Clinical Placements

General Requirements

Clinical placement of a trainee shall be to a clinical team with responsibility for patients in general adult medicine, or its subspecialties, either in inpatient or ambulatory settings or both. Placements should be designed to develop a graded responsibility through each training year.
Trainees should attend prescribed courses of study and tutorials directly related to the training program, usually around four hours per week of employed time.

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Training Sites
Training can be undertaken in the following:
University Teaching Hospitals - the entire 36 months of training may be undertaken in UTHs;
General Teaching Hospitals - up to 24 of the 36 months may be undertaken in GTHs, the remaining 12 months to be spent in a UTH;
Secondment Hospitals - training in these institutions will be on rotation from a UTH or GTH.

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Formal Teaching Program
Formal teaching should be organised and delivered by appropriately skilled and experienced staff, applying currently accepted educational principles to the teaching program.

The structured educational program provided in a currently recognised educational format should be of sufficient duration to achieve the training objectives. Ideally, all trainees and trainers will receive a written copy of the general and formal teaching course objectives. It is recommended that this is a minimum of 120 hours per year (e.g. four hours per week for 30 weeks).
In general this program will be organised by DPTs on a hospital basis, although state-based programs at a central site may also exist. Smaller hospitals may wish to use video-conferencing facilities to aid teaching.

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Access to Resources

To meet the objectives of the training program, the trainee requires access to general facilities and resources that include:

• a library, containing recognised texts and a relevant range of current journals, and with a computerised database (Medline);
  
• facilities for teaching in a clinical setting;
  
• facilities for meetings and teaching sessions;
  
• a structured learning program;
  
• audiovisual teaching equipment.

A broad range of clinical staff is expected to have input into the trainees' learning experience.

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Clinical Supervision
Clinical supervision will come from a number of people through each year of the program. The clinical supervisor is usually the current consultant in charge of the clinical team to which the trainee is attached. Clinical supervisors will usually have no more than two basic trainees under their supervision.

The level of supervision of the trainee is dependent on ability and will vary as the trainee progresses through the program. Opportunities for directly supervised, indirectly supervised and monitored, and relatively independent clinical practice should be provided according to the ability of the trainee. As a guide, eight hours per week of direct trainee/supervisor clinical contact is expected, plus one hour of trainee/supervisor individual contact.

The trainee is essentially apprenticed to the clinical supervisor. As well as the direct clinical responsibility carried by the specialist for the work of all members of the clinical team, the additional responsibilities of a clinical supervisor are:

• to review the training objectives for each placement with the trainee at the beginning of the placement, and objectively assess progress against these objectives at least every three months, and at the end of each placement;
  
• to create a suitable individual learning environment for the trainee;
  
• to ensure that a wide range of opportunities for clinical skill development is available to the trainee.

Clinical supervisors may be called upon to contribute to an objective-based assessment of the trainee's suitability to sit for the Examination.

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Educational Supervision

Individual direct educational supervision provided by the supervisor should include:

• ensuring that the trainee makes effective use of the learning environment provided;
  
• directing and focussing learning so the trainee develops good self-directed training techniques;
  
• ensuring that the trainee develops an understanding of the wider aspects of vocational training.

In addition to direct educational supervision from current clinical supervisors, the overall educational supervision is given by the DPT.

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