Expanding settings for medical specialist training

Appendix A: Terms of Reference

Page last updated: October 2006

Medical Specialist Training Steering Committee
Reference Group 1: Risk Assessment
Reference Group 2: Implications for Service Delivery in Public Hospitals
Reference Group 3: Review of Training Programs

Medical Specialist Training Steering Committee

Terms of reference

The Medical Specialist Training Taskforce (the Taskforce) has developed a training model, to formally incorporate a more diverse range of settings into medical specialist training. These settings include public hospitals, private hospitals, private practice settings, rural and regional settings, community based practices and non-clinical settings.
  1. The Medical Specialist Training Steering Committee is required to oversee:

    1. The development of a risk assessment detailing the benefits and costs associated with the revised training model. This will be undertaken by an independent consultant and informed by the work of the Taskforce, in particular the Risk Assessment framework. A reference group to guide this activity will be chaired by the Australian Government.

    2. An exploration of the implications for service delivery in public settings. This will be undertaken by an independent consultant and informed by the training model developed by the Taskforce. A reference group to guide this activity will be chaired by a state or territory government representative. All State and Territory Health Departments may participate.

    3. A review of training programs to better align training curricula with settings for delivery as guided by the Taskforce recommendations for training items 3-7. Training modules could be provided by any Australian Medical Council accredited provider, such as the relevant specialist college, a university, or other appropriate body. A reference group to guide this activity will be chaired by a specialist college educational expert. This reference group must include state and territory representation.

  2. Each reference group will be required to report its findings to the Steering Committee, to be used in providing advice to AHMAC.

  3. The Australian Government will chair the Steering Committee. Membership will also include at least three state and territory representatives, and a representative of each of the following: the Committee of Presidents of Medical Colleges, the Australian Medical Association, the Australian Medical Association Council of Doctors-in-Training, the Australian Medical Council, private hospitals, Censors in Chief of medical specialist colleges and additional experts as required.

  4. The Australian Government will provide secretariat services for the Steering Committee.

  5. The Steering Committee will provide advice to the Australian Health Ministers' Advisory Council in consultation with AHWOC. Further information regarding the proposed work plan and timeframes for the Steering Committee is outlined in the flow chart overleaf. Top of page

Reference Group 1: Risk Assessment

Terms of reference

Reference Group 1 will progress the Medical Specialist Training Steering Committee Terms of Reference by:
  1. Providing guidance to a tender process and consultancy for assessments of:
    1. The additional costs associated with implementing the model of training developed by the Medical Specialist Training Taskforce, including those which are currently undertaken without charge.
    2. The quantitative or qualitative value of the benefits associated with the training model.

  2. Develop a Statement of Requirement, for the tender process, which is based upon the Medical Specialist Training Taskforce report to the Australian Health Ministers' Advisory Council.

  3. Use data provided by the Australian Government, which assesses the balance between the increased number of training positions demanded by new medical school and Australian Medical Council graduates, and the number of training positions required to meet community need.

  4. Reporting to the Steering Committee on the assessment results.

  5. Contributing to and liaising with the following other Reference Groups as appropriate:
    1. Reference Group 2: Implications for Service Delivery in Public Hospitals
    2. Reference Group 3: Review of Training Programs

The Reference Group will be disbanded at a time determined by the Medical Specialist Training Steering Committee.

The Reference Group will include representation from the Steering Committee and other experts as required.

Conduct of business

  1. The meeting papers will be distributed in the week prior to the meeting.
  2. The Minutes will be distributed by email to all members prior to the next meeting/ teleconference.
  3. The Minutes will include actions, the responsible person, due dates, and outcomes, where applicable.
  4. Meetings will proceed with no requirement for a quorum.
  5. The Australian Government will provide secretariat services to support this work.Top of page

Reference Group 2: Implications for Service Delivery in Public Hospitals

Terms of reference

Reference Group 2 will progress the Medical Specialist Training Steering Committee Terms of Reference by:
  1. Providing guidance to a tender process and consultancy for an assessment of the implications of the proposed training model for service delivery in public hospitals.

  2. Develop a Statement of Requirement, for the tender process, which is based upon the Medical Specialist Training Taskforce report to the Australian Health Ministers' Advisory Council.

  3. Use data provided by the Australian Government, which assesses the impact of the increased number of training positions demanded by new medical school and Australian Medical Council graduates on the number of training positions required to meet community need.

  4. Reporting to the Steering Committee on the assessment results by 2006.

  5. Contributing to and liaising with the following other Reference Groups as appropriate:
    1. Reference Group 1: Risk Assessment
    2. Reference Group 3: Review of Training Programs
The Reference Group will be disbanded at a time determined by the Medical Specialist Training Steering Committee.

The Reference Group will include representation from the Steering Committee and other experts as required.

