more_vertThe Australian Institute of Health and Welfare developed a national data standards strategy and implementation plan to enhance the comparability, quality and coherence of information across the Australian education and training sectors, including early childhood education, school education, vocational education and training (VET) and higher education. This project report summarises the activities and process undertaken over 12 months from October 2013 to develop the strategy and implementation plan.
Preference: Education
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Securing a rural health workforce for the next generation of rural Australians
The value of investing in advancing rural training pathways should not be forgotten
The establishment of rural-based academic networks in health was a key initiative of the incoming federal Coalition government in 1996 to help overcome the shortage of medical and other health professionals in rural and remote Australia. University departments of rural health1 were initially established in medical schools to increase the capacity of rural health services to provide high-quality education and clinical training of students from multiple disciplines, and support the delivery of clinical services to communities. In a second phase of development from 1999, the addition of rural clinical schools expanded the network to provide at least 1 year of clinical training for 25% of Australian medical students in a rural community.
Now, 18 years on, rural Australia has access to an unprecedented network of 28 academic departments invested in clinical training. This represents a substantial footprint across each state and the Northern Territory. The rural academic network delivers rural-based clinical training in both hospital and community settings for more than 5500 medical, nursing and allied health students annually and includes access to interprofessional learning and simulation training. In some university departments of rural health and rural clinical schools, there are opportunities for students to contribute to service delivery to underserved rural communities through service learning. In this educational approach, students deliver clinical care under supervision to patients with high health need and poor access to services, in student-led clinics or in an assisting role.2 Progressively, academic teams have also formed to undertake research, evaluation and development work on the rural health agenda, including carrying out studies on the effectiveness of rural training in delivering rural health workforce outcomes and health service redesign for rural and remote communities.
Developing rural health as a career path
Academic departments contribute to the development of rural training pathways using multiple strategies that are sequenced through the different phases of career development; from promoting health careers to secondary school students in rural communities, delivering rural-based clinical training for undergraduate students, through to providing professional development for rurally located practitioners across the different disciplines. Vocational training in medicine for a career in rural health has benefited from the expansion of prevocational training opportunities managed by rural health services, the regionalisation of general practice training,3 and growing acceptance of rural generalism as an occupational classification and potential career path for medical graduates. The rural training of medical students is integral to the pathway and is starting to deliver workforce outcomes for rural health services and communities, as evidenced by the increasing number of these graduates undertaking prevocational and vocational training in rural areas.4,5 The development of rural training pathways for nursing, dentistry, pharmacy and other allied health disciplines to build a generalist workforce is not as well advanced.
The 2013 Review of Australian Government Health Workforce Programs6 reported on the importance of creating a coherent pathway for rural and regional education and training — for medical training in the first instance and then for nursing, allied health and dentistry. The report concluded that these developments had the potential to achieve better health workforce outcomes for rural Australia, as well as promote generalist medicine and integrated primary care. The policy direction is clear, yet there is uncertainty in an environment where there will be increasing competition for funds. How the establishment of primary care networks and rebuilding of general practice training will affect the ongoing development of rural training pathways has yet to be determined. The decision to invest during a previous period of fiscal constraint delivered an internationally regarded rural academic network; it is timely to now invest in the advancement of training pathways to secure a rural health workforce for the next generation of rural Australians.
[World Report] Russia’s gaps in diabetes control
The incidence of diabetes is increasing in Russia, and problems with data collection, care, and access to educational programmes are hampering improvements. Fiona Clark reports from Moscow.
[Correspondence] Sex and relationship education should be statutory
As members of Sexpression:UK, a network of student projects based at UK universities dedicated to providing comprehensive sex and relationship education (SRE) in schools, we are deeply concerned by the inadequacy of SRE teaching throughout the UK education system.
Determinants of rural practice: positive interaction between rural background and rural undergraduate training
To the Editor: The rural clinical school (RCS) initiative is acknowledged as a successful policy response to the rural–urban medical workforce imbalance.1 Kondalsamy-Chennakesavan and colleagues’ article regarding the location of practice of Commonwealth-supported alumni from the University of Queensland Rural Clinical School (UQRCS) concludes that there appears to be a compounding effect of RCS experience on a background of “rurality”, when compared with metropolitan students undertaking similar rural placements.2
These results differ from those of the University of Sydney RCS3 and the University of Western Australia RCS,4 the former of which was not referenced by the authors. These earlier articles suggest that long-term RCS placements change the likelihood of all students’ uptake of rural internships3 and rural practice in general,4 not simply those of rural origin versus metropolitan origin students.
Australian universities operating RCSs employ differing admission criteria for undergraduate and postgraduate courses, course durations and pedagogical constructs in their curricula; both rural and metropolitan students are subject to differing personal or financial circumstances.5 Within the Commonwealth RCS funding parameters, there is the potential for a plurality of interpretations and implementation of RCS placements.
The authors’ conclusions reflect the situation pertaining to their institution, and hence it would not be justified to generalise that the goals of the RCS scheme are best served by restricting or preferencing long-term RCS placements to students of rural rather than urban origin.
‘Captain’s call’ medical school won’t fix doctor shortage
Western Australia’s medical workforce is growing faster than almost any other in the country, underlining concerns that the resources-rich state’s medical training pipeline is already running at capacity even before the establishment of a controversial new medical school at Curtin University.
