“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 (Australian Healthcare Ministers' Advisory Committee, 2015)
The Australian Taxpayer makes a considerable investment in the future of the healthcare system. Nationally, over $300M is invested per year to train interns, yet there is little 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 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 (largely the public health services) are unable to validate the work readiness of their new employees (National Intern Work Readiness Forum).
Consequently, employers set unreasonably low expectations of their staff, resulting in under-utilisation of the workforce, reduced productivity, disenchantment of interns and inefficient training.
Conversely, some 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 error when performing tasks and procedures, leading to error, injury, cost and distress for both patient and doctor alike.
Universities meanwhile continue to struggle to measure the longterm outcomes of their graduates once in the workforce, significantly impairing their ability to calibrate the quality of their undergraduate programs.
The Review of Medical Intern Training, 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.
It seems likely that AHMAC will endorse these recommendations in the near future, requiring all junior doctors to adopt an online portfolio of their skills and training. This requirement fits neatly with the new Medical Board of Australia recommendations for all junior doctors to have a CPD Home, as described in a recent blog post.
Platforms such as Osler's Clinical Portfolio will therefore become increasingly important to training interns and junior doctors into the future.