Volume 199 - Issue 5
Crisis? What crisis? Capitalising on increasing intern numbers in the ACT
Authors: Melanie Angstmann, Tobias J Angstmann and Tim McDonald
Med J Aust 2013; 199 (5): 322. || doi: 10.5694/mja13.10164
Published online: 2 September 2013
Published online: 2 September 2013
To the Editor: Increased numbers of medical graduates in Australia over recent years are causing great concern about the capacity of current prevocational training systems to effectively absorb extra trainees.1 For example, in the Australian Capital Territory, 42 intern positions in 2007 increased to 96 in 2013 - an increase
of 130%.
ACT Health has seen this increase in intern and junior doctor numbers as an opportunity to improve current ...
To the Editor: Increased numbers of medical graduates in Australia over recent years are causing great concern about the capacity of current prevocational training systems to effectively absorb extra trainees.1 For example, in the Australian Capital Territory, 42 intern positions in 2007 increased to 96 in 2013 — an increase of 130%.
ACT Health has seen this increase in intern and junior doctor numbers as an opportunity to improve current systems, and has taken an evidence-based, systems engineering approach to solving the problem.2 The underlying principles identified in developing the new system were:
providing high-quality, patient-focused clinical services in the ACT; and
providing excellent training for interns (specifically, improving handover, supervision, clinical exposure, education, accountability and continuity of care).
The new system is based around a clinical year of four terms, each of 13 weeks’ duration, abolishing the nights/relief term from previous years. The supervised general clinical experience provided by this system exceeds the mandatory requirements of the Medical Board of Australia.3
In each term, doctors work in small teams (“pods”), each with 8–12 interns and residents (postgraduate year 2) working in similar clinical disciplines geographically collocated within the hospital. The same pod of junior doctors remains responsible for the same patient group over 24 hours, 7 days a week, for the entire 13-week period.
Rotations of 13 weeks allow junior medical officers (JMOs) to gain a deeper understanding of their allocated specialty, and working within the pod structure provides experience and knowledge of the specialties that are grouped together.
This structure is also aimed at improving the completion of administrative notes and forms, such as discharge summaries,4 which we hope will improve communication between hospital staff and general practitioners.
Supervision and the opportunity for education have also been increased by expanding the numbers of supervising registrars and specialists. ACT Health employed specialist staff specifically to support and mentor the JMO cohort.
The reduction to a four-term year reduces the amount of administration and reporting by 20%. Coupled with the longer exposure that term supervisors have to JMOs, this allows more detailed assessment of training competence. The four-term structure also has advantages for seconded metropolitan and rural sites, as the lower frequency of rotations makes travel and relocation to these sites less disruptive for hospital medical officers and the clinical services, and also exposes JMOs to these settings for a longer period.
The pod system is at an early stage of implementation, but we envisage that it will provide better clinical services to patients in the ACT, and better training, supervision and clinical experiences for junior medical staff. Initial feedback about the current system is positive; more formal evaluation will follow throughout the year. We hope that in evaluating these changes in the ACT across a range of significant key performance indicators, we can share the lessons learnt from this approach.
Competing interests
No relevant disclosures.
References
- Australian Medical Association. Junior doctors and medical students call for urgent solution to medical training crisis [media release]. 22 Oct 2012. https://ama.com.au/media/junior-doctors-and-medical-students-call-urgent-solution-medical-training-crisis (accessed Dec 2012).
- Turner JP, Rodriguez HE, Daskin MS, et al. Overcoming obstacles to resident-patient continuity of care. Ann Surg 2012; 255: 1126-1128. 0_CBBGADDH
- Australian Medical Association. AMA position statement. Core terms in internship — 2007. https://ama.com.au/position-statement/core-terms-internship-2007 (accessed Aug 2013).
- Coit MH, Katz JT, McMahon GT. The effect of workload reduction on the quality of residents' discharge summaries. J Gen Intern Med 2011; 26: 28-32. 0_CBBEEBCJ