NATIONAL MEDICAL TRAINING ADVISORY NETWORK CONSULTATION SUBMITTING YOUR FEEDBACK

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1 NATIONAL MEDICAL TRAINING ADVISORY NETWORK CONSULTATION SUBMITTING YOUR FEEDBACK Please review the discussion paper (available as a pdf on the HWA website and provide your feedback in accordance with one of the preferred options below: Option 1: Complete your feedback using this form and it to nmtan@hwa.gov.au Option 2: Hard copy send a printed copy of your completed form to: Health Workforce Australia National Medical Training Advisory Network consultation GPO Box 2098 ADELAIDE SA 5001 Feedback form Instructions Please provide responses using the template provided. The questions are designed to help you to focus your response and help HWA when analysing submissions. You do not need to answer every question. National Medical Training Advisory Network consultation 1

2 Section 1: Cover page Your details Organisation or individual providing feedback: Royal Australian & New Zealand College of Psychiatrists Contact person (if different from above): Dr Anne Ellison Position: General Manager, Practice, Policy and Projects Telephone: (03) Demographic information Response from an individual Gender: Male Female Role or involvement in medical training: Click here to enter text. Specialty (if applicable): Click here to enter text. Years of practice (if applicable): Click here to enter text. Location of current practice (postcode): Click here to enter text. Overseas experience: Click here to enter text. Response from an organisation Role or involvement in medical training: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is responsible for training, educating and representing psychiatrists in Australia and New Zealand. National or jurisdictional response: The RANZCP is a bi-national College that represents psychiatrists in Australia and New Zealand. Confidentiality Health Workforce Australia (HWA) would like to give you the following options about publishing your name (organisation or individual) on our website as a participant in this consultation: Yes, I give permission for the organisation or my name to be published on the HWA website as a participant in this consultation. I do not give permission for the organisation or my name to be published on the HWA website a participant in this consultation. National Medical Training Advisory Network consultation 2

3 National Medical Training Advisory Network consultation 3

4 Section 2: What are the key elements of a coordinated medical training system? Consultation questions Principle 1 Training of the medical workforce should be matched to the community s requirements for health services, including where those services are required geographically and in what specialty. 1. What is working well (and why) in the current training system and should be continued? The Specialist Training Program (STP) provides opportunities to tailor training positions to meet local service needs Prevocational General Practice Placements Program (PGPPP) is a community based, Commonwealth funded program that enables trainees to develop an understanding of what GP work is like prior to commencing training Similarly, rural clinical schools and rural training posts provide trainees with clinical experiences particular to the needs of rural and Indigenous communities where mental health services may be limited. Frequently, this involves increased dependence upon multi-disciplinary networks. Hunter New England, in New South Wales, is one example with demonstrated successful recruitment and retention rates for psychiatrists New technology-based initiatives (such as Telehealth) are also working well, particularly in psychiatry Recruitment of Aboriginal and Torres Strait Islander medical students and specialists should also be continued, with further investment from the Commonwealth Government. Developing strategic links with medical training schools and organisations to promote and encourage recruitment into psychiatry. Current initiatives include scholarships for Indigenous doctors to attend the RANZCP Annual Congress The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is also a key partner in the (DoHA funded) Mental Health Professionals Network which has established a national multidisciplinary network for continuing professional development, comprising 456 networks, 200 of which are located in (ASGC - RA) 2-5 The RANZCP training program is bi-national and New Zealand also offers examples of training policies that are working well. Health Workforce New Zealand (HWNZ) funds vocational training positions and links this with the medical workforce pipeline. In order to identify priority training areas, HWNZ have developed Priority Listing for vocational training. Priority Listing is linked to the funding of vocational streams. The speciality of psychiatry ranks as a Red Zone area, indicating an area of need and requiring funding priority. A number of other generalist disciplines fall into this group, with sub-speciaities in the Green Zone receiving reduced funding streams, until they emerge again as Priority Areas. These rankings are based on annual workforce projections. Further examples of effective training models from New Zealand include the establishment of four training hubs which are based on the Deanery model of training in the United Kingdom. Each training region manages prevocational and vocational training. This was established in New Zealand three years ago. No evaluation has been undertaken on this model to determine its effectiveness; however, training hubs are in place across Australia 2. How can we balance the need for better national coordination of medical training with existing state, regional and local training coordination efforts? Provide a single forum in which medical Colleges can discuss workforce and training issues across training jurisdictions will assist in coordinating different training efforts Provide medical Colleges with more information on how decisions are made regarding workforce requirements across jurisdictions. The RANZCP would welcome the opportunity to provide representation on the NMTAN Provide opportunities for accredited training in specific areas to meet specific unmet service needs (especially in rural and remote areas) National Medical Training Advisory Network consultation 4

