Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Cetiscape 3 February 2011
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CLINICAL EDUCATION
& TRAINING INSTITUTE
Issue 3 February 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 1
Intergenerational health systems: securing a sustainable future
Thursday 10 February 2011, John Loewenthal Auditorium, Westmead Hospital
“The world has changed; we are living longer and the burden
of chronic illness is rising. A revolution in health systems Future thinkers at the forum
technology and delivery may be our only hope for future
Centre for Health Innovation and Partnership (CHIP)
generations.” — so read the banner at the Intergenerational
Clinical Education and Training Institute (CETI)
Health Systems Forum, an unprecedented gathering of
government, education, community and business groups in
Regional Development Australia-Sydney
western Sydney.
NSW Government Education and Training
The forum sought a common set of directions to address
Western Sydney Institute of Technical and Further
some of the major issues affecting health and community Education
care, focusing on the potential of digital technologies to
College of Health Sciences, University of Western
better coordinate, integrate and improve services. Sydney
In his opening remarks, Professor Glen Maberly, Director
Penrith Business Alliance
of the Centre for Health Innovation and Partnership,
Western Sydney Community Forum
reminded everyone that demographic change presented
Western Sydney Local Hospital Network
huge challenges for public budgets, as health care costs
Nepean Blue Mountains Local Hospital Network
(already 28% of the NSW state budget) threatened to grow
unsustainably. Smarter health care was the alternative.
digital devices like the iPhone — and what we need to do is
“I will be happy when we stop talking about technology
take relatively simple steps to connect health workers to the
and start talking about smart systems,” Professor Steven
information potentially available to them.”
Boyages, CETI Chief Executive, said in his address to the
forum. “The technical means for improved health care don’t Professor Branko Celler, Dean of the College of Health
have to be invented — they are ubiquitous, on the internet, on Sciences at University of Western Sydney, described the
In this issue
Safety with injectable medicines 6
Intergenerational health systems: securing a sustainable
Nursing grand rounds via videoconference 7
future 1
Emergency department demand increases 7
Postgraduate clinical placements 2
making a difference
HSP 8
Above and beyond 3
Survey of General Practitioner Procedural Training
Scholarships for doctors in rural training 3
Program 8
Improving care for patients with osteoporosis 4
Diploma of Rehabilitation 9
Coming: 5th NSW Rural Allied Health Conference 5
Karma – a prevocational general practice placement
Coming: NSW Prevocational Medical Education Forum 5 experience 10
Sepsis kills 6
Building 12, Gladesville Hospital, Victoria Road, Gladesville NSW, 2111 Editor: Craig Bingham
Locked Bag 5022, Gladesville NSW 1675 02 9844 6511
CLINICAL EDUCATION
& TRAINING INSTITUTE p: (02) 9844 6551 f: (02) 9844 6544 e: info@ceti.nsw.gov.au cbingham@ceti.nsw.gov.au
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February 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 2
CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
potential of telehealth to empower patients to manage their the future as an opportunity for the development of a stronger,
health from homes with the aid of clinicians connected by smarter health care industry in Sydney’s west.
phone. He hopes to see a Cooperative Research Centre
The forum initiated a wideranging discussion about the
in Telehealth established at UWS to drive evidence-based
possibilities for cooperative action to realise smarter health
adoption of this aid to effective and efficient patient care.
systems, which many participants saw as resting on “power
Mr Paul Brennan of the Penrith Business Alliance drew to the people” — more information for health care consumers,
attention to the health-care corridor that runs from Westmead and more engagement of consumers in managing their
Hospital to Nepean Hospital, Penrith, taking in UWS and the health. The positive benefits and potential pitfalls of a patient
western clinical school of Sydney University. This is Sydney’s controlled electronic health record were debated at length.
demographic centre and an area populated with skilled workers
A communiqué issued by the forum will be available soon.
who need local employment. Mr Brennan saw the challenges of
The destiny of our demography: from pyramid to ... coffin?
