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1 Quality Framework for Intern Training Accreditation The aim of this document is to provide a national framework for assessment of the performance of the bodies that assess and accredit intern training programs. These bodies currently are the postgraduate medical councils. *There are differences between the delivery of education and training in other phases of medical education and in the internship which shape the documents. *Even more than the other phases of medical education, delivery of training and education for internship depends on the health care institutions and services. Internship is supervised work-based training supplemented with appropriate educational activities, which is delivered by health care institutions. The bodies that presently accredit specific posts and health services for intern training, the postgraduate medical councils, have set standards for intern training and worked with health services to encourage improvements in the quality of intern training in line with these standards. Through the development of and adherence to the Australian Curriculum Framework for Junior Doctors, they have provided the framework for education and assessment of junior doctors performance. Unlike medical schools and specialist medical colleges, however, postgraduate medical councils are not education providers. The AMC s approach to setting national standards for intern training reflects the differences in delivery of training and education in this phase of medical education. Rather than accredit postgraduate medical councils as education providers, the AMC has proposed criteria for assessment of the intern training accreditation work of the postgraduate medical councils, similar to the criteria applied to assess the work of the AMC as an accreditation authority under the National Law. The development of this framework has taken three documents into account: The Quality Framework for Accreditation (June 2011) was developed by the Australian Health Practitioner Regulation Agency, the National Boards and the Accreditation Authorities for the ten health professions which joined the National Registration and Accreditation Scheme on 1 July The Quality Framework is the principal reference document for AHPRA and National Boards to assess the work of the accreditation authorities. The Framework describes eight good practice domains relating to the accreditation functions defined in the National Law. Each domain is accompanied by specific attributes. The Prevocational Medical Accreditation Framework for the Education and Training of Prevocational Doctors (CPMEC 2009) which aimed to increase consistency, transparency and efficiency in prevocational medical accreditation processes in all Australian States and Territories, and to align prevocational accreditation with the best local and international accreditation processes. The PMAF describe 13 principles underpinning prevocational accreditation, as well as standards which outline the specifications, processes or procedures required for implementing prevocational education and training. World Health Organisation and World Federation for Medical Education (2005) WHO/WFME Guidelines for Accreditation of Basic Medical Education. The AMC is proposing that the framework for assessment of postgraduate medical councils performance as intern training accreditation bodies build on the work already completed in developing the Quality Framework for Accreditation and applying this framework to the assessment of the performance of the accreditation authorities for the ten registered health professions, including the assessment of the AMC. 1

2 The domains at a glance This document customises the eight domains of the Quality Framework for Accreditation agreed between AHPRA, the national boards and the accreditation authorities for the registered health professions. Five of the domains in this document relate to the governance, operation, and the program accreditation practices of the accreditation authority. These domains are relevant to a Quality Framework for Intern Training Accreditation. Of the remaining three domains, the domain relating to accreditation standards has been omitted. This domain is The accreditation authority develops accreditation standards for the assessment of programs of study and education providers. The proposed model for intern training accreditation, provides one set of national guidelines for intern training which intern training accreditation bodies would apply in assessing intern training programs. There is no need for a domain relating to the development of standards. Two domains from the Quality Framework for Accreditation relate to processes for assessment of overseas-trained health practitioners which are defined as accreditation functions under the National Law. These two domains have been omitted from this document. The Five Domains at a Glance 1. Governance - The intern training accreditation body effectively governs itself and demonstrates competence and professionalism in the performance of its accreditation role. 2. Independence The intern training accreditation body carries out independently the accreditation of intern training programs. 3. Operational management - The intern training accreditation body effectively manages its resources to perform functions associated with accreditation of intern programs. 4. Processes for accreditation of intern programs - The intern training accreditation body applies the approved national standards for intern training in assessing whether programs will enable interns to progress to general registration. It has rigorous, fair and consistent processes for accrediting intern programs. 5. Stakeholder collaboration - The intern training accreditation body works to build stakeholder support and collaborates with other intern training accreditation bodies, and medical education standards bodies. Process for assessment The AMC believes that the performance of intern training accreditation bodies could largely be assessed by paper-based and online processes. Any site visits as part of this process would be to provide opportunities to discuss and clarify the intern training accreditation body s policy and processes, and to observe key activities such as a local site inspection, or surveyor training. This is consistent with the process applied to assess the accreditation authorities under the National Law, which was a largely paper-based process, with opportunities for discussion between each accreditation authority and its national board. 2

3 Domain 1. Governance The intern training accreditation body effectively governs itself and demonstrates competence and professionalism in the performance of its accreditation role. The intern training accreditation body is a legally constituted body and registered as a business entity. The intern training accreditation body s governance and management structures give appropriate priority to the accreditation of intern training programs relative to other activities. The intern training accreditation body is able to demonstrate business stability, including financial viability. The intern training accreditation body s accounts meet relevant Australian accounting and financial reporting standards. There is a transparent process for selection of the governing body. The intern training accreditation body s governance arrangements provide for input from stakeholders including input from the health services, intern supervisors, and junior doctors. Notes None required Domain 2. Independence The intern training accreditation body carries out independently the accreditation of intern training programs. Decision making about accreditation of programs processes is independent and there is no evidence that any area of the community, including government, health services, professional associations has undue influence. There are clear procedures for identifying and managing conflicts of interest. Notes To ensure the independence of the accreditation function, the intern training accreditation role should be defined in a formal agreement with the relevant service purchaser or purchasers. 3

