Specialist training in private hospitals
The Australian and New Zealand College of Anaesthetists have three training programs in private hospitals. At Westmead Private Hospital in New South Wales specialist trainees rotate for periods of three months from the public hospital. Noosa Private Hospital is part of a network of public and private hospitals providing rotations for three or six months, and a specialist trainee at Gosford Public Hospital is involved in one list per week at a satellite private hospital to gain experience in procedures that are not available at the primary site.In Western Australia, the Royal Australian and New Zealand College of Radiologists have three training positions that are entirely based in a private hospital. All radiology trainees also have experience in a rural hospital which provides both public and private care. Trainees benefit from these experiences because of the wider casemix, and are provided with accommodation while they are in the rural setting.
Specialist training in outer-metropolitan private settings
The Australian Government has established a set of training pilots to place specialist trainees from a range of medical specialties in the outer metropolitan specialist trainees program, thus facilitating private practice placements for specialist trainees. The program aims to develop and implement effective and sustainable models for specialist training in private practice while providing training opportunities for specialist trainees outside teaching hospitals. Built into the model are mechanisms to address issues such as indemnity and fee management.Currently there are placements in this program within the Royal Australasian College of Physicians - including two adult medicine placements in New South Wales and four in Victoria, plus two paediatric placements in Victoria.
The Royal Australasian College of Surgeons has five trainees in a similar program (4 full-time and 1 part-time) with posts in New South Wales, Queensland and Western Australia.
Specialist training in private practices
The Australasian College of Dermatologists has provided training in private practices in New South Wales, Queensland and the Northern Territory. These rotations vary from one day per week to full-time for six months, or half-time for 12 months. An evaluation of the program indicated that the posts are effective in meeting course objectives and have a high level of satisfaction from trainees, patients and supervisors.The Royal Australian and New Zealand College of Ophthalmologists has full-time posts in private practices in rural New South Wales and another in an urban setting in Victoria. Each post is part of a network and provides training for four trainees (three months each) per year. There is potential to expand this scheme to include posts in Tasmania and Queensland.
All trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists spend 6-12 months in rural practice, during which they are involved in clinics managed through private practices. It is estimated that, at any one time, approximately 10 trainees are involved in this kind of experience – plus another 5 in the sub-specialties of ultrasound and reproductive endocrinology and infertility.
The Royal Australian and New Zealand College of Psychiatrists has training in three private practice clinics in Victoria, New South Wales and Queensland. They noted that at some of these settings trainees need a four to eight week orientation to prepare them for working in the new environment.
The Royal College of Pathologists of Australasia (RCPA) has 30 trainees in private practice in New South Wales, Victoria, Queensland and Western Australia. Twenty are under a scheme funded by the Commonwealth Government and ten directly funded by private laboratories. The RCPA has a requirement that each trainee must spend a minimum of two years in one or more public pathology laboratory.
Specialist training in community based team practices
Trainees from the Royal Australasian College of Physicians (paediatrics) have a number of sessional placements including community health care centres, Aboriginal medical services and child protection agencies. In one such rotation, trainees combine hospital-based specialty ambulatory care at the Royal Children's Hospital Melbourne (RCH) with community clinics in particular geographic locations on site with child and family teams. Through these experiences they gain a better understanding of health issues for children and families in a community context, the health and other resources available in the community, and multidisciplinary team work. They also maintain links with their professional peers and continue to benefit from the education/training/research infrastructure at the RCH.The Australasian College for Emergency Medicine (ACEM) has accredited several special skills posts in New South Wales, Northern Territory, Western Australia and Queensland for training experience. These posts, called 'retrieval services', are with organisations such as the Royal Flying Doctor Service. All ACEM trainees are required to have 18 months in non-emergency department training and can have a maximum term of six months in one of these posts.
Home-based care as an expanded community setting
Palliative medicine trainees are required to do three mandatory training terms, one of which is training in a community setting - an outreach or home care service. The aim of this term is for trainees to gain experience, under supervision, in providing palliative medicine consultations in domiciliary settings and ambulatory care clinics. Palliative medicine has two and a half FTE trainees currently undertaking this training. They visit patients at home or in hostels and nursing homes at the request of the specialist, or by GP referral. It is a team approach to these visits, with the trainee being accompanied by the community nurse or occupational nurse. Alternatively the trainees may do joint visits with the community consultants.Specialist training in non-clinical settings
As part of the non-emergency component of their training, the Australasian College for Emergency Medicine trainees have the option of working in laboratory environments, such as toxicology or forensic medicine, or in simulation centres.As part of their first year of training, all Royal Australasian College of Surgeons' trainees are required to successfully complete a three day course developing basic surgical skills.
These examples demonstrate ways in which training is already expanding into non-traditional settings. As the number of specialist trainees undertaking training rotations in different settings increases, this process needs to become more formalised to ensure consistency and adequate support for both trainees and settings.