A future with more elderly in the population, and a smaller proportion of workers: demographics cited by Glen Maberly from a Productivity
Commission report.
Postgraduate clinical placements
When the NSW Health Care Advisory Council met on general practice, community settings, specialist and private
Thursday 9 December 2010, CETI Chief Executive Professor practice and private hospitals.
Steven Boyages and Dr Marie Louise Stokes presented a Several initiatives have already been implemented. Up to 50
report on the increasing numbers of medical graduates in prevocational general practice training places in NSW will be
NSW requiring placement for clinical training as the new funded by the Commonwealth from 2011, based mainly in
medical schools produce their first graduates. rural and regional areas. CETI has developed a streamlined
Provided clinical training opportunities are expanded, there is accreditation process for general practices and regional training
providers wishing to offer clinical placements for junior doctors.
an opportunity for the increase in medical graduate numbers to
address workforce shortages in rural and regional areas, and CETI’s Rural Division will centrally coordinate the NSW Rural
in disciplines such as general practice, emergency medicine, General Practitioner Procedural Training Program to support
psychiatry, geriatrics and palliative care. Strategies under the rural GP procedural workforce.
consideration to increase postgraduate clinical placements The Health Care Advisory Council reiterated the importance
include shift rostering, new models of service, increasing the of developing effective strategies to retain the medical
number of facilities offering placements, and expanding the graduate workforce in rural areas, and to invest in paediatrics
range of alternative training settings, which could include and general practice.
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February 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 3
CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
Above and beyond
“I will go to any lengths looking for a cure More information about Cure Cancer Australia
for cancer – I’m even prepared to climb can be found at <http://www.cure.org.au>.
mountains!” says Associate Professor
Michael is a longstanding member of
Michael Agrez, a colorectal surgeon at John
CETI’s Prevocational Training Council,
Hunter Hospital, and one of Australia’s
and has recently joined the Prevocational
most dedicated Directors of Prevocational
Accreditation Committee. At John Hunter
Education and Training.
Hospital, he was an early adopter of the
In July, Michael is climbing Kilimanjaro Australian Curriculum Framework for Junior
(Africa’s tallest mountain) to raise money for Doctors, piloting implementation of the
the Cure Cancer Foundation. framework in new term descriptions and
You can sponsor Michael by visiting reflective portfolios for trainees, and gathering
<https://www.gofundraise.com.au/AgrezM>. new data about the experiences that trainees
gain (or sometimes do not gain) in their core
Cure Cancer Australia commenced in 1967
training terms.
and is an independent Foundation for cancer
research with its own Medical Grants Advisory Michael Agrez, shown here Michael’s ambitious climb to conquer cancer
Committee to select projects with the greatest training for the assault on is typical of his energy and community spirit,
potential that have been submitted by young Kilimanjaro in his mountain and CETI will be cheering him on all the way.
post-doctoral researchers. climbing kit.
Scholarships for doctors in rural training CETI :
you be working in two or more rural terms this year? Are you
Will The Clinical Education
in a CETI network training program? and Training Institute
you can answer yes to both questions then you may be entitled
If (CETI)EDUCATION
CLINICAL
is a statutory health
& TRAINING INSTITUTE
to apply for a rural scholarship of up to $6,000, depending on corporation established
your level of training. by the NSW government
The Rural Scholarship Fund supports medical trainees committed to training to promote excellence
and providing patient care in rural locations in NSW. in clinical education and
training.
Prevocational (PGY1 or 2), basic physician, paediatric physician, emergency
medicine (new for 2011), pre-specialist surgical and psychiatry (basic and CETI collaborates with
advanced) trainees can apply. universities, colleges,
Applicants must complete a minimum number of regional and/or remote clinicalINSTITUTE
leaders, hospitals,
CLINICAL EDUCATION
& TRAINING
terms in NSW Health facilities in the 2011 clinical year as follows: health services and the
Prevocational trainees — 2 terms
community to achieve
better health through
Basic trainees — 2 3-month terms
education, training and
Advanced trainees — a full clinical year. development of a clinical
Trainees who will complete the minimum number of terms and are in a workforce that meets the
CETI networked training program can apply for a rural scholarship. If their healthcare needs of the
application is successful they will receive payments of: people of NSW.
