Issue 30 | November 2015
Ensuring safe and effective training and education settings
The South Australian Medical Education and Training (SA MET) Unit supports the work of the SA MET Health Advisory Council (Advisory Council), in particular the function of accrediting all prevocational trainee medical officers (TMOs) positions within South Australia.  The SA MET Unit and the Advisory Council work collaboratively to improve and ensure the quality of education, training and welfare for TMOs in the State’s health services. The Advisory Council was accredited in October 2013 for five years as the delegated authority for the Medical Board of Australia (MBA) to accredit intern positions in South Australia and reports annually on other TMO posts to the Minister for Health.

Accreditation visit teams, supported by the SA MET Unit, facilitate the accreditation process by reviewing documentation, visiting Local Health Networks (LHNs) and their units and facilities to evaluate TMO education, training and support against the Accreditation Standards.  Accreditation visit teams vary in size from three for a unit visit to eight for a facility visit.  All accreditation visit team members must be trained prior to undertaking an accreditation visit and every accreditation visit team is led by a senior clinician and always has a TMO representative. The other members consist of a registrar, medical education officer or director of clinical training and other consultants.

The Accreditation Standards provide the point of reference against which the quality of prevocational medical education is assessed.
The SA MET Accreditation Standards have six domains:
  • Governance and Program Management
  • Monitoring, Evaluation and Continuous Improvement
  • Education, Training and Clinical Experience
  • Supervision
  • Assessment
  • Trainee Medical Officer Welfare
By meeting the SA MET Accreditation Standards health services demonstrate they provide safe and effective education and training programs for TMOs. The accreditation process will use evidence to test the extent to which health services meet these standards through document analysis, TMO surveys and visits to local health networks (LHNs).

The SA MET Unit, in particular the Accreditation Team, value the contribution of the visit teams and the work of the Accreditation Committee and Advisory Council Members in ensuring the process of accreditation is robust and managed seamlessly. 

SA MET Unit update

Associate Professor Alison Jones, Manager, South Australian Medical Education and Training (SA MET) Unit

There are a range of exciting projects keeping us busy at the moment. A few members of the SA MET Unit team recently attended the 20th Medical Education and Training Forum in Darwin. The 2015 Forum was an excellent platform to recognise and discuss the emerging topics in the prevocational medical education and training space, to hear from inspirational students, junior doctors and GPs about the work they are doing in rural and remote settings, and to see how much emphasis there now is on junior doctors’ mental health and well-being. It was a great opportunity to learn more about the work the Medical Council of New Zealand is leading in the implementation of the prevocational training program and the processes underpinning this – including the use of an e-portfolio.  
I think a conference highlight for all would be the Djuki Mala performance at the Gala Dinner and the band that followed which comprised doctors from around the region. For me, key reflections included ways to manage the generational differences in approaches to, and expectations of, training and also opportunities to open up prevocational pathways to ensure junior doctors receive exposure to settings that are aligned with population health needs.

Now we are all back into the South Australian space, we are occupied with local issues including looking at the intern numbers going forward, ensuring all available prevocational positions are accredited to the standards set out by the Advisory Council, on behalf of the Medical Board of Australia, and checking we have the right governance structures and policies in place to lead us into the next few years. We are also working closely with many of the Transforming Health committees, to continue to advocate for consideration of any impacts on education and training during these times of major change. Given that major changes can also lead to concerns about the impacts, we are exploring ways we can ensure effective communication to our stakeholders through our website and other media.

Please do not hesitate to contact me or any of my SA MET Unit colleagues if you think there are things that need to be brought to our attention. We continue to strive to ensure the Unit is well placed to meet the needs of stakeholders.

Contact the SA MET Unit through our website or via email.