Data compiled by the Australian Institute of Health and Welfare show that although WA has fewer doctors per capita than any other State or Territory, its medical workforce expanded by more than 60 per cent in the nine years to 2013, with only Queensland growing at a faster rate.
But WA medical graduates are being forced to move interstate to get the training the need to become fully-qualified doctors
The figures add to warnings by the AMA, the Australian Medical Students Association, the Western Australian Medical Students’ Society and other medical groups that the Federal Government’s decision to help fund a new medical school at Curtin University is poor health policy.
“The problem with a new medical school is that we already have far too many medical students in the system,” AMA President Associate Professor said. “This year we have over 3600 applications for internship positions; there are only 3300 positions available.”
Prime Minister Tony Abbott said the Commonwealth was backing the Curtin medical school as a way to help boost the number of doctors working in WA, and is part of a massive expansion of undergraduate medical education in the past decade.
Across the country, there has been a huge 150 per cent surge in medical school places since 2004 – there are currently 3736 students enrolled – but A/Professor Owler said this had not been matched by a commensurate increase in the prevocational and vocational training places medical graduates need in order to become fully-qualified doctors.
The AMA President said that in Western Australia alone there was a shortfall of 84 training places for GPs, and a report by the now-disbanded Health Workforce Australia warned that, on current trends, the increasing mismatch between growth in the number of graduates and training places would result in a shortfall of 1011 places by 2030.
A/Professor Owler said that opening yet another medical school was not the solution.
“The issue is not the number of medical students; it is the training bottleneck,” he said. “We have a shortfall of training positions for those medical graduates that we are training now. Adding another medical school doesn’t make any sense without putting the resources in to make sure that we have the training positions available.”
A/Professor Owler this was particularly problematic because most post-graduate medical training was provided in public hospitals, whose Commonwealth funding was to be slashed by $57 billion in the next 10 year.
“How are these people going to be trained in our public hospital system when we are actually taking billions of dollars out of the system?” he asked.
Mr Abbott tried to reassure A/Professor Owler and the AMA, saying he had been given a guarantee by the West Australian Government that it would provide extra training places.
“I always that the AMA seriously. I have a great deal of respect for the AMA,” the Prime Minister said. “They’re absolutely right to be concerned about the consequent clinical training places, and what we’ve done is work with the West Australian Government to get a guarantee…that the clinical training places will be provided.”
Mr Abbott paid tribute to WA Premier Colin Barnett and lobbying by WA Liberal MPs including Ken Wyatt and Christian Porter in convincing the Commonwealth to commit up to $20 million a year to operate the 110-place school, which will be built with $22 million from the State Government and around $60 million from Curtin University.
But A/Professor Owler said the decision showed that politics had won out over good policy: “Satisfying a political requirement by investing in the whims of the local politicians doesn’t satisfy good health policy”.
“It’s a calamitous captain’s call by Captain Chaos. That’s the only way to describe it, because it’s going to cause chaos with the medical training of students,” the AMA President said. “Politics has taken precedence over good policy.”
His comments earned a rebuke from Treasurer Joe Hockey, who told the ABC’s Insiders program that the President’s language was “extreme, and certainly not fitting for someone representing a great profession. Quite frankly, I think his comments were out of order.”
But A/Professor Owler said he made no apology for using “colourful” language to describe the situation, particularly given that the health system was “still coping with the sort of policies that we announced in last year’s Budget. How are you going to train these people when Joe Hockey is taking $57 billion out of the funding system?” he told The Australian.
“Our job is to make sure we get the best health policy,” he said. “And when the Government does something that is bad for the Australian health care system, our job is to point that out.”
In addition to a bottleneck in the training pipeline, there is a maldistribution in the medical workforce, with doctors much more scarce in rural and remote areas.
Both the AMA and AMSA said that, rather than building yet another medical school, the Government should be investing scarce health funds into medical training – a point made by Health Workforce Australia in its Australia’s Future Health Workforce report released last year.
In the report it warned that unless there was a change in policy, the country would swing from a small oversupply of doctors in 2017 to a situation of under-supply, with a shortage of 2500 practitioners by 2025 and a shortfall of 5000 by 2030.
Instead of pumping out more medical graduates, the agency recommended the Government hold the medical school intake steady this year while devising long-term training plans.
Because of the long time it takes to train a doctor (at least 10 years), “adjusting medical student numbers is not an effective means to deal with short-term imbalances between supply and demand”.
Instead, it said, governments should use temporary migration to address immediate service gaps – in WA, which grew rapidly during the mining boom, more than a third of doctors are trained overseas – while devising and executing a clear, long-term plan to train the doctors needed to satisfy future demand.
A/Professor Owler called on the Government to reconsider its decision and “put the focus back on the training pipeline if they are serious about having the GPs and specialists that not only Western Australia needs, but the rest of the country needs as well”.
Adrian Rollins
Budget breakdowns
Organ and Tissue Donation
Despite programs to encourage more donors there has been a decline in the rate of organ donations over the past two years according to ShareLife.
The Australian Government hope to improve organ and tissue donation rates by providing $10.2 million over the next two years. The funding will go towards delivering clinical education to hospitals, developing a new Australian Organ Matching System and enhancing the Australian Organ Donor Register.