$1500 for prevocational trainees
CETI innovates to improve
$5000 for basic trainees communication, capacity
$6000 for advanced trainees. and competency in health
CLINICAL EDUCATION
& TRAINING INSTITUTE
Applications for the Rural Scholarship Fund open at the end of February and care by promoting blended
close on 15 April 2011. learning approaches,
including face-to-face
For more information, follow the links on the CETI website or contact Andrea
teaching, simulation and
Ross (02 9844 6530) or Kirsten Campbell (02 9844 6536) at CETI.
e-learning.
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February 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 4
CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
Improving care for patients with osteoporosis
CETI is working with the Agency for Clinical Innovation (ACI)
to help bring potentially life-saving preventive care to elderly
patients with brittle bone injuries or fractures. Although the
risk increases with advancing age, the largest impact on the
community is in relation to the relatively young old.
This month ACI and its Musculoskeletal Network launched a
new model of care to prevent the risk of repeat fractures in
patients with osteoporosis.
The bones of people with osteoporosis are fragile and brittle,
with a significantly higher likelihood of fracture from even
minimal impact or injury.
It is estimated that 2.2 million Australians have osteoporosis, Pictured left to right: Professor Markus Seibel, Professor Lyn
which affects half of all women aged over 60 and one in three March, Robyn Speerin (Network Manager of ACI’s Musculoskeletal
older men. The economic cost was estimated in 2007 at Network), The Hon. Carmel Tebbutt BEc MP, Minister for Health
$7 billion, including more than $1.5 billion in direct health costs. and Deputy Premier, and Professor John Eisman. Photo: ACI.
About half of all patients who have one osteoporotic bone
fracture will have another.
support for junior doctors at the front line to identify,
In NSW, 35% of patients who were admitted to hospital with investigate and treat patients with osteoporosis.
a minimal trauma fracture between 2002 and 2008 were
A working group has been convened to develop a curriculum
subsequently admitted to the same hospital with a refracture.
under the leadership of Orthopaedic Surgeon Dr Kerin
This accounted for 16,225 admissions, with an average
Fielding, with representation from endocrinology, rheumatology,
length of stay of 22 days. These data do not include patients
gerontology, falls prevention, curriculum development and
admitted with a refracture to a different hospital.
information technology. The web-based curriculum is close to
Many people who have multiple osteoporotic fractures have completion and will be available to NSW Health staff online.
ongoing pain and disability, reduced quality of life and die Users will be able to work their way through topics at their own
prematurely. pace and at any time of the day or night.
While the increased risk of refracture is well known and The Chief Executive of ACI, Dr Hunter Watt, said the new
evidence-based guidelines highlight the need to intervene at model of care addressed one of the biggest health issues for
the time of the first fracture, in far too many cases it is simply elderly people in NSW.
not happening.
“This is a huge issue. People who suffer osteoporotic fractures
National audits have repeatedly shown that only 20%–30% often are faced with chronic pain, are less able to manage
of female patients, and even fewer male patients, are being activities of daily living, and risk losing their independence and
identified at first fracture for preventive care. This means developing other chronic conditions because of immobility. Their
that more than four out of five people presenting at health risk of premature death also is very real.”
services with an osteoporotic fracture are being denied the
“ACI funded this model-of-care project and the
health benefits of effective fracture prevention.