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

One of the key delegated functions of the Council is that of accreditation. The accreditation process assures the regulators that the clinical setting in which junior doctors work is appropriate for their training, and that there are adequate supports in place for them. This is ‘mission critical’ work.
In South Australia we have an extraordinary team of dedicated health staff who undertake the accreditation processes, working to newly developed standards. I want to acknowledge this team, ably led by Associate Professor Mitra Guha. They do an enormous amount of work to support training, frequently working in their own time with no funding. It is dedication to the task that drives them. They get my heartfelt thanks for this excellent work.  
Major accreditation in 2015
In 2015, the SA MET Unit Accreditation Team has been busy facilitating the accreditation of numerous prevocational training posts across all Local Health Networks (LHNs). In particular, this year saw the first complete LHN accreditation under the revised accreditation standards, with Northern Adelaide Local Health Network facilities (the Lyell McEwin Hospital and Modbury Hospital), undergoing accreditation in August 2015.

Whyalla Hospital also underwent accreditation for prevocational training and is now accredited for PGY2+ rotations in General Medicine, Obstetrics & Gynaecology/Paediatrics and General Surgery/Orthopaedics. 

Royal Australiasian College of Surgeons - discrimination, bullying and sexual harassment
No room for bystanders update on the Royal Australasian College of Surgeons investigation into discrimination, bullying and sexual harassment. The Royal Australasian College of Surgeons (the College) released the final Expert Advisory Group (EAG) report on discrimination, bullying and sexual harassment on 28 September 2015.
The EAG report confirmed that discrimination, bullying and sexual harassment are pervasive and serious problems in the practice of surgery in Australian and New Zealand.  The research found that 49% of Fellows, Trainees and International Medical Graduates report being subjected to discrimination, bullying or sexual harassment and 71% of the hospitals that responded to the research reported discrimination, bullying or sexual harassment by a surgeon in their hospital in the last five years. 

This data and information is frightening and these serious issues need addressing.  The EAG have stated that this must change. They feel that it is time that individual surgeons are held accountable to meet their legal and professional responsibilities to their patients, trainees, colleagues and peers.  Bystanders can no longer remain silent, but need to speak up when they witness discrimination, bullying or sexual harassment. The College will need to embrace this opportunity to lead positive lasting change.  

The College have committed to publishing an Action Plan in November 2015.  This plan will introduce more transparency, independent scrutiny and drive changes in the three core areas identified in the EAG report: culture and leadership, surgical education and complaints management. In addition, the College has issued an apology to those who have suffered discrimination, bullying and sexual harassment.  They will now be working with Specialty Societies and Training Boards, and seeking external partners, to make sure these issues are addressed effectively. 

The College are to be congratulated for taking action on this issue.  As employees of SA Health, we abide by the Code of Ethics for the South Australian Public Sector and SA Health’s Respectful Behaviours Policy.  There is definitely no room for bystanders in SA Health.  
2015 CPMEC Clincial Educator of the Year
Congratulations to Dr Penny Need, Director of Clinical Training (DCT) Repatriation General Hospital and Director of General Practice Training, who is the South Australian nominee for Clinical Educator of the Year.   

Dr Need was nominated for her contributions to the education and training of junior doctors in the Southern Adelaide Local Health Network (SALHN).  In particular her tutorials embrace practical and easily retainable principles and junior doctors find her approachable and happy to provide advice and guidance.  
Preparation for the new Royal Adelaide Hospital and Transforming Health accreditation
The SA MET Unit is assisting the Central Adelaide Local Health Network (CALHN) in accreditation matters subsequent to any changes in clinical services within the LHN. The SA MET Unit is also liaising closely with the new RAH office regarding accreditation for prevocational training.

Changes due to Transforming Health are already beginning to occur, with numerous LHNs submitting Change of Circumstance Accreditation Applications in 2015. The SA MET Unit Accreditation Team is committed to ensuring a smooth and efficient accreditation process during the Transforming Health changes.     
Doctors in Training (DiT) Committee
Are you a Junior Doctor interested in education and training?