Currently around 1500 people are on Australian organ transplant waiting lists at any time. One organ and tissue donor can transform the lives of 10 or more people.
The Government will also continue to provide minimum wage for up to nine week to employers of people who have taken leave to donate organs as part of the Supporting Leave for Living Organ Donors Programme. The aim of the Programme is to help alleviate the financial stress that can be experienced by living organ donors by reimbursing employers for payments or leave credits provided to their employees for leave taken to donate an organ and recover from the procedure. The Government announced that the Programme will continue for the next two years.
Tropical health
The Government will provide $15.3 million over four years to invest in research into exotic disease threats to Australia and the region.
The National Health and Medical Research Council will receive 6.8 million to support research into tropical diseases, build collaboration and capacity in the health and medical research workforce, and promote the translation of this research into health policy and practice.
The Government will also provide $8.5 million to establish an Australian Tropical medicine Commercialisation grants program to support Australian researchers to commercialise therapeutics and diagnostics in tropical medicine.
National Drugs Campaign
The Government will provide $20 million over two years to renew the National Drugs Campaign. The Campaign aims to reduce young Australians’ motivation to use illicit drugs by increasing their knowledge about the potential negative consequences of drug use. It is a media campaign to promote the avoidance and cessation of illicit drug use.
The campaign will focus on raising awareness to young people and their parents about the harm caused by illicit drug use, in particular methamphetamine also known as ice.
Royal Flying Doctor Service
The Government has committed additional funding to support the Royal Flying Doctors Service to deliver emergency and primary health care services to people in rural and remote communities of Australia.
The Service will receive an extra $20 million as part of the Government’s commitment to rural and remote communities.
Kirsty Waterford
Public and preventive health programs under cloud
The future of important public and preventive health and support programs for Alzheimer’s, palliative care, alcohol and addiction, rural and Indigenous health are under a cloud after the Federal Government announced almost $1 billion of cuts from health programs.
In a decision that has thrown doubts over the funding of organisations including Alzheimer’s Australia, Palliative Care Australia and the Foundation for Alcohol Research and Education, the Government said it would achieve savings of $962.8 million over the next five years by “rationalising and streamlining funding across a range of Health programs”, including so-called Health Department Flexible Funds, dental workforce programs, preventive health research, GP Super Clinics and several other sources.
AMA President Associate Professor Brian Owler the lack of detail around the savings was concerning.
“There is a lot of uncertainty in Canberra and around the country at the moment as to whether those important programs, those important organisations, such as Palliative Care Australia, Alzheimer’s Australia, the Foundation for Alcohol Research and Education, and many other non-government organisations, are going to be continued to be funded,” A/Professor Owler said. “Rather than announcing that these cuts of almost $1 billion are going to be made to those flexible funds, and leaving it up in the air for these organisations, we need to see certainty around where those cuts are going to be made, how they are going to be applied, so that these organisations can not only plan for their future but also continue their very important work.”
In addition, the Government has tagged the Health Department for an extra $113.1 million of savings in the next five years as part of its Smaller Government initiative.
It said this would be achieved by measures including consolidating the Therapeutic Goods Administration’s corporate and legal services into the Health Department, axing the National Lead Clinicians Group, replacing IT contractors by recruiting full-time staff and “ceasing activities that mirror the work of specialist agencies”, such as the Independent Hospital Pricing Authority, the National Blood Authority, and the Australian Institute of Health and Welfare.
Adrian Rollins
Priorities for professionalism: what do surgeons think?
Professionalism underpins the commitment made between a profession and society. This social contract balances the benefit to a profession of a monopoly over the use of its knowledge base, its right to considerable autonomy of practice, and the privilege of self-regulation with responsibilities and accountabilities to the community.
Medical practitioners have embraced professionalism over the millennia, from the Hippocratic Oath1 to the 19th century2 and the present day. Professionalism has recently been highlighted,3 but there have been concerns that not all its components are viewed as important4,5 or are reflected appropriately in surgical training endeavours.6
Definitions of professionalism are abundant, contested and reflect educational, sociocultural and historical contexts.7,8 Core elements include mastery of a complex body of knowledge and skills, service to others, commitment to competence, integrity, altruism and promotion of public good, autonomy, self-regulation and accountability to society.9 Given the dynamic and changing context, it is important to understand how professionalism is evolving.
Little is currently known about how surgeons involved in training and surgical trainees perceive the importance, priority or value of the different areas that they need to master to be competent and to perform well. In Australia and New Zealand, the Royal Australasian College of Surgeons (RACS) has defined the competencies required for surgical practice. The RACS surgical competence and performance guide is the basis of the curriculum that leads to the Fellowship of the College.10 It is based on the competencies developed by the Royal College of Physicians and Surgeons of Canada — the CanMEDS model.11 Local adaptation since 2001 has seen the RACS develop nine competencies to reflect the technical expertise and decision making required in surgical practice. Three attributes per competence provide further detail, although not comprehensiveness, to the overall requirements. Given the broad and changing definitions of professionalism, we evaluated the RACS competencies and associated attributes for importance.
Our study explored systematically what surgeons and surgical trainees understand as priorities for competent professional practice. It was undertaken within the broader context of developing system-wide training programs to enable surgeons to demonstrate their professionalism more fully.