Conduct of business

  1. The Agenda will be distributed in the week prior to the meeting.
  2. The Minutes will be distributed by email to all members prior to the next meeting/ teleconference.
  3. The Minutes will include actions, the responsible person, due dates, and outcomes, where applicable.
  4. Meetings will proceed with no requirement for a quorum.
  5. The Australian Government will provide secretariat services.Top of page

Reference Group 3: Review of Training Programs

Terms of reference

Reference Group 3 will report to the Medical Specialist Training Steering Committee on:
  1. The educational imperative for training in settings other than public teaching hospitals, including private hospitals, public hospitals, private practice, community based settings, rural and regional setting and non-clinical settings

  2. The proportion of time estimated by specialist colleges for clinical and non-clinical training to take place in each setting of the training model

  3. For each specialty and, where applicable, sub specialty the learning goals related to each type of setting

  4. The infrastructure and resource requirements required in each potential setting to support the learning objectives, bearing in mind that the proposed training model recommends a networked approach to training settings and should anticipate collaborative resourcing arrangements between specialties, settings and governments.

  5. Overlaps between the learning goals, training settings and opportunities for standardisation and collaboration between colleges with respect to training in settings other than public teaching hospitals.
This report should be consistent with the following Medical Specialist Training Taskforce recommendations to the Australian Health Ministers' Advisory Council, in November 2004:
  1. A common inter-college educational framework (Item 1A) is incorporated into the Australian Medical Council process for accreditation of specialist medical education and training programs.

  2. Experiential training is complemented by alternative methods of training (Item 1B).

  3. The diversification of training maintains its relevance and applicability to the professional capabilities required by the specialty (as is evidenced in CanMEDS).

  4. High quality supervision (as currently aimed to be provided in public teaching hospitals) is provided to all trainees in all training settings, with consideration of the financial implications.

  5. Training infrastructure and resources are integrated, horizontally and vertically. That is, across all levels of medical education including undergraduate, postgraduate and vocational; and across all health related teaching disciplines.

  6. The principles for training, which were developed by the Medical Specialist Training Taskforce (Item 1C).
Reference Group 3 will also contribute to and liaise with:
  1. Reference Group 1: Risk Assessment
  2. Reference Group 2: Implications for Service Delivery in Public Hospitals
  3. Training stakeholders and experts, including the Australian Medical Council, specialist medical colleges, and universities.
The Reference Group will be disbanded at a time determined by the Medical Specialist Training Steering Committee.

The Reference Group will include representation from the Steering Committee and other experts as required. Top of page

Item 1A: Definition of an Ideal Medical Specialist

A medical specialist has the competence and expertise to successfully apply professional medical knowledge, skills, and attitudes to new situations as well as familiar tasks. These abilities are demonstrated through clinical skills, patient care, and professional judgement across five domains:
  • Cognitive: Acquisition and use of knowledge to recognise and solve real-life problems

  • Integrative: Appraisal of investigative data against patient needs in clinical reasoning, manage complexity and uncertainty

  • Psychomotor: Procedural knowledge, technical skill, manual dexterity, and adaptability

  • Relational: Ability to communicate effectively, accept accountability, team-work, and consultative

  • Affective/moral: Self-awareness, ethical, critically reflective, responsible, healthy and safe

Item 1B: Alternative methods of training

  • Mentoring and role modelling

  • Rapid learning (virtual) environments and simulation/skills centres

  • Case discussions, audit, peer review, and critical appraisal of literature

  • Workshops and conferences

  • Self-directed learning

  • Multi-disciplinary teams

  • Software and web-based training Top of page

Item 1C: Principles for training

  • Trainees must have a stable professional environment and receive appropriate levels of professional and educational support throughout their training.

  • Trainees are given opportunity to receive training whilst providing service delivery commitments.

  • Trainees must be provided with equitable and flexible access to training opportunities, including portability of training and recognition of prior learning.

  • Trainees receive appropriate and consistent entitlements and reimbursement for their services.

  • Trainees must be provided with the opportunity to experience research and pursue scholarship, and contribute to the teaching of others.

  • Lifelong learning principles must be incorporated into specialist medical training.

  • Training should encourage concepts of health as well as illness (disease diagnosis, management, prevention and health promotion).

  • Trainees are provided with the tools and skills to provide training to undergraduate and prevocational students, in their environment.

  • Health service providers recognise and promote that training underpins the long-term sustainability of the workforce.

  • Specialist medical colleges, specialists and supervisors promote service delivery by trainees in all appropriate settings, in accordance with the benefits that trainees bring into training settings and the longer term benefits to all patients of more appropriate training arrangements.

  • Settings involved in specialist medical training are equipped with the necessary infrastructure and resources required for training.

  • Trainees must be involved in the governance and management of training