Musculoskeletal Network worked with medical, nursing and
The NSW Model of Care for Osteoporotic Refracture allied health clinicians and consumers from across the State,
Prevention is an easy-to-use guide to best practice care for as well as stakeholder groups such as Arthritis NSW and
doctors, nurses, other health professionals and managers Osteoporosis NSW, to make it happen.”
across the NSW health system. It aims to ensure that all
“The challenge now is implementation and we are delighted
patients presenting with brittle bone fracture are assessed and
that CETI is working so closely with us on the need to
offered advice and treatment to prevent further fractures. This
educate front-line clinicians.”
may include bone density scanning, measurement of vitamin
D levels, assessment of calcium intake and thyroid function, Professor Lyn March, a senior rheumatologist from Royal
disease management advice and self management support. North Shore Hospital and one of the authors of the
guide, said it was designed to address a very real area of
High quality services already are in place at Concord, St
underperformance in the health system.
Vincent’s, Royal Prince Alfred, Royal Newcastle Centre and
the Mid North Coast Local Health Network. “It is not acceptable that when the markers are so clear and
so much can be done to prevent refracture, so many people
CETI is working with ACI to address one of the keys to
with osteoporosis continue to miss out.”
implementation of the model of care — education and
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CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
“That is condemning many thousands of people to a future of families. Why wouldn’t you do it? I am delighted that we are
pain, inability to perform normal activities of daily living, loss now at the implementation stage.”
of independence, developing other chronic diseases and
“Early identification of people in NSW who have osteoporosis
dying prematurely.”
is a critical component of the new model of care because it
“It also means that Australians continue to pay billions of will enable early treatment, which can reduce further fractures
dollars in health care costs and loss of productivity for issues by up to 50%.”
that can be prevented.”
“This model of care has been shown in many trials, including in
Australia, to reduce medical complications, reduce readmissions
to hospital and reduce the number of premature deaths. It also
has been shown to improve quality of life of individuals and their
Coming events
îStrong foundations in shifting sands
5th NSW Rural Allied Health Conference
The Glasshouse, Port Macquarie, 9–11 November 2011
î
Principles and practice
NSW Prevocational Medical Education Forum
Proudly presented by CETI’s Rural Division
Rural allied health services bring together a blend of
11–12 August 2011
multidisciplinary skills requiring a flexible approach to
At this year’s prevocational forum, medical educators, cooperation, coordination and collaboration. Interdisciplinary
directors of training and administrators will share their rural health partnerships have become strong foundations
experience, workshop the issues that matter and hear which will continue to sustain quality care in shifting sands,
practical advice from leaders in JMO education. the transitional period of the current national health reform.
In 2010, CETI commissioned an external review of the This conference will provide an opportunity for all allied health
prevocational training networks. In November, the review staff, managers and education
team reported that it “found an extra-ordinary level of providers to demonstrate
commitment of individuals and institutions at all levels to how collaborative health
prevocational training across the NSW health system.” partnerships create models of
care which achieve positive
The team delivered inspiring recommendations for renovation patient journeys.
of prevocational training that it hoped would multiply the
This conference is designed
effectiveness of this commitment. During 2011, CETI is working
to attract rural and remote
with its partners in the local health networks to unlock the
allied health clinicians from new graduates to senior
potential identified in the review.
managers, and those who work in partnership with allied
health services.
On the agenda
learning model in prevocational training: who learns
The Pre-conference workshops
what, when, how.
There will be a choice of pre-conference workshops to attend
Tuning the networks for smoother performance on Tuesday 8 and Wednesday 9 November. Come along,
Workable methods of assessing trainees and evaluating share experiences and take home some practical information
programs: building better feedback to put straight into practice with your team.
Maximising the benefit of general practice training terms
Call for abstracts in March
Innovations in training and education.
In March authors will be invited to submit an abstract relevant
For more information, please contact Craig Bingham
to the theme Strong Foundations in Shifting Sands, using
(02 9844 6511, cbingham@ceti.nsw.gov.au) or visit the
examples of established rural collaborative partnerships
website <www.ceti.nsw.gov.au/prevocational>. which achieve positive patient outcomes. First time
presenters welcome.
For more information please contact Jenny Preece (02 6692
7716, jenny.preece@ncahs.health.nsw.gov.au) or visit the
website <www.ircst.health.nsw.gov.au>.