Methods
Ethics approval for the study was obtained from the human research ethics committees of the University of Melbourne and the RACS. The overall research design included a detailed questionnaire comprising a number of question banks, with some free-text fields, distributed to 3054 RACS trainees and Fellows who were actively involved in the educational activities of the College. Separately and consequently, a semistructured interview was undertaken with a smaller number of the questionnaire respondents who volunteered for the interview stage. This article relates to the bank of RACS competency questions.
Participants
At the time of the distribution of the questionnaire, from 9 August to 30 September 2010, there were 1222 trainees and 4763 actively practising Fellows within the RACS. All trainees were invited to complete the questionnaire, and all Fellows recorded in the membership database as being involved in educational activities were also selected. Fellows who were not involved in surgical educational activities did not receive a questionnaire. The final number invited was 1222 trainees and 1832 Fellows from all regions of Australia and New Zealand. Although all questionnaires were identified with a unique identifier to allow for follow-up, anonymity and confidentiality were assured.
Materials and procedures
The questionnaire incorporated the nine RACS competencies and the associated three attributes per competency (Box 1), with modification for brevity and clarity. The questionnaire was content valid as it was directly based on the established RACS competency framework. Within the questionnaire, all participants were informed that the intent of the research was to progress the understanding of professionalism and the way it is supported, taught and learnt. Participants were instructed to rate the importance of each attribute for professionals on a 5-point Likert scale (1 = not at all important, 5 = very important).
The questionnaire was disseminated electronically with a follow-up email. A hard copy of the questionnaire was sent to those who had not responded and was then followed up by a telephone call.
Statistical analysis
Neither the nine competencies nor the 27 attributes have previously been confirmed statistically as independent factors. Analysis was undertaken to compare the importance of the attributes at an individual and grouped level, and to determine whether they were independent and whether the RACS groupings were confirmed by the data.
The data were coded and entered into SPSS version 17 (SPSS Inc). We also applied tests of skewness and kurtosis.12 Because of the skewed nature of the data, we conducted non-parametric statistical tests to analyse subgroups: the Mann–Whitney U test for pair comparisons and the Kruskal–Wallis test for comparison of more than two groups. The results for all attributes were assessed within their respective competencies to gain a relative understanding of the importance of that competency. Comparisons were made between Fellow and trainee, genders, age groups, specialties and regions. In this article, we present our findings for Fellows and trainees, and by gender.
We also applied tests of reliability, with internal consistency being calculated through use of Cronbach α value (theoretical values between 0 and 1). Inferential statistics were then used to identify differences between groups and to look for relationships between attributes. Groups for comparison had a sample size greater than 100. Correlation studies were structured to investigate relationships between particular characteristics of the subgroups.
We undertook multivariate analysis to establish the independence of the variables and also to determine whether the groupings of attributes proposed by the RACS within the competency framework could be validated in the context of our questionnaire. The exploratory factor analysis used an extraction method of unweighted least squares.
Results
In total, 1834 of 3054 questionnaires were returned (60%): 1204 of 1832 Fellows (66%) and 630 of 1222 trainees (52%); 1521 of 2566 (59%) male and 313 of 488 (64%) female trainees and Fellows. Seven hundred and nine (39%) responses were from general surgery Fellows and trainees and 357 (19%) were from orthopaedic surgery Fellows and trainees, the largest two of the nine surgical specialties.
The results were skewed to the more important. This was confirmed by tests for both skewness and kurtosis, both of which were evident to a high degree. Testing of reliability was undertaken, with a resultant Cronbach α value of 0.971.
The 27 attributes identified by the RACS were all graded as individual attributes (Box 2) or grouped as competencies (Appendix 1). They were all regarded as important to very important, except for responding to community and cultural needs. The top five attributes shared a sense of strong individualism, with an emphasis on being able to communicate effectively. However, there was a clear gap to the more lowly ranked attributes, particularly responding to community and cultural needs, and supporting others.
We calculated differences in the mean ranking of importance for the 27 attributes (Box 2, Appendix 2, Appendix 3). The overall mean was 4.44 (4 = important, 5 = very important). There was a small but significant difference between genders, with women regarding the overall group of attributes as more important than did men (mean, 4.51 [SD, 0.37] v 4.43 [SD 0.37]; P = 0.001) There was no statistically significant difference between Fellows and trainees for the overall group of attributes (mean, 4.44 [SD, 0.41] v 4.44 [SD, 0.40], respectively; P = 0.99).
Competencies were ranked by priority for Fellows and trainees, and for males and females (Box 3). There was consistency in the top three priorities for Fellows and trainees overall, and for male Fellows and trainees, where technical expertise, communication and professionalism were prioritised. For female Fellows and trainees, the top three priorities were communication, technical expertise and medical expertise. The lowest priorities across all groups were health advocacy, management and leadership, and scholarship and teaching.
Among individual attributes, there were statistically significant differences in perceived importance at the subgroup level (Appendix 2). In comparing Fellows and trainees, the four attributes with statistically more significant differences were caring and compassion, documenting and exchanging information, setting and maintaining standards, and responding to community and cultural needs. In particular, trainees identified as more important the three attributes for collaboration and teamwork (teamwork, documenting and exchanging information, and establishing a shared understanding).
In our analysis by gender, female trainees and Fellows ranked all attributes as more important than did male trainees and Fellows. Statistical significance was most noted for teamwork, meeting patient, carer and family needs, documenting and exchanging information, establishing a shared understanding, and communicating effectively (Appendix 3).