The South Australian Medical Education and Training (SA MET) Doctors in Training (DiT) Committee provides strategic advice to the SA MET Health Advisory Council on ways of improving the quality of trainee medical officer (TMO) education, training and welfare from a medical student and TMO perspective.

The DiT Committee has just developed web pages specifically designed to engage any medical student or TMO who is interested in education and training. These pages will provide up to date information on the work of the Committee and identify possible ways that you can become involved in future work projects or work groups. Visit the SA MET website to view the DiT Committee page.

2015 Confederation of Postgraduate Medical Education Council (CPMEC) Junior Doctor of the Year Award
Dr Shreya Verma is the South Australian Junior Doctor of the Year nominee.  Dr Verma is currently working at the Mount Gambier and Districts Health Service (MGDHS).    Dr Verma has entered Medicine from a Dentistry background with the intention of undertaking surgical training in Maxillofacial surgery. 

This has led to her delivering formal tutorials on facial fractures and emergency dentistry to the junior doctors, students and salaried medical officers. She is currently preparing online training modules around this topic as well.  Congratulations Dr Verma, for being nominated as the South Australian nominee for the CPMEC Junior Doctor of the Year.

From the Regional Training Manager

Ronda Bain, Regional Training Manager, SA MET Unit

In the newspaper we often see articles detailing bullying or sexual harassment reports occurring within hospitals.  We are all aware that this is a very serious issue, as demonstrated by the review undertaken by the Royal Australasian College of Surgeons and its findings. The SA MET Unit share these concerns with all the medical community regarding this matter.  
One of the roles of Accreditation of the LHNs is to ensure that the training environments are safe and effective.  During the Accreditation process junior doctors have the opportunity to provide information on these issues.  To ensure that all junior doctors have the opportunity to speak out about these issues we now conduct the Quality Assurance of Training Settings twice a year.  This is an anonymous survey distributed to all junior doctors asking questions about their experience in the training environment. Areas that need improving are reported back to the LHNs and followed up.  This opportunity for junior doctors to provide feedback anonymously to SA Health is important and I encourage all doctors to complete the survey when we next launch it.  Should you like to complete a paper based survey and send it back anonymously to us please contact the SA MET Unit and we will distribute a survey to you.  The latest report from the survey undertaken this year is available here.
Part of caring for junior medical officers is to ensure they have the skills to manage difficult situations and the resilience to keep on going.  With that in mind, we have delivered more training modules throughout this year focusing on skills to assist junior medical officers.  One of these focused on workplace stress and conflict and another on building leadership skills and the evaluations from the participants was positive.  Next year we will be launching our training in PERMA+,  a two day workshop designed to build resilience and assist us to thrive in the face of adversity.  The first workshop is in March and initially we will be targeting Registrars, Consultants and Supervisors.  For more information and to register your interest, click here.  Further courses will be conducted throughout next year and these will be available for junior medical officers as well. 
If there are any other topics that you think should be addressed through training, please contact me via email.  Together we can ensure that the training environment supports all medical staff and ensure it is a safe and effective environment.
20th Medical Education and Training Report - Dr Shreya Verma
The Forum was held in Darwin this year and it certainly was warm.  However, one of the most refreshing things I noticed was the amount of junior doctors not only attending the conference, but also presenting at it. It was lovely to see the investment that junior doctors are willing to put into their prevocational training. 

Most junior doctors are only in prevocational training for 2-3 years, but these years are especially formative and help us to enter into and prepare for, specialist training.
As discussed at the conference, we are supported by Universities during our medical school years, and then by our respective training colleges during our years as a registrar, but the time in between, the so-called prevocational years, can lack structure and academic support. It is here where support from CPMEC is vital. CPMEC governs the state-based medical education bodies, and represents interns and residents from a broad range of backgrounds.