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CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
Sepsis kills
ACI and CEC joint project to improve the recognition and
management of severe infection and sepsis
Appropriate and timely recognition and management of A pilot study using the draft
patients with sepsis is a significant problem in healthcare. sepsis pathway and a staff
Sepsis is associated with high morbidity and mortality; severe education program has been
sepsis and septic shock have a mortality of around 25%.1 In undertaken in emergency
another study, the mortality rate for patients with septic shock departments at John Hunter,
increased by 7.6% for every hour of delay in commencing Liverpool, Concord and Prince
antibiotic therapy.2 of Wales Hospitals. Preliminary
audit results have been very encouraging, with a marked
Sepsis has been identified by the NSW Root Cause Analysis
reduction in time to administration of intravenous antibiotics
Review Committee as a recurrent emerging problem. The
and heightened staff awareness of sepsis and the need for
Clinical Excellence Commission Clinical Focus Report on the
prompt treatment. There has been wide consultation with
Recognition and Management of Sepsis3 found significant
rural clinical groups and the pilot study is being extended to a
deficits in a range of clinical settings, with a higher proportion
rural site. Staff feedback from the pilot study and audit results
of problems being reported in the emergency department.
are informing the finalisation of the draft sepsis pathway,
Key clinicians and other experts have identified improving education resources and project support for the state-wide
recognition and management of sepsis as a high priority implementation in May 2011.
for local health networks. In response, the Agency for
For more information please contact Dr Tony Burrell, Director
Clinical Innovation and Clinical Excellence Commission
Patient Safety (02 9269 5550, tony.burrell@cec.health.nsw.
are collaborating with the newly-formed Emergency
gov.au) or Mary Fullick, Project Manager (02 9269 5542,
Care Institute on a joint initiative. The project will enable
mary.fullick@cec.health.nsw.gov.au).
a consensus approach to improving the recognition and
management of sepsis at a state level. 1 The Australasian Resuscitation in Sepsis Evaluation (ARISE) Investigators
and the Australian and New Zealand Intensive Care Society (ANZICS) Adult
The goals for the project are to reduce preventable harm to Patient Database (APD) Management Committee. The outcome of patients
with sepsis and septic shock presenting to emergency departments in
patients through early recognition of sepsis, appropriate fluid
Australia and New Zealand. Critical Care and Resuscitation 2007; 9: 8-18.
resuscitation and reduced time to administration of antibiotics.
2 Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation
Phase 1 of the project will focus on emergency departments
of effective antimicrobial therapy is the critical determinant of survival in
and Phase 2 will focus on improving the recognition and human septic shock. Critical Care Medicine 2006; 34: 1589-1596.
management of sepsis for inpatients. Education for junior staff 3 Clinical Excellence Commission, 2009.
will be a key component of the project.
A generic adult sepsis pathway has been developed
following wide clinical consultation. The pathway aims
to support recognition of severe infection and sepsis in
the emergency setting and to give clear guidelines for
notification, escalation and initial management. The sepsis Safety with injectable medicines
pathway promotes:
New National Recommendations for User-applied Labelling
flagging of severe infection and sepsis at triage
early of Injectable Medicines, Fluids and Lines propose standards
involvement of senior clinicians in diagnosis and for handling injectable medicines to ensure that patients
management are never inadvertently injected with the wrong medicine or
appropriate and timely fluid resuscitation injected by the wrong route.
prompt administration of antibiotics (goal is within one The recommendations and support materials can be found
hour of triage) at <http://www.health.gov.au/internet/safety/publishing.nsf/
serum lactate monitoring to assist diagnosis and ongoing Content/PriorityProgram-06_UaLIMFL>
monitoring CETI supports this initiative and is consulting with its partners
referral of care to appropriate clinical teams, including in the NSW health system to ensure that clinical training has
retrieval if appropriate. embraced the labelling standards.
