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Ramp down of 2017
From the Presiding Member
Professor Kevin  Forsyth
Presiding Member, South Australian Medical Education and Training
(SA MET) Health Advisory Council 

  
As the year draws to a close, I extend my thanks to all staff within our health and university sectors who have contributed to the training, education and support of our junior doctors. Thank you. And thanks also to all the junior doctors who have worked so hard in our health sector, bringing support to so many.
 
We have a new SA Health strategic plan. It is very encouraging to see within this plan an emphasis on research, education and training and innovation. SA Health seeks to have a learning culture in the workplace, and strengthen partnership with the wider education sector. This sends all of us a message that learning and development is a central element within health. I strongly applaud this priority. Health is a knowledge industry, we are all continuously learning and improving our medical work. As we head into 2018, let’s ensure that we all foster this learning culture within our health sector.
 
Have a safe and happy Christmas and New Year.
Assoc. Prof. Alison Jones, Director, of Medical Education and Research, reflects on 2017.
Read more
Executive Director of Medical Services, Don Mackie, gives a short summary on the changes seen at CALHN. Read more
Read doctors perceptive on the move from the old to the new RAH, with Dr Claudia Janowski and Dr Abbey LeBlanc Read more
A chat with Dr Samantha Iannella,  winner of the CPMEC Australia and New Zealand Junior Doctor of the Year Award. Read more
Q&A with Dr Christine Burdeniuk, SA nominee for the CPMEC Clinical Educator of the Year Award. Read more

Read an update from the SA MET team.
Reflecting on 2018
Associate Professor Alison Jones
Director of Medical Education and Research, SA MET Unit
 

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2017 has been a varied year in the work of the SA MET Unit. The accreditation team has been busy managing change of circumstance requests and new unit accreditation requests that have occurred as Transforming Health has taken shape. We are pleased we have been able to be responsive to the needs of the Local Health Networks for their junior medical workforce and still maintain the integrity of the accreditation process for prevocational training to the level that is required by the Medical Board of Australia and the Australian Medical Council. I would personally like to thank the extensive work done this year by the Accreditation Committee and the members of accreditation teams who visit sites and review reports. Under the leadership of Associate Professor Mitra Guha and the Accreditation Committee, we have continued to be commended for the work done particularly around intern position accreditation.

Some of the challenges this year have included managing the significantly higher than normal number of Commonwealth supported graduates and providing them with an offer of internship in South Australia. We are grateful to the Local Health Networks for their support with this and for the patience of the graduates who received their offers later than usual.  SA MET has been looking at the medical training pipeline, the pressure on numbers and specialty training positions and alternative pathways such as Career Medical Officer roles. We continue to look at how we can improve our use of technology and adopt more effective communication methods to engage the junior doctors and ensure they feel supported. We also maintain a strong presence in national work such as the Intern Work Readiness Project, the National Medical Training Advisory Network and the accreditation processes conducted by the Australian Medical Council.

On a personal note, I undertook the Australian Institute of Company Director course this year and this has made me reflect on the importance of good governance and ensuring councils and committees have an appropriate balance on their agendas for compliance roles (accountability and monitoring) and performance roles (strategy and policy).  We can look into this further in 2018. I know that the staff in the SA MET Unit continue to be highly motivated in the work they do and can see the value in terms of supporting quality training environments for the medical workforce. We value feedback as always and want to extend again our thanks to you all for the collegiality and respect in the way you work with us. Wishing you all a wonderful Christmas and a great 2018.


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A major year for the Central Adelaide Local Health Network
Dr Don Mackie
Executive Director of Medical Services
Central Adelaide Local Health Network


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2017 has been a major year for Central Adelaide Local Health Network (CALHN) and the wider South Australian community culminating with the opening of the new Royal Adelaide Hospital. Many years of planning came down to three crucial days of carefully moving patients from the old site to the new location on the west end of North Terrace. The enormous contribution of staff in managing the highly logistical process together with SA Ambulance Service led to a smooth transfer of patients, with patients being seen at the new site within minutes of opening. While a number of challenges have been faced upon beginning operations at the new facility, much work has been done with our partners Spotless and Celsus to streamline processes.
 
