In this edition: National framework for internship special...
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SA MET Unit Newsletter
Issue 25 | November 2014
Latest News - Intern Assessment
Associate Professor Alison Jones, Manager, South Australian Medical Education and Training (SA MET)
 
While it has been a long journey, we have reached our destination with the finalisation and release of the new national intern assessment process.  The Medical Board of Australia (MBA) and the Australian Medical Council (AMC) have finalised a national framework for medical internship. 
 
I have been involved in the AMC Intern Assessment Evaluation Group, chaired by Ms Debbie Paltridge. We developed the processes and resources required for assessment of the skills and knowledge of interns. View the AMC
communique here.

The utilisation of the national process for assessing the progress of interns and national standards for intern training will strengthen the education of Junior Medical Officers.
Intern Training – National Standard and Assessment Background
This year, a new national framework for medical internship took effect. This included a national registration standard for Australian and New Zealand medical graduates to obtain general registration on completion of internship.  To advance national alignment of intern training the MBA in conjunction with the AMC developed a national framework for intern training.
 
The national framework for intern training has now been approved by the MBA. The framework includes:
Intern outcome statements are not a curriculum. However, they state the board and significant outcomes which interns should achieve by the end of their programs.

The national process for assessing interns is defined by the registration standard. It outlines the national requirements for assessment of interns' performance. Key documents include the intern outcome statement, term assessment form and assessing and certifying completion.


The national standards describes the requirement for processes, resources and systems, contributing to good quality intern training. Intern training programs may demonstrate meeting the standards in various ways.

The guidelines for terms document outlines the experience interns are required to obtain during terms. These guidelines encourage innovation by defining clinical experiences in diverse health settings.
 
The document and forms developed by the AMC working group include:
From the Chair
Professor Kevin Forsyth, Chair, SA MET Health Advisory Council

The AMC has undertaken a thorough and extensive process in consideration of the expected outcomes from the intern year of training. This has resulted in an outcomes document and an intern assessment form. Defining internship more carefully helps to bring clarity to what interns are expected to achieve during their internship, one of the most critical periods in the life of a doctor. These documents will ensure consistency and alignment across all areas in Australia.  Feedback was provided to the AMC on the first draft of the assessment form, resulting in a modified term assessment form. Key changes in the newer version include:
  • The domains of assessment are exactly matched to the intern outcome statements
  • The descriptors for the domains have been simplified
  • The “not observed” option is still available
  • Instructions for completing the form are simpler
  • The form no longer instructs the term supervisor to observe the intern in the workplace before completing the assessment
  • While the form no longer invites the term supervisor to include observations from multiple sources, this information can be added to the comments section.
  • Interns are still invited to complete a self-assessment, but the form explicitly states that the self-assessment is not for submission.  This can be important step in the interns’ training, as self-regulation, self-assessment and managing workload and stress are important
  • The form no longer includes a section to record additional responsibilities or duties that the intern has undertaken during the term, this could be recorded under Domain 4.
Local Implementation
The SA MET Unit has developed an online AMC Assessment form, accessed through the South Australian – Online Training and Information System (OTIS). Two successful trials have been held, with Medical Education Units. Users have provided positive feedback, indicating that using the online assessment process is intuitive and requires minimal training.
 
Medical Education Units, Supervisors and Junior Doctors can:
  • Track and manage online mid-term/end term assessments and Improving Performance Action Plans (IPAPs)
  • Set permission for users to review or complete assessments
  • Upload Junior Doctors' photos to the assessment form
  • Access, download and save PDF versions of assessments at any time
Completing assessments online is an innovative development; however it is important to remember that the online assessment is a means of recording the assessment and does not change the process for conducting an assessment discussion. The SA MET Unit can provide assistance in using OTIS to support junior doctors and their supervisors. Please contact samet@health.sa.gov.au.

If you do not wish to utilise the online assessment, a print version of the national intern assessment forms is available on the AMC website here.
Interviews regarding the Online assessment form
Two Medical Education Units have trialled the online assessment form and SA MET has interviewed team members from these Medical Education Units.

Lynne Burn, Medical Education Officer, The Queen Elizabeth Hospital (TQEH)


How has the new national intern assessment form changed the assessment process?
It hasn’t really changed the assessment process. The intern still makes an appointment with the term supervisor and a discussion takes place as to the intern performance. The term supervisor completes the online assessment and then, the intern is able to sign off.

What feedback have you received from supervisors who have used the new online national intern assessment form?
We surveyed our term supervisors who trailed the tool. The theme of the feedback was that it's an easy tool to use. One term supervisor said connecting to the assessment took a while. (This particular issue seems to be a problem with the internet browser)

You have introduced the online assessment at your hospital.  Was it difficult to get supervisors to utilise this and did you notice increases in efficiency through using this tool?
Prior to introduction we invited term supervisors to meet regarding the new Assessment form. No negative comments have been received regarding the new form. We have only trailed the online form with four units over terms 3 and 4 this year. Uptake is 100%. We are going live with the remainder of TQEH for Term 5.

What level of training has been provided to supervisors, both in the online and paper based environments?

As above, term supervisors were invited to education sessions. Term supervisors and interns receive an instructional email for using the OTIS online Assessments. They are informed that I am available to assist them with any problems.

David Everett, Director of Clinical Training and Kylee Nuss, Medical Education Officer, Women’s and Children’s Health Network

David, you were involved in the review of the national framework for intern training.  Have you noticed many differences in the new form?
First I would like to say that it was a privilege to be the only Director of Clinical Training on the working group and my main role was to represent the voice of the interns in the process and keep the group looking through the eyes of the interns experiencing the process.
 
I was involved in the creation of the first version of the assessment form, released earlier this year and users of the form were asked to provide feedback in a recent national survey. A lot of feedback was received. The AMC then decided to reconvene the working group again to review the form and this resulted in the next version which is now available for use.
 
The new form is significantly abbreviated; fewer words and the descriptors are now brief. The other major difference is the removal of the IPAP form, as really most interns never need to have this used. The IPAP form is now a separate form.


Kylee and David, how do you think this online process will assist the Medical Education Units and the Directors of Clinical Training in efficient completion of intern assessments?
Kylee: the best thing is that it is easily accessed by all who should have access. It has been beneficial! The only issues we have had are when people either have locked themselves out of the program or have forgotten their log on. These are easily fixed issues. I am confident we will be utilising the form online in 2015.
 
David: we have adapted the Intern Assessment Form to be utilised in the assessment of our PGY2s successfully. In fact, this year all but two areas used the online form.
 

Kylee, what have the supervisors said in regards to utilising the online assessment?   
We have had little feedback from the supervisors, and that is a good thing. If it was taking too long to complete the assessment or there were issues with it, we would have certainly heard something!
 

Is there anything that you would like added or modified to the OTIS online process?
David:  we are a little different from the other Medical Education Units using this process as we are not the ‘home hospital’ for the interns.  We have interns with us for one rotation, from their home hospital.  However the OTIS system does not allow us to see the final assessments of the interns, who completed a rotation with us, as this assessment is with the home hospital.  If we could access this then it would help us.  (Good news David, we are working on that modification right now!)
 
Kylee: I send the reminders to supervisors and interns to complete their assessments, I am not aware if the forms are completed unless the junior doctors and supervisors tell me or I login and check for completed forms. Is it possible the system can send an email notification when the online assessment has been completed?  (That is a great suggestion Kylee and something we hope to address next year.  Your input into the functional requirements is vital)
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