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February 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 7
CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
Nursing grand rounds via videoconference
Jenny Preece
Rural and Remote Health Project Officer, CETI Rural Division, Dorrigo Multi-Purpose Service
In 2008, NSW Health Nursing Office, in collaboration with Evaluation of NCAHS nursing grand rounds at 18 months has
the NSW Institute of Rural Clinical Services and Teaching found that networking with peers, nurses educating nurses and
(IRCST, now the CETI Rural Division) identified mentoring sharing experiences in the management of actual cases has
and supervision of rural and remote nursing staff from been a very practical approach to focusing on best practice.
smaller facilities across NSW as an area to be addressed, Reflection on team and individual clinical practice and identifying
particularly where triaging and initial emergency management lessons learned from each episode of care has often influenced
of patients is frequently undertaken in the absence of a change in clinical processes. The regular communication
medical officer. between sites has created an accepted form of peer review.
Isolated rural nurses feel more comfortable sharing and
In 2009, IRCST introduced rural and remote nursing grand
rounds via videoconference linking nurses from eight analysing experiences with professionally isolated colleagues
isolated health facilities in North Coast Area Health Service and comment they now feel part of an extended team.
(NCAHS) for generalist case presentations and discussion of Over time, the operational framework developed in NCAHS
interesting or challenging patient journeys of relevance to the was consolidated into an implementation toolkit to enable the
rural setting. Nurses are rostered monthly to present a patient spread of nursing grand rounds across NSW.
journey for discussion, with guest speakers presenting a
case-based inservice at regular intervals as an educational Rural and remote nursing grand rounds via videoconference
component. Presentations can involve the use of PowerPoint have now expanded to include smaller sites across the
or simply tell the patient story. Keeping the sessions case- former Greater Western Area Health and Greater Southern
oriented — a rural patient’s story told by rural nurses — Area Health Services, with Hunter New England proposing to
ensures that discussions are relevant and meaningful. implement the program in 2011.
Emergency department
demand increases
The recent “Christmas rush” in NSW public hospital There is typically less elective surgery performed in public
emergency departments was intense, with the number of hospitals towards the end of each year and this held true in
patients seen eclipsing those treated at the height of the 2010. The proportion of patients receiving elective surgery
2009 swine flu pandemic. on time remained stable and there has been a decrease
since last quarter in the time patients wait for non-urgent
More than half a million patients attended NSW emergency
surgery. Wait times for urgent and semi-urgent elective
departments from October to December 2010, according to
surgery have remained relatively unchanged.
Hospital Quarterly, Issue 3, the most recent report from the
Bureau of Health Information. This is nearly 30,000 more than The report and related materials, including performance profiles
in the previous quarter, nearly 21,000 more than the same time for individual hospitals, are available at <www.bhi.nsw.gov.au>.
last year, and nearly 18,000 more than in July to September
2009, when the swine flu pandemic was at its peak.
Bureau Chief Executive Dr Diane Watson said attendances
during the quarter were at a two-year high, with increased
numbers generally seen across October and November UM
Need the advice, support or creative
FOR
as well as a Christmas holiday spike. In the face of extra JMO thinking of a representative group
pressure, emergency departments generally held their NEW SOUTH WALES
of junior doctors?
performance. Patients were seen within recommended time
frames for all triage categories, except triage category 3 Contact the JMO Forum via CETI’s Prevocational
(patients with a potentially life threatening condition). Program Coordinator: Craig Bingham
(cbingham@ceti.nsw.gov.au, 9844 6511).