Looking forward to 2018, we are now transitioning back to a business as usual model, and using the change of facility to progress the ongoing work of clinical staff in continuously improving the care we deliver to South Australians in the future. While the move was a monumental occasion, change goes on, with major projects to come such as completing the full implementation of EPAS at the RAH and development planning towards recent state investments into the Queen Elizabeth Hospital.
 
As for junior doctors, CALHN provides the largest training organisation in South Australia, and have recently established a Trainee Medical Officer forum at the RAH, representing the first of its kind in SA. This highlighting the huge importance of this group in the operations of our hospitals. We look forward to engaging with all our staff, senior and junior, in delivering world-class care to the community.


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Questions and Answers with
Dr Abbey LeBlanc

Can you please introduce yourself and describe your current position?
I am an advanced trainee currently working as the Medical Education Registrar in General Medicine at the RAH. As part of the move to the nRAH, many staff members helped out by taking on additional responsibilities, and working additional shifts. During the week of the clinical move, I worked night shifts as the senior medical registrar (including the first night the nRAH was open!), helping to support the nights RMOs and interns.

Can you des the challenges you face during the move?
We faced a number of challenges not only during the clinical move, but also in the weeks and months leading up to the transition.  During the initial period, all staff were required to make time for specific education, training, and hospital tours in addition to their regular clinical workloads. Leading up to the move itself, we began ‘ramp down’ at the old RAH, which involved transferring clinically stable patients to other hospitals, including peri-urban locations, and rapidly assessing and treating patients who presented to the emergency department, where possible, transferring these patients to other hospitals to continue their care. This required not only caring for patients as we usually would, but approaching our clinical work with a system-focused view, which a lot of us don’t necessarily usually consider from day to day. This was a challenging period to ensure both efficiency and safety in our clinical practice, that was well supported by senior leadership, including increased consultant involvement (with General Medicine consultants at times, assessing and clerking patients in ED to facilitate early transfer!), and daily consultant-run clinical safety meetings. It often goes without mention that whilst we were facing many challenges on the ground at the old RAH, doctors, nurses, allied health and administrative staff at all public hospitals across South Australia were managing increased clinical workloads and higher patient turn over to enable us to ramp down at the RAH.

The week of the clinical move itself was quite a humbling experience. Whilst I have previously experienced working in unfamiliar hospitals and new health care systems, both in Adelaide and interstate, I had not anticipated the challenges we would face with moving into a brand new hospital. Not only, were each of us as individuals unfamiliar with the new physical space we were working in, the new technology and equipment we were using, and novel work-flow patterns, these factors were new to everyone on-site! Whilst in hindsight this seem obvious, I had not anticipated that simply asking somebody else for help, (as you usually would when working in an unfamiliar environment) or rather, finding someone who knew the answer to your question, would be a lot harder than it sounds. These challenges demanded rapid adaptation and problem solving skills and a little creativity, particularly during the first few nights.

Do you have any examples of team work over this busy period?
There are many examples of team work which come to mind when reflecting on the move, many of which occurred during the first few days of the move. Medical Emergency Response (MER) calls inherently demand a high level of team work to ensure safe, rapid responses to deteriorating patients. As  nights team, we responded to our first MER call and the nRAH within an hour of our first shift commencing, when we were called to see an unwell patient on the haematology ward with sepsis. This was my first realisation that everyone was new, and nothing was familiar. All of the simple things that would have been innate and automatic at the old hospital including locating IV fluids, using the pneumatic tube system, even finding light switches required conscious and deliberate thought. Simply trying to do the most menial of tasks felt like being a toddler learning to walk – nothing was automatic. In dealing with all of these new systems, we reverted to the basics of team work, each verbalising our needs and concerns, using direct communication methods, and helping each other out with simple problem solving. We established a physical “home base” in one of the staff hubs, and facilitated regular “check-ins”, sitting down for a quick cup of tea with the whole team at intervals throughout the night to check that everyone was okay, and debrief about any problems that had arisen. Whilst it was a stressful period, it was also very exciting to be part of the first nights team on site at a brand new hospital – an opportunity that I can only assume occurs once in a career.

