3.2 Surveying specialist medical colleges

Reference Group 3 contacted all medical specialist colleges asking for information on current examples of training across a range of settings, the potential to expand these opportunities, and the learning goals that would apply to each setting.¹⁶

The responses from the colleges were collated to provide comparative information on current and optimal training across settings (within each college), educational goals for each setting (between colleges and across settings), and infrastructure and resource requirements.

Survey results

The survey results indicated that specialist colleges are already recognising the potential of diversifying training opportunities and intend to increase the proportion of training in settings outside public hospitals.

Most colleges expressed support for a relatively modest increase in training across the alternative settings. Some colleges, such as the Australasian College for Emergency Medicine and the Australasian College of Dermatologists, projected that their greatest increase would be into regional public hospitals, while the Royal Australian and New Zealand College of Radiologists indicated they were expecting a substantial change in the balance of their training programs towards private ambulatory care. For all other colleges, the greatest increase in projected training settings was into metropolitan private hospitals and private and/or community ambulatory care. The majority of colleges proposed a relatively modest increase of 10-20% across all settings.¹⁷

The Royal Australasian College of Physicians identified important learning goals for consultant physicians and paediatricians working in settings other than public hospitals. They need to:

• Gain experience in diagnosis and ambulatory care management of patients with complex chronic multi-system disease. The aim of such care is to keep patients as well as possible and minimise hospitalisation. For example heart failure with co-morbidities of hypertension and renal disease, or chronic obstructive lung disease with co-morbidities of diabetes and angina, or a child with a developmental disability and associated recurrent respiratory infections.
  
  
• Develop skills in multidisciplinary team care with community-based health professionals, rather than hospital teams. For example cancer care, palliative care, visiting nurse services and home support services.

Paediatric trainees need to gain an understanding of referral processes and be able to liaise with local resources which impact on child health and development. These include maternal and child health services, early intervention services, social welfare services, school nursing, preschool and school educational services.

In addition, with changes to the casemix seen in public hospitals, it is now necessary for trainees in many of the surgical specialties to have some of their training experiences in private settings. This is needed so they can confidently perform some of the most common operations such as elective general and orthopaedic surgical procedures and reconstructive and plastic surgery.

Types of expanded settings

Possible expanded settings for specialist training include private hospitals, private practices, community based team practices and non-clinical settings.

Private hospitals

Private hospitals provide important alternative training opportunities. A small number of private hospitals are of a similar size to, and have similar clinical resources as, moderate sized public teaching hospitals. Many of these are already used for medical training and an increasing number support specialist training. There is however a need to develop and support educational infrastructure in these environments.

Smaller private hospitals often care for patients with a different spectrum of illness than public hospitals. These hospitals offer valuable opportunities for training in a broad range of procedures, some of which are now uncommon in larger public hospitals. In the survey of colleges, many identified private hospitals as being able to contribute to specialist trainees’ clinical experience, as well as training in procedural skills.

Private practices

The training opportunities in private clinical practices are wide - ranging from office based consultative work to large, well resourced diagnostic groups providing sophisticated diagnostic imaging or pathology services. Specialist trainees would receive a comprehensive education which should complement the clinical experience received from hospitals, and prepare them for working as specialists in private practices. An increasing number of trainees in dermatology, pathology and diagnostic imaging are offered training opportunities in private practices.

Community based team practice

Community based team practices often care for patients with special needs - such as the very young, the elderly, the disabled, the dying or those with mental illness. These practices provide opportunities for experiencing team based clinical care of chronic rather than acute illness, not readily available in acute public hospital settings. They also provide opportunities for health promotion, prevention (particularly secondary prevention), early identification and early intervention. For this reason, block periods of time in community based health services have already become an important part of training in geriatrics, psychiatry, paediatrics and child health.

The Royal Australasian College of Physicians identified the dual relationship between the competencies in the relational domain (eg communication skills) and community training settings. Communication skills and the capacity to relate to people from all cultures and backgrounds are important for all medical specialists, especially those who work in multi-disciplinary environments such as community based team practices.

Non-clinical settings

Clinical settings remain the most frequent settings for practical training. However specialist colleges acknowledge that valuable learning can occur in non-clinical settings such as tertiary institutions, clinical skills laboratories, and scientific and clinical meetings.

Simulated learning environments can complement clinical environments and may reduce the patient risk of the novice student. They can be used to increase trainees' skills and confidence, while providing them with thorough and comprehensive feedback and supervision.

16 See Reference Group 3 report, More Doctors, Better Training: Specialist medical training to meet the needs of all Australians to 2016 (2006).
17 See Reference Group 3 report, More Doctors, Better Training: Specialist medical training to meet the needs of all Australians to 2016 (2006) for detailed survey results (Appendix E).