Although the first nine factors identified through multivariate analysis accounted for 58.8% of the total variation in the data, further analysis did not demonstrate strong grouping to the nine categories. Indeed, the covariance values of six attributes exceeded 1.0, suggesting some overlap between the groupings. Also, as the Cronbach α value was high at 0.971, some redundancy in the items was indicated statistically.
Discussion
Our study looked at the breadth of professionalism among surgeons and surgical trainees by exploring the nine competencies defined by the RACS. Our findings confirmed a clear priority ranking for these competencies and their attributes.
All competencies were regarded as important; however, there were statistically significant differences between the nine competencies and 27 attributes. Although the multivariate analysis did not confirm the independent nature of these variables, there was a clear gap between the prioritised importance of technical expertise, communication, professionalism and medical expertise compared with health advocacy, and management and leadership. Our findings suggest an emphasis on individual skills rather than on achieving a common goal. Attributes relating more to society at large were prioritised less than individualised skills. Also important was the strong similarity between the responses of the trainees and Fellows who undertake educational roles on behalf of the RACS. This may indicate the socialisation of aspirations between trainees and their mentors and educators.
Similar studies have emphasised that values held in high regard by society, such as altruism, charity and communication, are not well appreciated.6,13 Another study, which also found that none of the factors of professionalism were regarded as unimportant, argued that this added little to the broader issue of the teaching of professionalism.14 However, we contend that the prioritisation does make a difference. In a conflicted and time-pressured professional existence, a higher priority will receive attention for training and learning compared with a lower priority. The nine competencies defined by the RACS reflect what every patient needs from a competent surgeon.11 Surgeons require expertise in each of these competencies, but it is the integration of all these attributes that will make a competent surgeon. In a health environment where collaboration and teamwork is regarded increasingly as a core skill, and where the ability to influence the health system through management, leadership and advocacy is becoming more desirable, these areas will require greater prioritisation among trainees and Fellows.
Skills such as teamwork and responding to the needs of the community involve complex interactions beyond individual excellence. Medical professionalism does not take place in a vacuum. It is situated within a social context and larger systems such as the education and health sectors, the national economy and broader international influences.8 The practice of medicine needs to be rethought more broadly.
Our study had some limitations. Surveys are limited in the information they provide. The study confirmed the importance of the attributes and their relative priorities but not the statistical independence of the nine competencies. Further qualitative studies are required to obtain greater clarity between the attributes.
With the exception of responding to community and cultural needs, we found that all RACS competencies and attributes were regarded as important. The priorities showed consistency across Fellows, trainees and genders, although there were some key statistically significant differences between the attributes. This may highlight gaps that need to be addressed in selection of trainees, in current surgical training and in ongoing professional development for surgeons. Certainly these areas need to be addressed urgently.5 Attributes, behaviours, judgement and skills are displayed as our professionalism in a complex and pressured working environment that demands prioritisation of activities. These priorities are also reflected in how trainees allocate their time, through the mentors they admire and the aspirations they develop. Professionally, well-rounded and truly competent surgeons are not a static phenomenon. We live in a complex world. The implications are clear: aspiring surgeons are likely to invest more in the development of competencies that they perceive as more important.15 Competencies that are not reinforced by educators, mentors, trainers and the broader peer group are more likely to be neglected, with possible detriment to clinical practice.16
1 The nine Royal Australasian College of Surgeons competencies and their attributes10
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Competency and attributes |
Description |
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Medical expertise |
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Competence |
Mastering and maintaining current knowledge and skills |
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Managing safety and risk |
Ensuring patient safety by understanding and managing clinical risk |
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Monitoring and evaluating care |
Regularly reviewing and evaluating clinical practice |
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Judgement and decision making |
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Considering options |
Generating alternative possibilities and assessing them |
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Planning ahead |
Predicting what might happen due to action or non-action |
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Implementing and reviewing decisions |
Undertaking chosen action but reviewing its suitability |
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Health advocacy |
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Caring and compassion |
A sympathetic consciousness of another’s distress |
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Meeting patient, carer and family needs |
Engaging them in planning and decision making |