Some of the key take-home messages included:
  • The importance of supporting junior doctor posts in rural areas
  • Sexual harassment and bullying continues to be an important problem in our hospitals
  • Mental health of our doctors is often overlooked and can have significant consequences
  • Prevocational medical education is facing some serious challenges
2016 will prove to be an interesting time for CPMEC, as it undergoes a transformation into a new and improved medical education advisory body. I was honoured to be able to attend the 2015 conference and hear the innovative and stimulating presentations. As I now embark on my specialty training, I think I will remain invested in CPMEC, and look forward to contributing to this vital medical education body in the future years.

Editor’s note:  thank you Shreya for this report and also for representing SA so admirably.

A moment with...
Dr Matthew Chu
Dr Matthew Chu was our interstate representative for the accreditation of NALHN. Dr Chu is a Senior Specialist (Emergency Department), Director of Prevocational Education and Training at Canterbury Hospital, NSW. 

What made you participate in an Accreditation visit?
It was an opportunity to see how another health facility conducts its teaching, education and supervision to support their PGY 1 and 2s. Accreditation to me is a peer review process. There are benefits to both sides of the fence. There is an opportunity for the facility being accredited to reflect upon their programme, consolidate on their strengths, identify and address their challenges and correct any weaknesses. 

The ultimate aim is to provide to its trainee medical officers a supportive environment so that they can learn effectively to   become safe and competent clinicians. From my end, I gain personal satisfaction if I can assist in facilitating this process. Similarly, the visit enriches my experience. It provides me with an opportunity to learn from the successes of the facility being accredited and to adopt new ideas to introduce into my own facility.
What one thing would you say is your most valuable learning from the visit?
The appreciation that no one institution is the same. Though the accreditation standards are universal, each institution faces different challenges, whether it be clinician engagement or resourcing issues. There is often a unity of purpose from the junior doctors who are thirsty to gain competence to the senior doctors supervising them. And that is to experience and provide respectively the best education and training opportunities possible despite the challenges.

In recognising the individuality of the facility being accredited the various members of the accreditation team bring their combined eclectic experiences with them in their deliberations. 

Coming from interstate, how did you find the South Australian Accreditation process?
I thought that the process was comprehensive and well conducted.  The collection of background evidence and submissions which included surveys from the trainees allowed a preliminary assessment to be made against the standards. This process facilitated the targeted examination of any issues which were either requiring clarification or identification. Members of the accreditation team were drawn locally and from interstate.

This process provided a balance of members who were split with representations involving JMOs and clinicians including Directors of Training in each team. The teams worked cohesively. There was a close working relationship between the SA MET project officers who provided the team with a great amount of active support. 

What do you feel is the most important outcome that Accreditation achieves?
Doctors who are competent, effective communicating professionals who practise safe patient care.
Dr Shreya Verma
Dr Shreya Verma was the South Australian nominee for the CPMEC Junior Doctor of the Year. Dr Verma is a Postgraduate Year 2 (PGY2) junior doctor, based at Mount Gambier and Districts Health Service. 

What has influenced you to undertake your chosen career pathway? 
I initially “discovered” oral and maxillofacial surgery (OMFS) in my first year of dental school. I spent the next five years trying to increase my exposure to this small but growing specialty, and decided that it was, in fact, what I wanted to do as a career.  As with other trainees, one of the biggest influences on my decision to undertake maxillofacial surgery was positive role models in my chosen career. I worked with some excellent OMFS registrars who were passionate about their training, and spoke candidly about the prospects and challenges of OMFS.
 Similarly, the consultants that I worked with were knowledgeable and excellent surgically. They helped to cement my determination to embark on this somewhat lengthy career pathway. 

My attraction to OMFS was its balance of acute presentations (trauma, infections) with the chronic (orthognathic cases, craniofacial and developmental abnormalities). I enjoyed both emergency surgery and the prospect of being able to follow up patients in the long term. I also enjoyed the complex and multidisciplinary nature of head and neck oncology, and the significant impact that us as health practitioners could have on families in a critical point in their lives.  Apart from the clinical attraction to OMFS, I also look forward to the opportunities in research and education that this exciting specialty has to offer.

