The stakeholder consultations expressed reservations about applying a national training model. Most respondents preferred custom built programs, built on consistent general principles, that acknowledge and accommodate differences across jurisdictions and disciplines. Training opportunities and options need to be identified by jurisdiction and speciality and implemented in a flexible and responsive manner. In most cases, changes to training settings should be implemented incrementally.
The Reference Group notes that the Council of Australian Governments agreed an implementation timeframe of January 2008 for the first stage of a system enabling specialist trainees to undertake training rotations in an expanded range of settings.
10.1 Overarching principles for implementation
- Existing training programs for the majority of specialties need to be expanded to facilities outside the traditional teaching hospital model to ensure that trainees can access the breadth and depth of clinical experience they need by allowing them to train in the full range of practice settings required for some aspects of medical specialist training.
- Development of new training arrangements should not have a detrimental impact on current training programs or services provided by major teaching hospitals.
- 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 shall 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 in order to meet the interests of patients and the healthcare needs of the community.
- Enhanced training arrangements will be accredited in accordance with relevant accreditation criteria to ensure the quality of that training (while recognising that trainees will usually rotate through settings for either block periods of time, such as 6 or 12 months, or on a sessional basis).
- Consistent with the above principles, enhanced training arrangements may be developed, funded and implemented at a national, regional or local level in accordance with the processes outlined below.
10.2 Operational principles
Proposals seeking funding to support expanding training arrangements must include:- Confirmation that all relevant stakeholders have agreed to participate
Stakeholders would normally include:(although for some proposals not all stakeholders mentioned below may need to be involved).
- Major metropolitan public hospital(s), public hospital networks or consortia (existing training sites);
- Additional training facility/ies (e.g. private hospitals, community settings);
- College;
- Supervisors; and
- Trainees
- 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(s) will meet curricula requirements and enhance the trainees' learning opportunities.
- Identification of impact on workforce issues including but not limited to:
- Public hospital workforce; and
- Recruitment and retention.
- Confirmation of no loss of trainees' employment entitlements and other related issues (e.g. workers' compensation and indemnity issues are 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.
- the extent/degree of educational need;
- the need to ensure that sufficient vocational training positions are available to meet increases in demand for specialist training positions; and
- the need to satisfy an overall workforce shortage in a particular specialty.
10.3 Governance and administration
An appropriate governance and administration structure to manage a program to expand specialist training settings in a variety of specialties and jurisdictions will need to be developed in recognition of the source(s) and quantum of funding, stakeholders involved, and the desired program outcomes.Relevant considerations will include:
- Role of teaching hospitals and colleges in specialist medical education
- Responsibility for allocation of funds
- Accountability for utilisation of funds
- Evaluation of program outcomes including:
- monitoring utilisation of funds
- monitoring quality and consistency of training in the additional settings
- Linkages between education/training and service requirements.
In the next section, two options are proposed for the governance and administration of programs to expand settings for medical specialist training.
10.4 Options
Options for a governance and administration structure include:- Council for Expanded Medical Specialist Training
- Expert Advisory Committee on Expanded Medical Specialist Training
1. Council for Expanded Medical Specialist Training
Appointment and accountability
It is anticipated that a council on this issue would most likely be established by the Australian Health Ministers' Conference (AHMC).Roles & responsibilities
Under this option, the council would be responsible for allocating funds in accordance with the operational principles.The council would also be responsible for monitoring the utilisation of funds and evaluating the outcomes achieved under the program, either directly or through jurisdictional reporting requirements.