How have you managed your wellbeing during the move?
From a personal perspective, I found moving to the new RAH to be quite an emotional and humbling experience. Having completed by MBBS at the University of Adelaide with the majority of my clinical teaching at the RAH, I then went on to complete my internship and most of by Basic Physician Training at the RAH as well. I came to know the old hospital as a second home – I have certainly spent more waking hours there over the last five year than I have at my actual home! I felt quite nostalgic leaving an institution that was such a formative part of my career, and consequently despite all the excitement, I was quite apprehensive about how we would settle into the nRAH. I can only image how these feelings must have been amplified for some of my consultants and mentors, who have worked more than forty years at the old hospital.
 
Whilst personal strategies for maintain perspective at home including spending time with my family, friends (and my kitten) as well as regular exercise have been vital to maintain my sanity during this busy and challenging period, I have also found significant benefit in adovacy activities at work. I am very lucky that in by dual roles as Medical Education Registrar and Chief Medical Resident at the RAH, I help facilitate multiple regular education meetings within general medicine, and am also involved in the CALHN Trainee Medical Officer forum, which both provide clear pathways to identify and solve problems or difficulties that we have faced in the new hospital. Actively contributing to positive change in the systems we work within, has helped me to feel both involved and empowered to help improve the way we work from day to day. This has greatly helped by own sense of wellbeing, and I would strongly encourage other TMOs to become involved in some of the many advocacy and leadership opportunities that are available to you as we continue to navigate a period of rapid change and development in SA Health in the coming years.
 
Questions and Answers with
Dr Claudia Janowski

Can you please introduce yourself and describe your current position?
My name is Claudia Janowski, and I am an intern at CALHN. Currently I am working in the vascular unit.
 
What unit were you on during the transition week, how would you describe the experience?
During transition week I was working on the nights team at the nRAH. It was definitely an interesting experience! To sum it up in a few words I would say it was exciting, a great team exercise which brings you together, and it was a unique time in our state’s healthcare that I was honoured to be a part of. I imagine that in Adelaide there probably will not be another brand new major hospital opening in my lifetime that I will be a part of!
 
What challenges did you face and how did you overcome them?
Initially the most concerning thing for me was finding my way around the hospital on MET calls. I was worried I would get lost! This did happen a few times but luckily I overcame this by printing my own copy of the hospital map, laminating it and taking it around with me to help navigate and it was never a huge issue. I also came into the hospital a few days before it opened and asked for another personal tour. This was useful because I figured out how the room numbering system worked and got my head around the general layout. I became a little more comfortable with the hospital, which ended up being really helpful when a few nights later I was wandering around by myself trying to find things.
 
Also another challenge was actually getting access to the things you need to do your job! Because I was covering lots of different wards on nights, and everything was still being set up in different places, it was unclear where things were e.g. blood taking equipment/jelco trolleys and paperwork. Often stock hadn’t arrived yet and it took a search across multiple wards to find the pathology paper you needed to send off an urgent blood test for example. The good thing is that the units were quite quick at noticing what had been ordered/what hadn’t arrived yet, and this was resolved quite quickly in the scheme of things. While in the interim phase, I carried around a bag with things like pathology paper for the printer, progress notes to write on, and essential blood taking equipment which proved to be very useful and save a lot of time hunting for things.


What did you learn from the experience?
I learned that you have to really take a step back and just enjoy the process. Being a part of the move to the nRAH, especially part of the nights team, is something I am really proud of and so glad I got to be a part of. For me this was a momentous occasion that is really a once in a lifetime opportunity.
 