4 Domain 3. Operational management The intern training accreditation body effectively manages its resources to perform functions associated with accreditation of intern programs. The intern training accreditation body manages the human and financial resources to achieve objectives in relation to accreditation of intern training programs. There are effective systems for monitoring and improving the intern training accreditation processes, and identification and management of risk. There are robust systems for managing information and contemporaneous records, including ensuring confidentiality. Notes: None required. 4

5 Domain 4. Processes for accreditation of intern training programs The intern training accreditation body applies the approved national standards for intern training in assessing whether programs will enable interns to progress to general registration. It has rigorous, fair and consistent processes for accrediting intern programs. The intern training accreditation body ensures documentation on the accreditation requirements and procedures is publicly available. The intern training accreditation body has policies on the selection, appointment, training and performance review of survey team members. Its policies provide for the use of competent persons who are qualified by their skills, knowledge and experience to assess intern training programs against the accreditation standards. There are procedures for identifying, managing and recording conflicts of interest in the work of survey teams and working committees. The accreditation process includes self-evaluation, assessment against the standards, site visits where appropriate, and a report assessing the program against the standards. The accreditation process facilitates continuing quality improvement in the delivery of intern training. There is a cyclical accreditation process, in line with national guidelines and standards, which provides for regular monitoring and assessment of intern programs to ensure continuing compliance with standards. The intern training accreditation body applies national guidelines in determining if changes to posts, programs and institutions will affect the accreditation status. It has clear guidelines on how the institution reports on these changes and how these changes are assessed. The intern training accreditation body follows documented processes for decisionmaking and reporting that enable decisions to be made free from undue influence by any interested party. The intern training accreditation body communicates the accreditation status of programs to employers, prospective interns and other stakeholders. It communicates accreditation outcomes to the relevant health services facility and other stakeholders. There are published complaints, review and appeals processes which are rigorous, fair and responsive. Notes: Intern training accreditation bodies should take account of the following national standards for the intern training process. National standards for intern training have been designed to support intern training accreditation at the level of the intern training program. Intern training accreditation bodies will need processes to review a sufficiently wide sample of posts in greater depth to identify any significant deficiencies or developments in the way the accredited program selects and monitors posts for interns. Over the accreditation cycle, the intern training accreditation body should use an appropriate mix of methods to assess whether the intern training program is meeting the national standards. The methods would include surveys/questions, self-assessment by the intern training program, paper-based review, video/teleconference discussions, and site inspections. Site inspections and discussions should be used to validate and assess 5

6 information about those areas which represent the greatest risk to the safety of the intern and the quality of the intern s training. While much can be learnt from site visits and particularly discussions with interns, intern training accreditation bodies are encourage to use cost and resource effective ways of holding these interactions. The benefits of site visits, for example in validating aspects of the information, discussing issues with supervisors, interns, clinicians, and in retaining institutional commitment, need to be weighed against the cost and burden. The AMC supports a nationally consistent re-accreditation cycle for intern training programs. If no major change occurs in the program, and regularly monitoring indicates that a program continues to satisfy national standards, then the full period of reaccreditation should be four years. Changes in an intern training program, institution or posts may affect the quality of the intern training and require assessment. Major changes in circumstances which would necessitate a review would include: o Absence of senior staff with significant roles in intern training for an extended period with no replacement (e.g. Director Medical Services/Supervisor of Intern Training, absence greater than one month). o Proposal for significant redesign or restructure of the health service that impacts on interns (e.g. significant change to clinical service provision or closure of a ward causing change to caseload and case mix for the term) o Rostering changes which significantly alter access to supervision or exposure to educational opportunities. o Change to resources resulting in significant reduction of administrative support, facilities or educational programs available Intern training accreditation bodies also need clear guidelines on the changes in a rotation or unit which need to be reported and clear processes to determine those which may lead to a review. Examples of such changes include: o Absence of a rotation supervisor for an extended period (e.g. one month) with no replacement. o Absence of immediate clinical supervision for any period. o Significant reduction of clinical staff available to directly supervise and support prevocational trainees, including after hours. o Changes to unit medical staffing resulting in interns undertaking higher/alternative clinical duties than as described in the rotation position description for an extended period. o Significant changes to rotation casemix or clinical activity that impact on prevocational patient load for an extended period. o Significant changes to rostered hours that diminish the role of the intern in the unit and/or their clinical supervision (e.g. introduction of a predominantly afterhours roster). 6

7 Domain 5. Stakeholder collaboration The intern training accreditation body works to build stakeholder support and collaborates with other intern training accreditation bodies, and medical education standards bodies. There are processes for engaging with stakeholders, including health departments, health services, junior doctors, doctors who supervise and assess junior doctors, the national board, professional organisations, and consumers/community. There is a communications strategy, including a website providing information about the intern training accreditation body s roles, functions and procedures. The intern training accreditation body collaborates with other relevant accreditation organisations. The intern training accreditation body works within overarching national and international structures of quality assurance/accreditation. Notes: The prevocational phase requires a partnership between the bodies that accredit programs, and the health services that provide the supervised clinical placements, work-based education and training, the supervisors of training and the educational resources and facilities for interns. This partnership is essential for ensuring the quality of the intern year. 7

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