Membership
If the council was to provide funding directly, the process of implementing expanded training arrangements would benefit from a wider membership beyond government, to include medical colleges, trainees and possibly private sector representation.For example, membership could consist of:
- One nominee of CEO or Chief Medical Officer of the Commonwealth
- Two nominees of states and territories (large state/small state)
- Two nominees of the Committee of Presidents of Medical Colleges
- Two nominees of the AMA Junior Doctors in Training
- Two nominees of the Workforce Principal Committee
- Two consumer representatives
Administrative support
Administrative support for a council could be provided by an independent secretariat hosted by the Commonwealth or jurisdiction(s).Technical support
If the council were to provide funding directly, significant technical support would need to be provided through a secretariat to implement the decisions of the council. The secretariat would need to have standing to negotiate and contract with training providers as a legal entity.If the council was providing funding to jurisdictions, it is likely that each jurisdiction would need to commit additional staffing to implement the decisions of the council, including negotiating and contracting with training providers, collating data and reporting on outcomes achieved.
Tasks
The tasks of the council (with secretariat support) would be to:- actively seek and assess submissions for new training arrangements
- determine which new arrangements shall proceed and the conditions of approval (with reference to principles established by the council)
- monitor training arrangements
- report on outcomes achieved
- establish and manage agreements with successful applicants
- monitor performance against the agreements
- report on outcomes achieved
2. Expert Advisory Committee on Expanded Specialist Training
Options under this model include an expert advisory committee which provides advice to those implementing to the expansion of training settings, or a "decision-making committee" which makes specific recommendations regarding how such expansion should be implemented.Appointment and accountability
It is anticipated that an expert advisory committee on this issue would most likely be established by the Australian Health Ministers' Conference (AHMC).Roles & responsibilities
This approach could be implemented in two ways:- The expert advisory committee could provide advice to those parties contributing funding to the expansion of training settings (e.g. Commonwealth, jurisdictions) on how implementation may be most effectively pursued, such as determining the criteria against which applications for funding should be assessed.
- Alternatively, the expert advisory committee may assess submissions for new training arrangements and make recommendations regarding which proposals should receive funding, quantum of appropriate funding etc. These recommendations would then be considered by the relevant party(ies) providing the funding.
Membership
Membership of an expert advisory committee would be likely to consist of representatives from up to four jurisdictions (drawn from larger and smaller states), nominated through AHMAC, with the Chair probably from either the Australian Government or an appointee of AHMAC. The jurisdictional representation could be rotated each year to ensure all participating jurisdictions are represented.Advice from other stakeholders likely to be involved in implementation (e.g. specialist medical colleges, clinicians, trainees, private sector) would also be valuable. This could be incorporated into the intergovernmental process through the membership of the committee, as a sub-committee, or on an ad hoc basis.
For example, membership could consist of:
- One nominee of CEO or Chief Medical Officer of the Commonwealth
- Two nominees of States and Territories (large State/small State)
- Two nominees of the Committee of Presidents of Medical Colleges
- Two nominees of the AMA Junior Doctors in Training
- Two nominees of the Workforce Principal Committee
- Two consumer representatives
Administrative support
Administrative support for an expert advisory committee could be provided by a secretariat hosted by the Commonwealth or jurisdiction(s).Technical support
If the expert advisory committee were to provide advice on the expansion of training settings to those parties providing funds (e.g. Commonwealth, jurisdictions) in relation to matters such as the criteria against which applications for funding should be assessed, the technical support required of a secretariat would probably not be significant. The onus would be on those parties funding and implementing arrangements to provide staffing support to undertake the required negotiating, contracting and reporting requirements.If the expert advisory committee were to assess submissions for new training arrangements and make recommendations regarding which proposals should receive funding, quantum of appropriate funding etc, the technical support required of the secretariat would be more significant, as they would need to undertake additional tasks such as processing and analysing submissions, liaising with applicants and reporting on outcomes. The onus would continue to be on those parties providing funding to implement any arrangements expanding training settings.
Tasks
The tasks of the expert advisory committee (with support of secretariat) would be to:- establish criteria/principles against which applications for funding would be assessed; and/or
- determine which new arrangements shall proceed and the conditions of approval.
- determine which new arrangements shall proceed and the conditions of approval (if expert advisory committee is only advisory)
- establish and manage agreements with successful applicants
- monitor performance against the agreements
- evaluate individual training arrangements
- report on outcomes achieved.