participants regardless of which health service they are the HSP participants. This has been the big step forward withinlocated in. the program, with many more steps to come in 2011.Dr Briege Hamill talked about sharing training resources Presentations from the HSP Education Strategy Forum arebetween HSP and the emergency department and how this was available on the CETI website: www.ceti.nsw.gov.au Hospital Skills Program launch at GWAHS.
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 15 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTELeading the wayCETI provides leadership in clinical education, and it and competence in clinical leadership skills; that workshopalso provides education in clinical leadership. Here are learning objectives have been met; and that key learningsthree programs that aim to build the leadership skills of have come from group discussions and sharing ideas, as wellour health workforce. as from the formal learning activities. All participants have had a face-to-face feedback session1 Rural Division: Leadership and Management Essentials ProgramThis is an experiential program for rural and remote health about their 360o leadership survey report and have commenced developing their own personal learning development plan. This involves the participants using the various self reflection activities and the themes from the 360workers tailored to meet individual learning needs and offers report to establish personal goals and identify strategiescore topics in leadership, management, communication in the areas of leadership styles, emotional intelligence,and team building, and a selection of elective topics such assertive communication and self care.as financial management, strategic planning, performance Each team has commenced planning a local clinical practicemanagement and conflict resolution, depending on what improvement project. From now until June 2011 the groupeach participant identifies in their personal development will work on their projects, participate in monthly groupplan. It is conducted through distance education, monthly teleconferences and have individual coaching with theteleconferences and two two-day workshops in Sydney. facilitator, Jan Dent.This year’s program is coming to an end in December with 327 of the original 32 participants completing all programrequirements. Medical Division: Future Leaders Development Program“I feel I have grown as a person, am more confident makingdecisions, am able to acknowledge that I made an error and Two programs in one (LEAP and LEAD), the Future Leadersapologise if needed, feel more confident delegating, am Development Program has a stream for doctors in trainingmore in control of my emotions and more aware of how they and a second stream for senior doctors.can impact on the team,” wrote one participant in providing LEAP – the future LEAders development Program will befeedback. “I have learned techniques on how to get staff to running for its third year in 2011. LEAP prepares doctors-be more responsible for their actions and also to give them in-training for leadership roles within the NSW public healththe ability to make decisions.” system. No other program exists in NSW that is focused onThe program will run again in 2011. Application forms are the needs of doctors in training in relation to leadership skillsavailable on the CETI Rural Division (IRCST) website (www. for medical education and training.ircst.health.nsw.gov.au) and will close on 14 January 2011. LEAD – the LEAdership Development program in medical education and training for consultant medical practitioners2 Rural Division: Clinical Team Leadership ProgramThis program for rural clinicians was modelled on the Clinical in NSW focuses on the needs of consultant medical practitioners in relation to leadership skills for medical education The aim of these programs is to deliver a high quality,Excellence Commission’s clinical leadership program. The innovative, interactive and inspirational leadership programmain modification was asking participants to pair with a GP for current and future clinician leaders in medical educationto undertake a clinical practice improvement project. and training within the NSW health system.The program aims are to: The major component of each program is five face-to-face increase the participants’ leadership and management workshops, a total of 10 days. Workshops are objective- skills and confidence driven, focusing on experiential learning through simulation strengthen partnerships between public health services group exercises, interactive lectures and feedback. and GP-VMOs Skills learnt in the workshops are complemented and developed increase the participants’ competence at leading a team- by an ongoing program of projects completed in syndicate based clinical improvement project. groups, self-directed and web-based training, a mentor programThe program includes eight full-day workshops held in and practical leadership experience in the workplace.Sydney. Applications for both 2011 programs will close on Friday 21Workshops evaluations have shown high levels of satisfaction January 2011. For more information and an application form:with the program content, organisation and presentation. go to www.ceti.nsw.gov.au and search for “future leaders”,Participants report that they have increased confidence or email <email@example.com>.