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Responding to community and cultural needs |
Demonstrating the impact of culture and spirituality, and considering community needs |
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Technical expertise |
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Recognising conditions amenable to surgery |
Understanding when intervention is or is not indicated |
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Maintaining dexterity and technical skills |
Demonstrating sound surgical skills |
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Defining scope of practice |
Undertaking surgery appropriate to training, expertise and surroundings |
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Professionalism |
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Insight |
Self-awareness, the ability to recognise and understand one’s actions |
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Morality and ethics |
Acting for the public good |
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Maintaining personal health and wellbeing |
Particularly if it impacts on colleagues and team members |
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Communication |
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Discussing and communicating options |
Communicating clearly with patients |
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Communicating effectively |
With patient, family and team |
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Gathering and understanding information |
Seeking timely and accurate information |
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Collaboration and teamwork |
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Teamwork |
Ability to recognise and respect the expertise of others and work with them |
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Documenting and exchanging information |
Ensuring a shared understanding among team members |
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Establishing a shared understanding |
All relevant clinical information is understood by team |
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Management and leadership |
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Setting and maintaining standards |
Supporting safety and quality by adhering to acceptable principles of surgery |
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Leading that inspires others |
Appropriate mixture of both calm demeanour yet clear decision making |
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Supporting others |
Providing cognitive and emotional help to team members |
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Scholarship and teaching |
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Improving surgical practice |
Evaluating surgical practice and identifying opportunities for improvement |
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Showing commitment to lifelong and reflective learning |
Through own learning |
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Teaching, supervision and assessment |
Facilitating education of students, patients and colleagues |
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2 Overall ranking of importance of attributes defined in the Royal Australasian College of Surgeons surgical competence and performance guide*
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Overall ranking of attributes from most to least important |
Sample size |
Mean (SD) |
Median (IQR) |
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Competence |
1818 |
4.77 (0.44) |
5 (0) |
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Insight |
1817 |
4.75 (0.46) |
5 (0) |
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Recognising conditions amenable to surgery |
1806 |
4.75 (0.45) |
5 (0) |
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Discussing and communicating options |
1807 |
4.60 (0.53) |
5 (1) |
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Morality and ethics |
1814 |
4.59 (0.59) |
5 (1) |
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Communicating effectively |
1806 |
4.58 (0.54) |
5 (1) |
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Caring and compassion |
1813 |
4.55 (0.58) |
5 (1) |
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Teamwork |
1813 |
4.54 (0.58) |
5 (1) |
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Maintaining dexterity and technical skills |
1806 |
4.53 (0.57) |
5 (1) |
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Setting and maintaining standards |
1806 |
4.51 (0.59) |
5 (1) |
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Gathering and understanding information |
1800 |
4.47 (0.56) |
5 (1) |
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Considering options |
1802 |
4.47 (0.57) |
5 (1) |
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Managing safety and risk |
1805 |
4.44 (0.61) |
5 (1) |
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Improving surgical practice |
1804 |
4.43 (0.61) |
4 (1) |
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Defining scope of practice |
1806 |
4.43 (0.66) |
5 (1) |
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Planning ahead |
1807 |
4.42 (0.62) |
4 (1) |
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Showing commitment to lifelong and reflective learning |
1808 |
4.39 (0.62) |
4 (1) |
||||||||||||
|
Monitoring and evaluating care |
1809 |
4.37 (0.62) |
4 (1) |
||||||||||||
|
Documenting and exchanging information |
1804 |
4.36 (0.62) |
4 (1) |
||||||||||||
|
Leading that inspires others |
1806 |
4.36 (0.64) |
4 (1) |
||||||||||||
|
Teaching, supervision and assessment |
1806 |
4.34 (0.63) |
4 (1) |
||||||||||||
|
Establishing a shared understanding |
1806 |
4.33 (0.62) |
4 (1) |
||||||||||||
|
Implementing and reviewing decisions |
1805 |
4.31 (0.62) |
4 (1) |
||||||||||||
|
Meeting patient, carer and family needs |
1805 |
4.31 (0.63) |
4 (1) |
||||||||||||
|
Maintaining personal health and wellbeing |
1796 |
4.28 (0.70) |
4 (1) |
||||||||||||
|
Supporting others |
1806 |
4.15 (0.71) |