You deliver formal tutorials on facial fractures and emergency dentistry, what is one key tip to assist others in delivering medical training?
The benefits of teaching are not only to share knowledge with others, but to cement my own understanding of certain topics. Our understanding of medicine keeps evolving, and involvement in medical education helps me to stay up to date with some of these advances. Teaching also is great to develop public speaking skills, and is a vital part of surgical training.
My one key tip for others delivering medical training is to keep changing the way you teach. Every time I attend a course or a lecture, I pick up some tips for myself. We all know that education is most effective when the information is presented in multiple formats. In reality though, this is not often done. During the last two years I have given lectures on OMFS topics, but we are now developing some online modules that interested doctors can complete at their own convenience. These modules also have an interactive component, which hopefully will make things more engaging.

I am trying to implement some of the techniques that I have seen more senior medical educators in my teaching. This has ranged from simple things such as positive reinforcement (handing out lollies for correct answers), to changing the structure of my power points completely.

What has been a challenge in your career so far?
I don’t think I’m alone when I say that work-life balance has been, and will continue to be, one of my biggest challenges.
Any training program requires a significant sacrifice of your “out of hours” time. As well as clinical duties, there are administrative tasks, teaching, research and education responsibilities. These obviously need to be balanced out with time for exercise, rest and spending time with friends and family. These days training programs seem to be getting harder to get into, and we all feel the pressure to burn the candles at both ends. I don’t think this time pressure alleviates during surgical training, or into fellowship and consultancy.

Because of this, I think it’s important to set a healthy work-life balance early. Step one for me was to stop taking on more and more “projects”. I’ve been working in private practice or hospitals for only 5 years, I think that if I wasn’t able to start setting myself some limits I would have already felt burnt out by now. I think it’s absolutely crucial to enjoy my job, because such a huge proportion of my life is spent at work. However, as cliché as this might sound, this year I’ve made an effort not to take too much of my work home, so I can properly enjoy my down-time.

As the South Australian 2015 Junior Doctor of the Year, you attended the 20th National Medical Education and Training Forum. What were your highlights of the forum? 
As I said in my report, the weather in Darwin was exceptionally hot, as were the topics discussed during the 4 day conference!  There were many highlights as reported previously, but I think it was seeing the investment that junior doctors are willing to put into their prevocational training. 

Associate Professor Terry Brown spoke of the contemporary challenges in prevocational medical education. The discrepancy between the numbers of graduating medical students and internship positions was highlighted. He emphasized that internship was not about being a “pencil pusher”. Rather, it was about transforming our medical education into clinical experience, and starting to define our career pathway. He gave us a candid and refreshing overview on challenges facing prevocational doctors and the CPMEC in the coming years. Most importantly, he called for us to take ownership of this problem, and invest to improve the academic and clinical quality of the prevocational years.
Master of Surgical Science
The University of Adelaide is now accepting applications for the 2016 Master of Surgical Science. The Master of Surgical Science is aimed at those wanting to enhance their research and scientific skills and are considering a career in surgery. It equips students with essential understanding of surgical principles, elements of research and its presentation and publication and is delivered around fulltime clinical commitments.  

There is a clinical, coursework and research component to the Masters and it is delivered through weekly lectures and tutorials. For an information sheet on the program and the application form please visit the SA MET website.

Full information regarding the program is also available on The University of Adelaide website. 
Upcoming workshops
Preparing to Lead (new!)
The Preparing to Lead course offers South Australian Junior Medical Officers (prevocational doctors) the opportunity to participate in a full day workshop. Gain skills and build your confidence in becoming a leader.
  • 13 November 2015 (only two places remaining!)
Training available for consultants, supervisors and registrars.
  • 10-11 March 2016
Visit the SA MET website for further information.
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 below.
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