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CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
HSP making a difference
Dr Simon Leslie, Medical Director at He now feels much
Shellharbour Hospital and Chair of the less threatened and
Hospital Skills Program State Training HOSPITAL SKILLS PROGRAM
understands that he
Council, reports. is being supported to Three hundred and fifteen medical
One of our CMOs thanked me yesterday, improve and will not be officers are now enrolled in
enthused about the Hospital Skills Program unfairly judged. He feels CETI’s Hospital Skills Program
(HSP) and the benefits to him. He had just part of a group that is and are enjoying the benefits
attended a half day in theatres re-skilling in learning and improving of more training opportunities,
airway management and could not speak highly together. He has greater better recognition and an
improved career pathway. For
enough of the experience and the benefits to him. He was also enthusiasm for work and
more information, speak to Acting
full of praise for the education day last week at Wollongong continuing professional
Program Coordinator Alpana
University and also for the simulation course he was sent to development, he has Singh (02 9844 6551, asingh@
attend at Royal North Shore Hospital last year. His face was engaged with other ceti.nsw.gov.au) or visit <www.
beaming and he was obviously very excited. team members and ceti.nsw.gov.au/hospitalskills>.
This was a doctor who before the HSP had worked solely become willing to work
on weekends, feeling isolated and even somewhat paranoid at any time of the week.
because his only contact with “administration” in the past This is just one example of how the Hospital Skills Program is
was with regard to complaints about him. His habit was to making a difference for our doctors.
avoid any oversight or scrutiny and his resultant negative
attitude affected his relationship with other staff.
Survey of General Practitioner Procedural Training Program
The GP Procedural Training Program is being evaluated Feedback gained from the survey will inform the future growth
through a survey of participants. and development of the program, enhancing its contribution
to a sustainable rural GP procedural workforce.
The program, now coordinated through the CETI Rural
Division, has had 285 participants since 2003. It provides Ms Linda Cutler is the Executive Director of the program
GPs and GP registrars with experience in procedural general which was transferred to the Rural and Remote Division
practice to equip them to practise in rural NSW. Participants of CETI in December 2010. Many will recall that Linda is
the former Executive Director of the NSW Institute of Rural
train on a full time, part-time or flexible basis in rural training
Clinical Services & Teaching (IRCST), which has now been
hospitals in one or more of the following five specialties:
brought under the CETI umbrella.
Anaesthetics
For more information about the survey or the GP Procedural
Emergency Medicine
Training Program, contact: Margaret Starr, Program
Obstetrics Coordinator, CETI (02 9844 6548, mstarr@ceti.nsw.gov.au).
Surgery
Mental Health.
The survey of participants who have completed their training
will be conducted by the NSW Health Department’s trained
telephone interviewers. The survey asks about:
trainee’s experience of the program and the extent to
the
which they are currently using the skills gained though the
training
the program has contributed to the GP procedural
how
workforce in NSW
the program has contributed to participants’ career
how
16th Australasian
decisions Prevocational Medical Education Forum
6-9 November 2011 Auckland, New Zealand
suggestions for improving the program.
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CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
New Diploma of Rehabilitation
Sue Steele-Smith
Education Consultant and Manager, Royal Rehabilitation College
Royal Rehabilitation Centre Sydney
The Royal Rehabilitation College The diploma also provides an
has developed a unique, nationally opportunity for specialised training of
recognised Diploma of Rehabilitation. allied health assistants to meet the
The diploma provides a practical, increasing demand for rehabilitation
multidisciplinary, flexible, accessible services due to the ageing and
and relevant program for those growing population.
seeking an accredited qualification in
The Royal Rehabilitation College
rehabilitation.
is a health-industry-based private
The Royal Rehabilitation College was registered training organisation that
able to gain national accreditation for is part of the Royal Rehabilitation
this course because an equivalent Centre Sydney. The college
multidisciplinary course did not exist specialises in the training and
within Australia. assessment of the Certificate IV
in Allied Health Assistance, with
The diploma is a self-paced course
over 200 participants nationally.
offered by distance education,
This experience with clinicians
which provides the greatest flexibility
throughout NSW and Australia has
around participant needs. The
highlighted the need for specific
course content was developed by
practical training in rehabilitation.
experienced rehabilitation clinicians
The concept, development and
working at the Royal Rehabilitation
accreditation of the Diploma of
Centre Sydney. Core units provide
Rehab in action. Rehabilitation is the result of this
the foundation for working in a
experience.