Can you describe any positive examples of team work/ looking after one another during the transition?  
From my experience, I really felt everyone pulling together to make things work. During some of the first days of the move, our seniors kindly put on a few extra interns overnight which really helped. Also, I found that general staff that I came across would have a good attitude and everyone was very supportive of one another and would help each other very easily.
 
One thing I really noticed on an organisational level was there seemed to be a great group of staff higher up who sought feedback about processes in the transition and what people working on the ground thought needed improvement. Multiple people I know emailed in, and the things they mentioned were really taken on board and actions were taken to fix things, which shows how the team and system worked so well at this time despite all the changes.
 
How have you managed and adapted with the change of hospitals?
For me personally, I’ve taken the approach that working in a brand new major hospital is, of course, going to take a bit of getting used to. With everyone pulling together and having some patience, everything will settle down after a few months. Which I think is exactly what happened. It has just been a matter of working as a team, being flexible and having a good time and good sense of humour along the journey.
 
Do you have any advice to JMOs in dealing with change in the health care system?
When adjusting to change: Be patient. Because what seems like change at first, soon becomes your “norm.” When trying to make a change: Discuss with those higher up who are listening – they really do take feedback on board. 

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Samantha Iannella is the 2017 winning recipient of the 2017 CPMEC Australia & New Zealand Junior Doctor of the Year Award.  Samantha is currently working as a Surgical RMO at CALHN, with completing internship in 2016 and is a Clinical Associate Lecturer by the University of Adelaide. Samantha is involved in representing various committees such as the South Australian Junior Medical Officer Forum (Chair position during 2017), Education Sub-Committee, Doctors-in-Training committee and the General Clinical Training Committee of the Queen Elizabeth Hospital. Samantha is also the co-founder of Airborne Aid. This is an international not-for-profit organisation that provides medical students travelling for overseas placements with medical aid donation packages.

Can you tell me a bit about the award and who it is run through?
The award is the Australia and New Zealand Junior Doctor of the Year Award for 2017. It’s awarded by the Confederation of Postgraduate Medical Education Councils (CPMEC), who oversee each state and territory’s respective education and training committees for junior doctors. It was presented at their annual conference (ANZPMEF) on 14th November in Brisbane. This award is presented annually to a junior doctor who has made a significant contribution to teaching and learning as a prevocational trainee in their workplace.
 
How did it feel to be announced as the Australian Junior Doctor of the Year?
It was a wonderful surprise and a huge honour, especially because the other nominees have done such incredible work in their home states. It is particularly meaningful because I was nominated by my peers. This gives me a great sense of pride in that the work we are doing to improve the training environment for junior doctors in South Australia is making a real difference. I’m also incredibly grateful for the support of SA MET, both for giving junior doctors a voice via the JMO Forum and for enabling me to attend the national conference.
 
Describe a highlight of 2017.
My work with the JMO Forum has brought me into contact with JMOs across Australia, working together on issues affecting trainees on a national level. This was particularly exemplified when I attended the ANZPMEF conference and heard all about the amazing work being done around the country by passionate JMOs and PMCs. It really energised me to bring some of these great initiatives back home, where I believe they can make a direct impact on the experience of SA junior doctors.


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Dr Christine Burdeniuk is the SA Nominee for the 2017 CPMEC Australia & New Zealand Clinical Educator of the Year Award. Christine is the Southern Adelaide Local Health Network (SALHN) Director of Clinical Training (DCT). Christine is a generous mentor, an advocate for intern and PGY2+ tutorials and is actively involved in numerous committees. 

Can you tell us a little bit about your role?
As the SALHN DCT I work with a wonderful team of passionate medical education officers, registrars and HR staff to provide a comprehensive service, encompassing education, pastoral care and mentoring for all our prevocational trainees.
 
We liaise with colleagues across disciplines to act on feedback collated from the prevocational trainees with the ultimate goal of continuing to improve their education and training opportunities and experiences in SALHN. Additionally through the SAMET accreditation process we ensure that all rotations allow prevocational trainees to meet their training requirements.