4 (1) |
||||||||||||
|
Responding to community and cultural needs |
1804 |
3.86 (0.83) |
4 (1) |
||||||||||||
|
|
|||||||||||||||
|
IQR = interquartile range. * 5-point Likert scale: 1 = not at all important, 2 = not important, 3 = somewhat important, 4 = important, 5 = very important. |
|||||||||||||||
3 Importance of the Royal Australasian College of Surgeons competencies10*
|
Overall |
Fellow |
Trainee |
Male |
Female |
|||||||||||
|
Competency |
No. of responses |
Mean (SD) |
Median (IQR) |
No. of responses |
Mean (SD) |
Median (IQR) |
No. of responses |
Mean (SD) |
Median (IQR) |
No. of responses |
Mean (SD) |
Median (IQR) |
No. of responses |
Mean (SD) |
Median (IQR) |
|
|
|||||||||||||||
|
Medical expertise |
5432 |
4.53 (0.59) |
5 (1) |
3573 |
4.59 (0.59) |
5 (1) |
1859 |
4.51 (0.59) |
5 (1) |
4506 |
4.51 (0.59) |
5 (1) |
926 |
4.59 (0.56) |
5 (1) |
|
Judgement and decision making |
5414 |
4.40 (0.61) |
4 (1) |
3561 |
4.39 (0.62) |
4 (1) |
1853 |
4.42 (0.59) |
4 (1) |
4489 |
4.39 (0.61) |
4 (1) |
925 |
4.48 (0.59) |
5 (1) |
|
Health advocacy |
5423 |
4.24 (0.75) |
4 (1) |
3567 |
4.24 (0.76) |
4 (1) |
1856 |
4.23 (0.72) |
4 (1) |
4499 |
4.22 (0.76) |
4 (1) |
924 |
4.43 (0.70) |
4 (1) |
|
Technical expertise |
5418 |
4.57 (0.58) |
5 (1) |
3561 |
4.57 (0.59) |
5 (1) |
1857 |
4.57 (0.56) |
5 (1) |
4492 |
4.56 (0.59) |
5 (1) |
926 |
4.63 (0.54) |
5 (1) |
|
Professionalism |
5427 |
4.54 (0.62) |
5 (1) |
3573 |
4.55 (0.62) |
5 (1) |
1854 |
4.53 (0.61) |
5 (1) |
4508 |
4.53 (0.62) |
5 (1) |
919 |
4.57 (0.61) |
5 (1) |
|
Communication |
5413 |
4.55 (0.55) |
5 (1) |
3560 |
4.56 (0.55) |
5 (1) |
1853 |
4.54 (0.54) |
5 (1) |
4490 |
4.53 (0.55) |
5 (1) |
923 |
4.64 (0.51) |
5 (1) |
|
Collaboration and teamwork |
5423 |
4.41 (0.61) |
4 (1) |
3567 |
4.38 (0.62) |
4 (1) |
1856 |
4.46 (0.59) |
5 (1) |
4498 |
4.38 (0.62) |
4 (1) |
925 |
4.54 (0.56) |
5 (1) |
|
Management and leadership |
5418 |
4.34 (0.67) |
4 (1) |
3565 |
4.33 (0.68) |
4 (1) |
1853 |
4.35 (0.64) |
4 (1) |
4495 |
4.33 (0.67) |
4 (1) |
923 |
4.41 (0.63) |
4 (1) |
|
Scholarship and teaching |
5418 |
4.39 (0.62) |
4 (1) |
3566 |
4.39 (0.62) |
4 (1) |
1852 |
4.38 (0.62) |
4 (1) |
4494 |
4.39 (0.62) |
4 (1) |
924 |
4.40 (0.62) |
4 (1) |
|
Total |
48 786 |
4.44 (0.63) |
5 (1) |
32 093 |
4.44 (0.64) |
5 (1) |
16 693 |
4.44 (0.62) |
5 (1) |
40 471 |
4.43 (0.64) |
5 (1) |
8315 |
4.51 (0.60) |
5 (1) |
|
|
|||||||||||||||
|
IQR = interquartile range. * 5-point Likert scale: 1 = not at all important, 2 = not important, 3 = somewhat important, 4 = important, 5 = very important. |
|||||||||||||||
AMA in the News
Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.
Print/Online
Medics to fix ‘fear’ culture, The Daily Telegraph, 4 April 2015
A change in the way doctors and nurses report abuse is needed to buck the scourge of sexual harassment and protect whistleblowers within the medical industry. AMA President A/Professor Brian Owler was committed to bringing about cultural change within the profession.
$8.40 more to see doctor, Herald Sun, 7 April 2015
Patients could be paying up to $8.40 for a visit to the doctor by 2018, more than they would have paid under the GP co-payment. AMA President A/Professor Brian Owler said the lazy policy would mean fewer patients would be offered bulk-billing.
Religious belief saw mum and baby die, The Daily Telegraph, 8 April 2015
The AMA has defended doctors at a top Sydney hospital forced to let a heavily pregnant woman and her unborn child die after the mother refused a blood transfusion because she was a Jehovah’s Witness. AMA Vice President Dr Stephen Parnis said doctors could not force a patient to accept treatment.
Not in the script – chemists selling your data, Sunday Mail Adelaide, 12 April 2015
Some chemists are selling their patients’ prescription information to a global health information company, which sells it on to drug firms, trying to boost their sales. AMA Chair of General Practice Dr Brian Morton called it an amazing invasion of privacy for purely commercial reasons.
Coalition’s ‘no jab, no pay’ policy ties benefits to immunisation, Australian Financial Review, 13 April 2015
Australian parents will lose thousands of dollars’ worth of childcare and welfare benefits if they refuse to vaccinate their children. AMA President A/Professor Brian Owler said the AMA backed the plan and said vaccination remained one of the most effective public health measures that we have.
Hospitals ‘storm’ warning, Adelaide Advertiser, 16 April 2015
The number of public hospital beds across Australia has fallen by more than 200 and no State has met emergency department targets. AMA President A/Professor Brian Owler said hospital performance benchmarks are not being met and things will only get worse as funding declines.
AMA hospital report card gives states fuel for fight, The Australian, 16 April 2015
Tony Abbott will face heightened pressure to reverse cuts of $80 billion to health and education, with a snapshot of public hospital performance handing the states fresh ammunition to press home their case. AMA President A/Professor Brian Owler will use the report to warn the Government that its extreme public hospital cuts are unjustified.
Church no longer exempt for jabs, Hobart Mercury, 20 April 2015
A religious exemption loophole, that allowed parents who opposed vaccinations to continue to receive childcare and family tax payments has been scrapped. AMA President A/Professor Brian Owler praised the move.
AMA warns against continued freeze on rebates, ABC News, 22 April 2015
AMA President A/Professor Brian Owler said at a time when the Government should be increasing its investment in general practice, the Medicare rebate freeze will eat away at the viability of individual practices.
Rape row over new anti-jab campaign, Adelaide Advertiser, 23 April 2015
A Facebook graphic on the Australian Vaccination Network site that compares vaccination to rape has been condemned by doctors, the Rape Crisis Centre, and politicians as abhorrent and insulting. AMA President A/Professor Brian Owler said the post undermines the organisation and shows lack of intelligence and common sense.