5 3. How can incentives in the system achieve a better alignment of training and workforce need? Continue the STP initiative, including allocation of posts to meet specific service needs (e.g. allocate 10% of posts to regional or rural areas) Utilise data on medical work/life issues to develop incentives that will influence work choices such as specialist interest and location of clinical practice 4. What training barriers limit the distribution of the workforce both geographically and across specialties? Ensure rotations are of sufficient length of time to meet lifestyle/family needs Provide prevocational and vocational training spaces Ensure continuity of employment entitlements Provide opportunities for public and private practice beyond training Government investment in building a viable academic and clinical infrastructure that will support education and training (e.g. appointments of academic chairs, research opportunities, provision of range of skills and experiences, onsite teaching, academic activities such as journal clubs, tutorials and presentations, administrative support, preserved time for clinical psychiatrists to engage in teaching and training of their registrars. These factors will assist in the attraction and retention of trainees to rural areas). 5. What training measures could be applied to achieve a better distribution of the workforce - both geographically and across specialties? Ensure alignment of training with actual clinical experience Ensure adequate access to supervision and opportunities for continuing professional development in areas with specific service needs (e.g. rural and remote areas) Develop indicators or success criteria based on training programs that are proving effective in recruitment and retention of trainees and specialists e.g. Hunter New England (NSW) and Barwon Health (Vic). Barwon Health has appointed a Professor of Psychiatry, which adds to its capacity to attract and retain trainees to that area Provide incentives matched to demographics. For example the interests of Gen-Y are different to those of older medical professionals. The MABEL Project has longitudinal data that could be very useful Principle 2 Matching supply and demand for medical training should recognise the changing dynamics of the healthcare system over time, including advances in service models and workforce development trends. 1. What is the best way to incorporate changing workforce trends and dynamics in the healthcare system into training planning? This requires effective feedback mechanisms and a coordinated, collaborative approach Establish a working group that includes key agencies (government, health jurisdictions and RANZCP); Collect core workforce data for modelling; Identify key areas of concern e.g. geographical mal-distribution and unmet service needs Develop strategies to address each Monitor effectiveness of strategies National Medical Training Advisory Network consultation 5

6 2. How can flexibility in training the medical workforce be retained to ensure the workforce can adapt to future health system changes? Ongoing data collection and modelling, establish priority areas Business development plans (combine with regional economic development plans) with rewards and incentives for innovation Establish milestones and KPIs to monitor progress Ongoing evaluation to identify what works with feedback to health jurisdictions Principle 3 Medical training should be provided in the most cost effective and efficient way that preserves the high quality and safety of Australia s current training system and the sustainability of the health service delivery system. 1. How can effectiveness and efficiency of medical training in Australia be measured? Training programs with core competencies mapped across the training program Identification of core medical competencies and entry requirements for specialist training programs High training completion rates within acceptable time frames Outcome measures that demonstrate effective treatment for consumers 2. How can the cost effectiveness and efficiency of medical training be improved without impacting on the high quality and safety of Australia s current education and healthcare services? Provide incentives to attract consultants who have an interest in teaching to these roles Ensure preserved teaching time in public hospitals in metropolitan and regional areas Reduce the time it takes trainees to pass through their chosen training pathways Ensure high quality and continuity of clinical supervision Utilise appropriate technology for distance learning Recognition of prior learning Provide opportunities for research and evaluation of services Involvement of consumers and carers in evaluation 3. Assuming all college and accreditation requirements are met, should there be a maximum period of subsidised postgraduate training for medical trainees? The RANZCP supports a maximum period of subsidised training in psychiatry and has a Failure to Progress policy. A trainee may be discontinued from the training program after 54 months Consider recognition of prior learning if a trainee exits a training program Principle 4 Training requirements should be informed by relevant and up-to-date information about future service needs. 1. How well does the current health system determine medical training requirements? This assumes that the health system should determine medical training, which is arguable. Specialist medical training involves education and training to a nationally and/or internationally accredited standard within a professional medical domain that is informed by broader criteria than service needs (for example research). Consequently, specialist medical training may not National Medical Training Advisory Network consultation 6