cetiscape December 2010 Promoting excellence in clinical education www.ceti.nsw.gov.au page 16 CLINICAL EDUCATION Issue 2 & TRAINING INSTITUTENational audit of medical internship acceptancesKirsten CampbellProject Manager, CETIA national audit of intern acceptances of job offers has found 2 – Extended Audit: Applicants identified as having Part41 applicants who accepted more than one position. As accepted multiple positions were contacted and askedone of these had accepted three positions, there were 42 to decide which position they wished to accept forintern positions that may have been made available for other January 2011. Only four jurisdictions — Australian Capitalapplicants who had not at the time received an offer. Territory, New South Wales, Northern Territory, and SouthThis was the first national audit of intern acceptances. It was Australia — participated in the extended audit.conducted in August of all intern acceptances for the clinicalyear 2011 by the National Intern Allocation Working Party. Theworking party was set up in February 2010 under the oversight Key findingsof the Confederation of Postgraduate Medical Education The total number of acceptances reported by jurisdictionsCouncils to develop opportunities for sharing information related by 27 August was 2697. The audit only examined 2313to multiple acceptances of intern offers across jurisdictions. intern acceptances as 384 applicants did not agree to their information being sent to the central administrator. Of these,The working party was chaired by Professor Geoffrey 374 were Queensland applicants who were limited by localThompson, Chair of the South Australian Institute of issues in their ability to ensure privacy law compliance.Medical Education and Training (SAIMET), and includedrepresentatives from each of the jurisdictions responsible for Eighty-three duplicate acceptances were identified, whichintern recruitment policy or allocation, junior doctors, medical represented 4% of the total number of acceptances. Fortystudents and Health Workforce Australia. Project support applicants had accepted two positions and one applicantwas provided by CETI and SAIMET. had accepted three positions. At the time of the audit, there were potentially 42 positions which could have been freed upReaching national agreement on what to audit and how it if all of the duplicate acceptances were resolved.would operate was challenging. The working party had toovercome a number of hurdles, as set out below, in order toensure participation by all of the jurisdictions. Next stepsJurisdictions reached agreement to undertake the audit as a A second audit is currently being conducting to see if thetwo-part pilot for 2011. number of duplicate acceptances has changed and further 1 – basic audit: Agreement to share intern acceptance Part audits are planned for early next year. The working party will information but not to follow-up individual applicants be looking to build on the audit next year and are hopeful that identified as having multiple acceptances. All of the all of the jurisdictions will participate in the full audit process jurisdictions participated in this part — Australian Capital for clinical year 2012. The working party will also be looking Territory, New South Wales, Northern Territory, Queensland, at other areas where national harmonisation of policies and South Australia, Tasmania, Victoria and Western Australia. processes would be beneficial.Clearing the “hurdles” to implement the National Audit of Intern Acceptances Process 4. Privacy 3. Communication 2. Process 5. Common Dataset 1. Buy-in 6. Confidentiality The Finish Intern positions left Privacy concerns Data on intern eligibility vacant in January due to about sharing applicant criteria collected and Intern allocation last minute withdrawals information. classified differently in Organisations approached differently from interns who had each Jurisdiction. responsible for intern Jurisdictions sought in each Jurisdiction been holding multiple Agreed on a simple allocation are different in advice and locally – therefore process, acceptances. common dataset using each Jurisdiction making accepted processes Jurisdictions concerned communication and participation in a central Potential applicants were implemented and MTRP classifications. about conflict of National agreement timings differed. process difficult. advised about impact integrated with the interest of central reached that all Following extensive of holding multiple national process – audit administration. Jurisdictions would Early communication discussion, agreement acceptances. Audit split into two parts (Part Confidentiality participate in a two part by the Jurisdictions reached on a wash brought applicant 1 and Part 2). agreements drafted National Audit Pilot. about the audit ensured successful participation up process that took decision making process and signed by central by all. into account these forward so vacancies administrator. differences. were known sooner.