The following represent the key areas of Doctors in Training (DiT) Committee activity over the past two years .
The DiT Committee has been active in contributing junior doctor opinion on the proposals in Transforming Health, especially as they may affect medical education and training as well as the working environment for trainee medical officers.
We submitted sixteen questions to a joint session with the SA MET JMO Forum where Professor Dorothy Keefe PSM (Clinical Ambassador for Transforming Health) presented on Thursday 20 August 2015. These questions are enclosed in the document found here.
Our four key messages on Transforming Health have been
- The detailed impacts of Transforming Health on medical education and training should be made explicitly clear as soon as possible to allow medical students, trainees, supervisors and Colleges to adjust to these changes.
- Trainee medical officers are vulnerable in the context of such extensive change and so for the safety and wellbeing of patients and SA Health junior doctor staff, it is critical that any negative impacts of Transforming Health on welfare are identified and mitigated promptly.
- It is incumbent on SA Health to conduct robust evaluations of the impacts of Transforming Health for ongoing quality improvement purposes and public accountability and the plans to conduct and report on quality assurance / evaluation work should be available for public and professional scrutiny.
- Increased engagement of junior doctors in the development and implementation of the Transforming Health proposals, as relevant to their education and training and welfare, will help alleviate concerns which currently exist.
More recently, after liaising with the Ministerial Clinical Advisory Group (MCAG) Transforming Health Education and Training Expert (THEE) Group, the DiTC has written to the Chief Executive Officers of each of the Local Health Networks with questions about the potential impacts of Transforming Health on medical training and trainee working conditions and welfare.
Currently as of June 2016, Ms Jackie Hanson (NALHN CEO) has replied and noted that there will be no reduction in the number of medical training places within NAHLN as a result of Transforming Health.
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 will review the document further and release and improved version for the 2017 intern cohort.
Code Blacks – Patient restraint
Patient restraint scenarios can be clinically, legally and emotionally challenging. Trainee medical officers, including interns, are often on the ‘front line’ of patient restraint from a medical perspective. After becoming aware of anecdotal concerns, the SAMET DiTC led a review of patient restraint in South Australia, specifically with respect to medical trainee involvement in such scenarios. The review included a survey of 2015 interns, analysis of existing SA Health protocols and evaluation of the relevant teaching provided by South Australian universities to senior medical students.
This review, which can be accessed here, made the following recommendations regarding patient restraint scenarios:
- Increased practical training for Code Black scenarios for final year medical students, interns and residents (including authoritative instruction regarding legalities and simulation training if possible)
- Increased site-specific education / induction regarding Code Blacks including intended roles for members of the Code Black team, ensuring all intended members of the Code Black team actually attend calls, and increasing awareness for medical officers regarding who to contact for after-hours support with difficult Code Blacks
- Increased awareness / accessibility of existing protocols (including consideration of a ‘Code Black lanyard card’ as a quick reference guide for trainee medical officers)
- Consideration of a unified Code Black protocol to standardise approaches to chemical and physical restraint across SA Health
- Improved protocol guidance for trainee medical officers regarding legalities around restraint
The paper was presented to the SA MET Health Advisory Council in May 2016 where the recommendations were supported. Action is now underway to encourage SA Health to implement these recommendations.
The DiT Committee have been working with the SA MET Advisory Council, regarding internships for local Commonwealth supported medical graduates from South Australian universities. The DiT Committee will continue to highlight the recruitment of internship for 2017 and beyond, working closely with the Advisory Council and providing regular updates to you.
National Review of Medical Internship
The DiT Committee reviewed the ‘options paper’ that arose after the initial round of consultation by the National Review of Medical Internship. This review has been asked to evaluate internship and assess whether it is ‘fit for purpose’ and it is entirely possible that very significant changes to internship could arise from the Review. The DiTC entered a submission into the second round of consultation and this is available here. The final outcomes of the Review, based on decisions by the Council of Australian Governments, are unclear at this time.
Bullying in the medical workplace
The DiT Committee was asked to express an opinion on bullying in the medical workplace. This was discussed at the October 2015 meeting and it was agreed that there are instances of bullying in the medical workforce in South Australia, though it is not systemic. One of the issues noted was that it can be variably difficult for medical students and trainee medical officers to report bullying and seek redress of such issues. The DiT Committee has suggested developing more targeted information for trainee medical officers to assist them in identifying appropriate reporting pathways should they feel they are being bullied.
The concept of a ‘procedural pager’ comes from the United Kingdom. In summary, this is a paging-based system for alerting trainee medical officers to opportunities to observe or conduct procedures (e.g. lumbar puncture, arterial line insertion, and so on). This project would require a significant amount of work to establish, but it is something that is actively being pursued by the DiT Committee with the hope that it can be brought to fruition in the future.
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!
The DiT Committee is extremely eager to hear any feedback about our activities as well as any ideas for other matters that we should pursue. Please feel welcome to contact any of the members at your Local Health Network or contact the Chair, Tom Crowhurst via email.