7 align neatly with specific service delivery needs in clinical settings at any point in time. The training program is intended to develop a trainee to the level of a junior consultant who is competent to provide safe clinical care for a range of presentations he or she is likely to encounter in routine clinical practice. So, service needs inform and guide training but do not, and should not, determine medical-training. 2. How well does the current higher education system determine medical training requirements? The points raised in the previous question apply also to higher education training programs. The RANZCP has approved specific university courses for inclusion in the training program. However, none of these would determine psychiatry training. 3. What feedback mechanisms exist for reviewing these system requirements? University courses utilised in the RANZCP are reviewed and approved by the RANZCP Board of Education, which includes psychiatrists involved in clinical supervision. Committees of the Board of Education include trainee representatives and the Committees consult with community representatives and Aboriginal and Torres Strait Islander peoples on core competencies, how these should be taught and assessed. During the process of accreditation, the AMC independently seeks feedback from each of these stakeholder groups. This feedback is provided to the Board of Education. 4. How can the data and information that shapes medical training policy decisions be improved? There are too many data sources of variable quality. There is no nationally consistent coding for mapping geographical distribution of psychiatrists. Nor is there a clear set of principles or definitions to guide data collection and interpretation. There needs to be a nationally coordinated approach to data collection with results made available to key stakeholder groups. 5. In a health system that is increasingly planned at a local level, how can local intelligence and data sets be balanced with national information? Establish networks and hubs such as Hunter Valley (Orange) NSW to capture local intelligence and collect data within a long-term national data collection strategy that is centrally coordinated. Release regular reports on workforce data. Continue the HWA and Mental Health Commission initiatives and regional workshops. Principle 5 Training places for Australian trained medical graduates should be prioritised over immigration of overseas trained doctors to fill workforce gaps in responding to short and long-term workforce need. 1. How can immigration be better managed to respond to short-term demand issues, while retaining a focus on domestic training to fill workforce gaps? Establish partner-training short-term programs with countries that have substantially equivalent training programs. Ensure that International Medical Graduates (IMG) who work in these positions are adequately supported and receive recognition of their experience. 2. How can local employment actions be linked to a state and national strategy, to replace immigration of doctors with Australian trained medical graduates? This question assumes that local doctors will want to locate to areas currently staffed by IMGs, however, there is little evidence to support this. There needs to be two-pronged approach; one that explores why Australian trained doctors do not want to work in regional and rural locations and what incentives could be developed to attract and retain them. The other requires a significant shift in attitude towards IMGs, many of whom have been recruited to these positions through government initiatives and have provided valuable services. The solution to this issue requires collaboration with regional economic development initiatives. National Medical Training Advisory Network consultation 7

8 3. How do we get the balance right between domestic training and skilled migration to meet current and future health service requirements? Refer to previous question. 4. Accepting many communities are reliant on employment of overseas trained doctors, how can the potential adverse impact on service provision be avoided as policies are adjusted? A significant amount of money has already been invested in IMGs and as previously stated, many IMGs provide a valuable resource. With demographic changes occurring in Australia, further work could be undertaken to provide support to IMGs and provide them with professional recognition so that they continue to contribute to the infrastructure of places where they are currently working. National Medical Training Advisory Network consultation 8

9 Section 3: What are the key functions of the NMTAN? Consultation questions Function 1 The NMTAN should provide a mechanism to link governments, professions, employers, colleges and universities. 1. Is this the right mix of members or should others be considered? Add Mental Health Commission 2. What are the benefits and drawbacks of having the National Medical Training Advisory Network of this size? Benefits include opportunities for identifying key issues for streamlining approaches and obstacles to achieving efficiency and effectiveness. Risks include being unable to achieve continuity and consensus across the federal-state stakeholders, escalating costs and inability to ensure implementation of recommendations. 3. How should the National Medical Training Advisory Network be managed and operationalised to maximise impact? MTAN needs influential leadership at senior level with a strong executive that is able to build alliances, manage stakeholders and navigate the political system. It also needs to develop a strong strategic and communications plan to provide regular information to the public. 4. In a system that is becoming increasingly regionally devolved, how can a national approach add value? The MTAN can provide the big picture and map out a strategic approach to addressing medical workforce needs. The networks approach means that it can also drill down to the local issues and feed these into the bigger picture. Function 2 The NMTAN should develop medical training plans informed by analysis of information and quality data sources to identify future workforce supply 1. What would be the best approach to accessing and collating such data? Assign responsibility to one body to ascertain what data is needed and who is collecting what? 2. How can service planning information, and therefore workforce requirements, be best accessed to inform national considerations of medical training? For mental health, obtain data on the treatment pathways for consumers and needs of carers across the life span to identify gaps and key services. Obtain data on service demands and service gaps e.g. after hours service requirements. 3. Where are the anticipated data gaps that need to be filled and how can they be filled? How to define distribution: should it be population based, by geographical location? Establish key sources e.g. HWA, MSOD, MABEL, AHPRA, AMPCo, Medicare, AIHW? Data on how doctors practice e.g. public-private mix, outreach. What "business models" do they develop for their practice? National Medical Training Advisory Network consultation 9

10 How does practice change over time? It needs to be easy for organisations to obtain data. National Medical Training Advisory Network consultation 10

11 4. Where key data sets are unavailable, what approach should be adopted to get the necessary information? Refer to question 3 in previous section. Function 3 The NMTAN s rolling five-year medical training plans should consider employment demand How well do the potential elements identified in the training plans meet national, regional, enterprise or sectoral needs? The potential elements seem appropriate. However, given the known difficulties associated with mal-distribution of specialists, inclusion of guidelines for accreditation of posts in the section on policy options and strategic approaches would be useful to establish consistency of the training environment How could the training plans recognise the changing dynamics of the health system including reform and innovation? By continuing monitoring, data collection and evaluation of initiatives with regular reports to key stakeholders. Presentation of grants and awards in recognition of excellence and innovation. Publication of comparisons with similar initiatives in UK, USA, Canada and New Zealand What additional issues should the plans consider to meet national, regional, enterprise or sectoral needs in the short, medium and long term? No additional issues What areas should be outside the scope of National Medical Training Advisory Network advice? Agree with exclusions detailed on page 23 of the MTAN Discussion Paper..3 The NMTAN s rolling five-year medical training plans should consider both trainee supply and employment demand. National Medical Training Advisory Network consultation 11

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