Volume 198 - Issue 6
The need for quality and quantity in emergency medical care rotations for interns
Authors: Andrew D Gosbell, Rob D Mitchell, Victoria A Brazil and Alana M Killen
Med J Aust 2013; 198 (6): 313-314. || doi: 10.5694/mja13.10176
Published online: 1 April 2013
Published online: 1 April 2013
Australia must continue to support learning in emergency medicine through sufficient resourcing for emergency departments - the most appropriate setting for such training - and via robust accreditation standards.
To the Editor: A national registration standard for internship will apply from 2014.1 In addition to 10-week rotations in medicine and surgery, interns will need to obtain 8 weeks’ experience in emergency medical care. A national framework for the accreditation of intern training programs is also being developed.2
The new standard allows emergency medical care rotations outside of emergency departments (EDs), including selected general practices. Although primary care settings can facilitate valuable training, there is limited evidence that a community placement can effectively substitute for an emergency medicine term.
Emergency medicine terms expose interns to a broad range of acute undifferentiated illness not often encountered in other rotations.3 These terms also facilitate acquisition of key skills and knowledge, including the ability to prioritise under time pressure, recognise “sick” and “well” patients, perform common procedures and interact with other health care team members.3,4 EDs are the most appropriate setting for this generalist medical experience.
Rigorous assessment of interns is an important but under-recognised capability of the emergency medicine experience. A recent study showed that ED-based terms are crucial in detecting underperformance,5 which probably relates to the proximity of supervision, the requirement for interns to act as primary treating clinician and the necessity for decision making. EDs may be the only setting where interns’ clinical skills are directly observed.
Supervisory capacity may limit provision of ED-based experiences4 and, with expanding graduate numbers,6 demand will increase further. Although emergency medicine terms in alternative settings may improve access to placements, the accreditation framework2 must protect against any dilution of clinical experience. Guidelines must define minimum standards for training opportunities, supervision and assessment, not just casemix.
Solutions that sustainably increase ED training capacity should be supported, including innovative models of supervision. Structured teaching and simulation also have roles.4 The More Learning for Interns in Emergency (MoLIE) program, for example, increases training capacity and simultaneously enhances the educational experience.7
Australia must continue to support learning in emergency medicine by sufficiently resourcing EDs to deliver high-quality teaching and training to interns, and the unique elements of emergency medicine rotations must be protected by robust accreditation standards.
Competing interests
Victoria Brazil and Rob Mitchell were members of the Australian Medical Council Working Party on Internship.
References
- Medical Board of Australia. Granting general registration as a medical practitioner to Australian and New Zealand medical graduates on completion of intern training. Melbourne: MBA, 2012. http://www.medicalboard.gov.au/documents/default.aspx?record=WD12%2f 9504&dbid=AP&chksum=wbPeZldtyqPMG vIkbt0Qgg %3d%3d (accessed Jan 2013).
- Australian Medical Council. Internship in the national registration and accreditation scheme. Canberra: AMC, 2012. http://www.amc.org.au/images/Accreditation/Internship-in-a-national-registration-and-accreditation-scheme-2012.pdf (accessed Jan 2013).
- Chong A, Weiland TJ, Mackinlay C, Jelinek GA. The capacity of Australian ED to absorb the projected increase in intern numbers. Emerg Med Australas 2010; 22: 100-107. 0_i1142885
- Brazil V. Interns in the ED: the real challenges of increasing numbers. Emerg Med Australas 2010; 22: 97-99. 0_i1142887
- Aram N, Brazil V, Davin L, Greenslade J. Intern underperformance is detected more frequently in emergency medicine rotations. Emerg Med Australas 2013; 25: 68-74. 0_i1142889
- Fox GJ, Arnold SJ. The rising tide of medical graduates: how will postgraduate training be affected? Med J Aust 2008; 189: 515-518. 0_i1142892
- Brazil VA, Greenslade JH, Brown AF. Enhancing capacity for intern training in the emergency department: the MoLIE project. Med J Aust 2011; 194: 165-168. 0_i1142896