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As workforce shortages continue to plague the Australian health care system, an innovative program in Melbourne utilising final year medical students as Clinical Assistants could present a solution to hospitals struggling to fill rosters.
Final year medical students working as Clinical Assistants could hold the key to easing some staff shortages in Australia’s busiest hospitals, but only if their job descriptions were clearer and their conditions were governed by a single enterprise agreement, experts say.
A Perspective article, published in the Medical Journal of Australia, proposes that the Clinical Assistant program designed by Western Health in Victoria during the coronavirus disease 2019 (COVID-19) pandemic could be adapted to plug critical gaps as hospitals across Australia struggle with unprecedented workforce shortages.
The program involved recruiting final year medical students to work as Level 4 Casual Support Service employees, who could perform paid shifts to assist with administrative and low risk clinical tasks, in addition to their medical school placements.
Dr Paul Eleftheriou and his colleagues from the University of Melbourne, who wrote the Perspective, believe the Clinical Assistant program could continue to benefit the health care workforce beyond the pandemic.
“The Clinical Assistant program continues to run in Victoria despite a decline in COVID-19 cases, but it has shifted from supporting an acutely pressured workforce during a pandemic to supplementing a chronically strained workforce,” Dr Eleftheriou and colleagues wrote.
“As we emerge from the pandemic, medical students could be one sustainable solution to chronic staffing shortages and to provide the health care workforce contingencies.”
A positive for medical students
In the Clinical Assistant program, students were able to choose their area of work and received direct supervision to ensure assigned tasks were aligned with core competencies for final year medical students.
Duties included COVID-19 screening tasks, initial patient investigations in the emergency department, clerical and administrative tasks for general surgery, and following up of pathology and radiology for the urology department.
Participants were remunerated at $32.73 per hour, and hours were capped and shifts were flexible to protect their clinical teaching time.
The Clinical Assistants reported positive benefits from participating in the program, citing an increased level of responsibility, autonomy and feelings of inclusion compared with their roles as medical students.
“Working in one of the busiest emergency departments in the country has been incredibly valuable in increasing my sense of clinical competency,” one Clinical Assistant reported.
“The role has increased my exposure to a wide range of pathology, improved my clinical reasoning skills as well as increased my proficiency at procedural tasks.”
Another Clinical Assistant reported, “I loved the experience of working as a [Clinical Assistant] in the obstetric department.”
“I was able to help the junior doctors, in particular the HMO’s who were busy and often found us to be very useful.”
Similar programs
Similar assistant models have since been adopted by other health services in Victoria throughout Australia, such as the Assistant in Medicine role in New South Wales (NSW). The Assistant in Medicine role was created by NSW Health in 2020, in anticipation of a surge of COVID-19 cases. The roles were designed to fit Local Health District needs rather than the students’ potential career interests.
Medical students in the United Kingdom, who are in their final few months of clinical training, can undertake assistantships where they can gain hands-on experience carrying out the work of a newly qualified doctor under supervision. However, unlike similar roles in Australia, assistantships can take place in the hospital where a trainee is eventually appointed and their role is often aligned with career interests (here).
Clear guidelines needed
If Clinical Assistants were used more broadly in the Australian health care system, there would need to be clear guidelines for role expectations across different jurisdictions and disciplines, they stressed.
“[Clinical Assistants] often work within departments that host medical student placements,” Dr Eleftheriou and colleagues wrote.
“This creates the potential for role confusion, as has been found with nursing students who concurrently work as health care assistants.”
The authors also argue Clinical Assistants’ employment conditions should be governed by a single enterprise agreement, similar to nursing and midwifery students.
“Care must be taken to ensure they are protected from pressures to work outside their scope of practice, or to prioritise [Clinical Assistants] work over medical school commitments,” they wrote.
A sustainable workforce solution
As workforce shortages continue to plague the Australian healthcare system, innovative approaches to staffing, such as the Clinical Assistants program, could play a significant role in Australia’s evolving health care landscape and filling vital staffing gaps.
“Clinical Assistants, unlike junior doctors, are not bound by rotations of specific length, assessment hurdles, or a specific training structure; they form a dynamic workforce that is available and adaptable to meet the health care system’s specific needs at any given time,” Dr Eleftheriou and colleagues wrote.
“Given the current workforce shortages and predicted required increase in skilled health care and social assistance professionals of 301 000 by 2026, Clinical Assistants have the potential to be an ongoing and sustainable workforce for an understaffed health care system.”
Read the Perspective in the Medical Journal of Australia.
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BTW just a addendum:
These clinical assistants need to be adequately taught and supervised. And the weakest aspect of skillset of any JMO or student is ironically of the simplest things (and he most important thing) to learn: medical communication, which ISBAR is the one tool to unite all other in ensuring safe and effective handover.
Despite the simplicity it is often undervalued and poorly practiced and no amount of clinical assistant or “pre-intern” experience, paid or unpaid, is going to make the internship easier and better if this essential lesson is not learnt and applied properly
Correct me if I am out of touch but the New Zealand final year students are already embedded in medical team in their last year of medical school and this attachment is paid (albeit poorly). So this proposal is not necessarily an Australiasian ‘first’. But this is probably best limited to final year students
However what worries me is the idea that the attachment hours can “flexible”. For a inpatient medical unit, clinical assistant is most valuable in their role (and learning) in the morning ward rounds. There is a more-or-less a routine in this aspect of inpatient medicine and likely the busiest time with the most learning opportunities. Personally I have no need for a clinical assistant as a scribe or professional organiser or ‘gofer’ after the ward rounds, except for outpatient clinics which again has reasonably set routine. If we are to have clinical assistants, (final year medical student or physician assistant – another controversy here), they should be here when they are actually needed and helpful rather than a casual arrangement convenient to the student.
Regular timely attachment and attendance (rather than casual presence) not only actually help the team, enhances learning opportunity but also teaches professionalism and ownership of the patient, the clinical role and the joys & woes of the team.
Until the assistant actually achieves this ownership, then they will only treat this as a gig to earn cash, rather than a window to a long term vocation. Perhaps not everyone feels being a doctor is a vocation anymore, but I fear the time when most doctors regards their work as “just a job”.
Perpetuating low wages for “doctors” in hospitals. The renumeration has to be at casual hourly rates. So getting a very similar permanent staff’s hourly rate of a medical receptionist, who gets Super, Sick leave, Holiday pay, and Long service.
No matter how much the (selected) students interviewed profess to have enjoyed and benefitted from these roles, programs like this are mere stopgaps which relieve those responsible for proper healthcare funding and workforce planning from their responsibilities. Temporary, underpaid and underskilled workers responsible for patient care dressed up as educational opportunities – Australian hospital medicine officially joins the gig economy.