The following represent the key areas of Doctors in Training (DiT) Committee activity over the past two years .
Unaccredited registrar positions
The SA MET DiTC are advocating on behalf of unaccredited registrars, following concerns raised of exploitation and unsafe practices. There are currently hundreds of unaccredited registrars working within SA Health. With no regulatory body this number is unable to be accurately quantified. These positions are created by Hospital departments based on workforce need. There is no accreditation to ensure adequate support, supervision and education is provided as part of this role. These junior doctors are also not a part of a college, thus have no formal education or training requirements provided by an external body.
There are a number of concerns which have been raised by junior doctors filling these positions within SA Health.
- Unaccredited trainees work significantly more night shifts compared to those on a training program, at a time where there is less supervision and support in the hospital. They often work considerably more hours, with risk of burnout and fatigue, impacting the ability to provide safe patient care.
- Education and training
- There is no formal education provided, such as that scheduled for interns, or provided by Colleges for their trainees.
- Training provided is often subject to the needs of the unit rather than the needs of trainees.
- Not having the same education and training as those within a program while undertaking similar scope of practice poses a risk of safety to junior doctors and patients.
- Junior doctors undertaking these positions are working towards applying (or reapplying) to their chosen specialty. Often these junior doctors are most vulnerable to bullying as they feel they are unable to speak up without jeopardizing their chances of successfully gaining an accredited position.
- With no one accountable and no protection, unaccredited registrars are one of the most vulnerable junior doctor groups in the workforce.
The DiTC are working with SA MET to help identify unaccredited registrar numbers and provide accreditation and oversight of these positions.
The SA MET DiTC has identified issues regarding the management of agitated patients and the deficiency in relevant legislation for restraint of patients who do not fit the Mental Health Act. Currently, there are still unsafe practices occurring, with trainees and clinicians resorting to legally inappropriate Inpatient Treatment Orders under the Mental Health Act when chemical or physical restraint is necessary, due to a lack of alternative encompassing legislation. This resulted in a Restrictive Practices Amendment Bill to the Consent to Medical Treatment and Palliative Care Act, for which the DiTC provided a response to. Due to the change in government, this has been delayed and currently a new Amendment Bill is being drafted.
As trainees perform a large proportion of service delivery within the public health system, especially afterhours when agitated incompetent patients must be managed, this continues to be a significant source of confusion and distress for doctors in training. The DiTC continues to advocate and communicate with the Department of Legal and Legislative Policy to ensure appropriate legislative frameworks exist.
Concerns have been raised regarding high JMO turnover, with individuals leaving their employment prior to the conclusion of their contract. Barriers to completing contracts as described by junior doctors include: difficulty accessing leave, increasing work pressures, unpaid overtime creep, bullying and harassment, and junior doctor burnout and exhaustion. The DiTC, along with the JMO Forum, have advocated that prioritisation needs to be given to ensuring JMOs have access to their full entitlement of leave each year, including annual leave, professional development leave, and sick leave. An adequate staff force is critical to ensure our staffing reserves remain at an appropriate level, and at times where leave isn’t required, this reserve can be utilised by relieving some of the burden from other units during times of flexed beds and increased demand.
Intern guide – ‘Surviving the First Month of Internship’
The SA MET DiTC produced an Intern Guide (entitled: Surviving the first month of internship) which was published for the 2016 intern cohort in South Australia. Evaluation of the document has demonstrated that it was well-received and useful for many new interns, but that there was also room for improvement. We have been reviewing this annually, and will release an improved version for the 2021 intern cohort.
Useful smartphone applications
The DiT Committee has compiled a list of useful smartphone applications that may be of interest to medical students and trainee medical officers. Please visit the useful applications page to check it out!