rehabilitation environment, while
there are elective options in spinal The Royal Rehabilitation Centre
injury, neurology, cardiopulmonary, Sydney provides specialist
orthopaedics, oncology, community, rehabilitation and disability services
mental health and aged care. There for people with complex and long
are also units on goal-directed care, term health care needs, traumatic
health promotion and prevention and brain injury and spinal cord injury.
research skills. Royal Rehab engages in extensive
education and research to improve
The diploma provides an opportunity
the rehabilitation outcomes for its
to refresh and enhance skills or
clients and, as a teaching hospital,
to retrain. It provides professional
Royal Rehab has strong partnerships
development with a practical
with the University of Sydney’s
rehabilitation focus and a chance
academic units.
to enhance skills and knowledge of
new areas of rehabilitation within an Registrations for the Diploma of
interdisciplinary learning environment. Rehabilitation are now open for
Support for this distance course 2011. For further information on
has come from clinicians working this fantastic learning opportunity
in rehabilitation who are interested contact Royal Rehabilitation College
in validating their skills or who are (02 9808 9626, enquiries@
returning to the workforce after royalrehab.com.au) or see
extended leave, and from others <www.royalrehab.com.au/college/
interested in moving into rehabilitation courses.html>.
from another speciality. Spinal rehabilitation.
10. cetiscape
February 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 10
CLINICAL EDUCATION
Issue 3
& TRAINING INSTITUTE
Karma — a prevocational general practice placement experience
Stella Tang was a Resident Medical complex care that demands medical prioritisation of their
Officer at Westmead Hospital when chronic conditions. How can someone learn this without the
she did a term in general practice. She exposure and the appropriate guidance?
is now a general practice registrar in
My time at TMC provided broad-based teaching and insight
Westnet network.
into how our health care system works. It encompassed more
The first day of my PGPPP term I dedicated one-on-one teaching by passionate mentors on a
found myself wondering if I had made vast range of medical subspecialties than any other medical
a HUGE mistake in choosing a general terms I have experienced. This was surrounded by a familial
practice rotation. The last two years of environment of comradeship and up-to-date medical practice in
my hospital training had disciplined me weekly clinical “grand-round” meetings of case presentations, in
into an efficient and effective discharging addition to access to quality nursing and allied health services
machine moulded by the likings of on site (diabetic educator, podiatrist, psychotherapist, mental
consultants and their specialities. The words “follow up with health nurse). This was a term that developed my confidence
your GP”, “that’s something your GP can look into”, “discuss in patient management and also fine-tuned my clinical and
that with your GP, it’s not an emergency problem”, “Your interpersonal skills in diagnosing, interpreting and managing
GP can refer you”, flashed before my eyes, and I began to common medical problems.
wonder if this was Karma.
I found it rewarding to see the outcome of my decisions
As inconceivable as it may be to some, I found myself being through continued and ongoing patient care, but my term
drawn into the complexities and value of community-based in general practice also emphasised the importance of
teaching in my placement at Toormina Medical Centre (TMC). establishing a good work and life balance. The freedom it
Now I wonder why general practice isn’t a core rotation, as it is provided with organising my own patient load, having devoted
the only “speciality” that treats the patient as a whole, not just lunch breaks and the regularity of working “normal” office
in bits. General practice is the integral hub that interacts with all hours was a stupendous luxury after the last two years of
these specialities (the ‘bits’). It’s the speciality that witnesses a unrostered overtimes. All in all, I cannot fault this rotation and
patient’s journey from birth to death and the speciality that has regardless of what “specialist” training you are endeavouring
the privilege to treat all the generations of a family at one time. to strive towards “holistic” patient care such as I was learning
and practising at TMC is what good medicine is about, and
Our core population in healthcare is ageing day by day as our
good medicine is what good doctors practice.
advances in medical intervention continue. This means that
our patients not only have multiple morbidities, but require After all, there’s Karma …
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