Doctors back review of Medicare rebates, West Australian, 23 April 2015
Doctors have backed a sweeping review of the Medicare Benefits Schedule, but warned the Federal Government not use it as an excuse to cut patient services. AMA President A/Professor Brian Owler agreed the MBS was outdated and said any savings from the review should be reinvested into the health system.
Aussie in sick new IS video, Sunday Herald Sun, 26 March 2015
The shocking new public face of Islamic State death cult is an Australian doctor. AMA President A/Professor Brian Owler said he was appalled that any medical professional would want to work for terrorists.
Transparency on dug company payments and trips a step closer, The Age, 28 April 2015
Patients will find out what payments and educational trips their doctors have received from drug companies. AMA Chair of General Practice Dr Brian Morton said it was insulting and naïve to suggest doctors would be unduly influenced by a free meal.
Terror doctor free to practise, Adelaide Advertiser, 28 April 2015
The Medical Board is refusing to deregister the former Adelaide doctor who left Australia to join the Islamic State terrorist group. AMA Vice President Dr Stephen Parnis said he expected the Medical Board to look closely at the case from legal and professional standards perspectives.
Scientists call for action on disease risks from climate change, Sydney Morning Herald, 30 April 2015
The Australian Academy of Science has released a report which shows a range of tropical diseases becoming more widespread in Australia due to climate change. AMA President A/Professor Brian Owler said the report should be a catalyst for the Abbott government to show leadership on reducing greenhouse gas emissions and mitigating their effects on health.
Radio
A/Professor Brian Owler, 774 ABC Melbourne, 7 April 2015
AMA President A/Professor Brian Owler talked about the decision to axe the proposed $5 Medicare co-payment in favour of an alternative Government plan to freeze the amount received by doctors in rebates.
Dr Stephen Parnis, 6PR Perth, 13 April 2015
AMA Vice President Dr Stephen Parnis discussed the use of the welfare system to boost immunisation rates. Dr Parnis said in the 1990s the Howard Government also linked immunisation to social security, which resulted in a big increase in vaccination rates.
A/Professor Brian Owler, Radio National, 16 April 2015
AMA President A/Professor Brian Owler discussed Federal funding for health. A/Professor Owler said the health system has never been adequately funded and doctors and nurses have done well to meet a rise in demand.
A/Professor Brian Owler, 2SM Radio, 16 April 2015
AMA President A/Professor Brian Owler talked about the use of paw paw for chronic back pain. A/Professor Owler said paw paw is a well-known treatment, but that people do not tend to use it as much nowadays.
A/Professor Brian Owler, 4BC Brisbane, 16 April 2015
AMA President A/Professor Brian Owler talked about the issue of health funding and the AMA Public Hospital Report Card. A/Professor Owler said the issue is capacity and resources, and that he is concerned about the future given reduced Commonwealth funding.
Dr Stephen Parnis, 2GB Sydney, 23 April 2015
AMA Vice President Dr Stephen Parnis talked about the recent Facebook post from the Australian Vaccination Skeptics Network, which compares forced vaccination to rape. Dr Parnis said the campaign shows how disgraceful and unhinged some anti-vaccination campaigners are.
A/Professor Brian Owler, 2UE Sydney, 28 April 2015
AMA President A/Professor Brian Owler talked about the Medical Board’s handling of the case of an Australian-registered doctor who has joined Islamic State. A/Professor Owler said he understands the Medical Board is working with security agencies to ensure that the public is safe, and to prevent any possibility of Dr Kamleh returning to Australia to continue practising medicine.
A/Professor Brian Owler, ABC NewsRadio, 30 April 2015
The Australian Academy of Science is warning of the impacts of global warming predicting food and water shortages, along with extreme weather events. AMA President A/Professor Brian Owler said climate change has been a political battleground and that Australia is not ready to cope with its impacts.
Television
A/Professor Brian Owler, Channel 9, 16 April 2015
AMA President A/Professor Brian Owler talked about the AMA’s Public Hospital Report Card. A/Professor Owler said many hospitals are not reaching targets in the emergency department treatment and elective surgery wait times.
Dr Stephen Parnis, Channel 9, 12 April 2015
AMA Vice President Dr Stephen Parnis talked about the Government’s announcement that childcare rebate payments will be cut for families who do not vaccinate their children. Dr Parnis said the children involved are innocent, and their futures need to be insured.
A/Professor Brian Owler, ABC News 24, 16 April 2015
AMA President A/Professor Brian Owler discussed the crisis in Australia’s public hospitals as Commonwealth funding is wound back. A/Professor Owler said the Commonwealth are not living up to their responsibilities to fund States and Territories properly to run hospitals.
A/Professor Brian Owler, Channel 9, 22 April 2015
AMA President A/Professor Brian Owler discussed welcoming the plans for a major review of the Medicare Benefits Schedule. A/Professor Owler said the review is clinician-led and is not just about finding savings.
A/Professor Brian Owler, Sky News, 29 April 2015
AMA President A/Professor Brian Owler discussed the future of the public hospital system if Federal Government cuts come into effect. A/Professor Owler said state governments lack the capacity to increase revenue to pick up the slack.
A/Professor Brian Owler, ABC News 24, 30 April 2015
AMA President A/Professor Brian Owler called on the Federal Government to show leadership on climate change or risk the health of Australians. A/Professor Owler said there was overwhelming scientific consensus that the climate is changing and there will be consequences for health.