7.5 Governance and administration

Reference Group 2 developed principles that could guide the implementation process. These take into consideration the recurring themes of educational imperative, the need to support clinical service and teaching in public hospitals (which will continue to play the major role in training specialist trainees), and the need to address workforce needs locally and nationally.

Reference Group 2 also identified some important matters that will need to be taken into account when options for a governance and administration structure are being considered. Stakeholder consultation, including consultations with consumers of health care, will be vital from the early stages of the process.

Overarching principles for implementation

The following overarching principles were developed by Reference Group 2 to guide the implementation process.

• Existing training programs for the majority of specialties need to be expanded to facilities outside the traditional teaching hospital model to ensure that specialist trainees can access the breadth and depth of clinical experience they need, and allow them to train in the full range of practice settings required for some aspects of medical specialist training.
  
  
• Development of new training arrangements should ensure that the quality and safety of clinical services provided by major teaching hospitals, and the teaching and research activities, can continue to improve.
  
  
• Public teaching hospitals should continue to play a central role in the training of specialist trainees and, wherever possible, should be encouraged to enhance the resources and facilities available to support a strong training experience. Any enhanced training arrangements implemented will not preclude teaching hospitals from expanding their existing training capacity.
  
  
• Enhanced training arrangements should be targeted at areas of specialist practice in which there is currently a difficulty in optimally meeting curricular requirements using the traditional public teaching hospital model for specialist training.
  
  
• Enhanced training arrangements should take into account the need to expand the number of specialist training positions to meet the interests of patients and the health care needs of the community.
  
  
• Enhanced training arrangements will be accredited in accordance with appropriate accreditation criteria to ensure their quality, to assist the quality and safety of their clinical services across the patient journey, and to make sure research activities continue to improve.
  
  
• Enhanced training arrangements consistent with these principles may be developed, funded and implemented at a national, regional or local level in accordance with the operational guidelines.

Suggested guidelines for expanded training arrangements

Proposals seeking funding to support expanding training arrangements must include:

• Confirmation that all relevant stakeholders have agreed to participate. These stakeholders would normally include major metropolitan public hospitals, public hospital networks or consortia (existing training sites), additional training facilities such as private hospitals or community settings, and colleges, supervisors and specialist trainees. Some proposals may not need all these stakeholders to be involved.
  
  
• Demonstration that curricula requirements cannot be optimally addressed using the traditional public teaching hospital model, and that this gap can be filled by using the new setting.
  
  
• Evidence of how the inclusion of the new setting will meet curricula requirements and enhance the specialist trainees' learning opportunities.
  
  
• Identification of the impact on workforce issues including, but not limited to, the public hospital workforce and recruitment and retention.
  
  
• Confirmation of no loss of specialist trainees' employment entitlements and that other related issues, such as workers compensation and indemnity issues, have been addressed.
  
  
• Evidence of accreditation or satisfactory progress towards the accreditation of the new training arrangements by the relevant college.
  
  
• Evidence of capacity to meet the program monitoring and data requirements.

Once the above have been satisfied, the next level of decision making will be between proposals for funding.

This decision making process should take into consideration:

1. the extent / degree of educational need
2. the need to ensure that sufficient vocational training positions are available to meet increases in demand for specialist training positions
3. the need to satisfy an overall workforce shortage in a particular specialty.

Options for governance and administration

An appropriate governance and administration structure to manage the program to expand specialist training settings in a variety of specialties and jurisdictions will need to be developed. It will need to recognise the source and quantum of funding, the stakeholders involved and the desired program outcomes.

Relevant principles and considerations will include:

1. the importance of involving all stakeholders, including consumers of health care, from the earliest stages
2. the role of teaching hospitals and colleges in specialist medical education
3. responsibility for allocation of funds
4. accountability for utilisation of funds
5. evaluation of program outcomes, including monitoring the utilisation of funds and the quality and consistency of training in the additional settings
6. linkages between education / training and service requirements.

Examples of possible governance structures range from a body that provides advice on the expansion of training settings - such as determining the criteria against which applications for funding should be assessed - or a body that makes recommendations and provides funding to jurisdictions for implementation, through to one that provides funding directly to parties implementing expanded training arrangements.

Depending on which structure is chosen, the responsibilities of the governance structure could include:

1. providing advice on the expansion of training settings
2. allocating funding
3. confirming the principles and guidelines to manage implementation
4. assessing submissions for new training arrangements and making recommendations about which proposals should receive funding, the quantum of appropriate funding etc.
5. monitoring the utilisation of funds and evaluating the outcomes achieved.

The degree of staffing support required, and the party required to provide that support, would vary depending on the structure adopted.

The governance structure would benefit from both government membership - Commonwealth and state and territory - and representatives from medical specialist colleges, trainees, health consumers and possibly the private sector. Expertise from these groups would be a valuable source of knowledge for implementation and evaluation. Members could be nominated through these organisations for their expertise and technical skills, rather than as representatives.

A review of the structure and function of the governance arrangements would be required after the initial years of operation to make sure it was still appropriate and effective over the longer term. Phased implementation may need to coincide with the increase in graduate numbers. The initial governance structure could therefore be a transitional arrangement, with the subsequent arrangements informed by the progress and outcomes achieved in the early years.