“The (current) assessment process is largely focussed on identifying the very few instances of serious underperformance, and provides little meaningful feedback for the majority.”
Review of Medical Intern Training
The Australian Taxpayer makes a considerable investment in the future of the healthcare system. Nationally, over $300M is invested per year to train interns (Australian Healthcare Ministers’ Advisory Committee, 2015), yet there is no qualitative or quantitative evidence that they currently meet the training objectives set for them.
In 2006 The Australian Curriculum Framework for Junior Doctors (Confederation of Postgraduate Medical Education Councils, 2012) was developed to provide structure to the learning and development of the next generation of clinicians. The ACFJD focused on the core knowledge, behaviours and practical skills in which a doctor should have achieved competency by the end of their second post-graduate year of practice. However, the ACFJD was released without mechanisms to deliver training or evaluation outcomes, and is widely been regarded as failing to meet its objectives.
In April 2014, the COAG Australian Health Ministers Advisory Council (AHMAC) commissioned the Review of Medical Intern Training (Council of Australian Governments, 2015) in response to increasing medical graduate numbers, and concern regarding the system’s capacity to train them within existing constraints.
The review found that despite the well-recognised variability in the skills of medical graduates, the “consumers” of Australia’s medical school product (the public health services) are unable to validate the work readiness of their new employees [National Intern Work Readiness Forum (Australian Healthcare Ministers’ Advisory Committee, 2016)]. Consequently, employers set unreasonably low expectations of their staff, resulting in underutilisation of the workforce, reduced productivity, disenchantment of interns and inefficient training.
Conversely, many interns continue to feel under-prepared at graduation. National surveys indicate that up to 44% of interns feel ill-prepared to perform basic procedures when they enter the workforce, leaving them prone to poorly perform tasks on patients, leading to error, injury, cost and distress for both patient and doctor alike.
Universities meanwhile continue to struggle to measure the quality of their graduates once in the workforce, significantly impairing their ability to calibrate the quality of their undergraduate programs.
The AHMAC report, and the National Intern Work Readiness Forum that followed it, have recommended fundamental changes be implemented, including :
- Defining the measurable competencies of a work-ready graduate
- Focusing on maximizing compliance with these competencies
- Development of robust assessment frameworks, based on the Entrustable Professional Attributes model, to assess work readiness
- Improving flow of information between university programs, regulators and employers
- Facilitating a philosophy of individual accountability for learning and development
- Supporting the expansion of training into non-traditional environments such as private practice.
The report called for research and development to support the change process, including delivery and assessment vehicles for the new framework.
Implementing the Osler platform would immediately address many of these recommendations.
|Box One : Abridged recommendations from the review of Medical Intern Training
Recommendation one : Internship should be changed to (abridged) :
- Require demonstration of specific capabilities and performance, within the time based model
- Ensure robust assessment of capabilities and feedback on performance
- Ensure doctors in training have sufficient responsibility, under supervision, to develop competence and confidence while maintaining patient safety
- Enable and require a philosophy of individual accountability for learning
Recommendation two :
- That internship should have entry requirements that reflect agreed and defined expectations of work-readiness that graduates must meet before commencing.
Recommendation three :
- Evaluation of different models of capability assessment, including [impacts on] resource requirements
- Evaluation of options for an e-portfolio to provide greater individual accountability for learning and support for the assessment process
- Examination of the capacity to assess and certify the capabilities and performance required for general registration within university programs
Recommendation seven :
- Provision of dedicated, time-limited support for local innovation initiatives that have the potential to create sustainable improvements in the training experience