As a team we pride ourselves on the educational opportunities we have created for trainee medical officers ranging from our intern tutorial sessions to clinical simulation and more. We are continually looking at new ways to engage trainee medical officers in education and training opportunities.

I represent the trainees at a variety of SALHN committees and through SAMET also have a voice at a SA Health level. This has been invaluable to understand the greater agenda with regards to training and service requirements.
Over the last year, what has been a highlight in your role as a DCT?
There have been too many highlights to list individually, but my greatest accomplishment is leading such an enthusiastic and passionate group of educators. We thrive on delivering high quality education and mentoring. I am also proud of being recognised as the CPMEC SA clinical educator of the year.

What is a project you are currently working on?
We are reviewing our Medical Juniors Education, Training and Skills Program (MediJETS) which involves targeting medical education for our PGY2+ trainees who are not in an accredited training program. Over the last 3 years it has evolved and is currently being offered as an afternoon of education per month, incorporating clinical skills and a series of tutorials addressing gaps in knowledge. We have engaged with a variety of disciplines across SALHN and have sessions delivered by Obstetrics and Gynaecology, Medicine, Surgery, Psychiatry and Paediatrics. We continue to modify the curriculum on the basis of feedback and are proud that we are inundated with support in SALHN – there is never a shortage of speakers who want to deliver education on topics about which they are passionate. Our challenge continues to be optimising the number of trainees who are actually able to attend.

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Education and Training
During this year SA MET Unit continued to deliver the PERMA+ training (resilience training) in a multi-disciplinary format.  In addition the Professional Development Program for Registrars was also delivered.  In May, Associate Professor Victoria Atkinson spoke on the program, Ethos, that St Vincent’s Health Australia has implemented. This program addresses poor culture in hospitals, discrimination, bullying and sexual harassment.  SA MET is currently examining how this could be implemented into South Australia.
 
SA MET was also fortunate to have the opportunity to hold the play Hear Me, in October.  This is a powerful and innovative play that examines all the complex issues that arise when things go wrong in health care.  After the play the participants provided feedback to SA MET on how the culture can be improved and strengthened across all Local Health Network. 
 

The online training, Reporting Deaths to the State Coroner, has been completed and will be launched in the New Year.  This training will assist doctors to understand the Coroner’s Act and their responsibility to report deaths to the Coroner.  The training is part of a package of information being developed on this legislation.  

Allocations and Recruitment
SA MET is pleased that all Australian Citizens and Australian Permanent Residents who graduated from South Australia received an Internship offer. SA Health saw an increase in the expected number of medical graduates this year and this resulted in the allocations finishing in November. Eighty five percent of successful applicants received their first preference. We appreciate everyone's patience during this time. 

The PGY2+ recruitment process is also ramping down for the year. Across all Local Health Networks there were a total of 464.5 positions. Through the online system 822 applications were received. Eighty seven percent of successful applicants received their first or second preference (first preference 69% second preference 18%). The Late Vacancy Management process commenced in late October and aims to fill any vacancies that arise.

SA MET has collected feedback from applicants and the shortlisting panels. This feedback will be used to improve recruitment processes next year. The 2017 Intern and PGY2+ report will be available shortly on the SA MET website. You can view some of the survey results below.
 
Accreditation Update
The SA MET Accreditation Team would like to wish everyone a Merry Christmas and a Happy New Year. The continued efforts and commitment to prevocational accreditation from our Accreditation Committee members, site visit team members and the Medical Education Unit staff within the Local Health Networks, is greatly appreciated. We look forward to working with you all again in 2018!
Special thank you to our outgoing Accreditation Committee Chair, A/Prof Mitra Guha; who has dedicated much time over the past seven years to accreditation processes. 


Upcoming workshops
Keep an eye out on our Facebook page and website for workshops commencing in 2018.



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What are your thoughts on this edition of the SA MET newsletter? Do you have you an experience you would like to share? Is there a particular theme you would like us to promote? Provide your feedback, experiences or general comments to HealthSAMET@sa.gov.au

Copyright © 2017 SA MET, All rights reserved.


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