On the eve of our first Board meeting for 2019, RACP Board Directors held another Conversation with the Board event, this time at The Royal Melbourne Children’s Hospital on Thursday, 28 February.
We aim to meet trainees and Fellows where they work and talk about issues that are important to them. At this meeting we sat around a table and discussed some challenging topics including gender equity, how we can make it easier for members to participate in College business (especially those with carer responsibilities), diversity, the pressure members are experiencing in the work place – particularly regarding training and how we can collectively address bullying.
I thank the members who joined us for a frank and open discussion.
Board Directors also spent some time at the RACP booth at this week’s RACP Congress in Auckland and chatted with members over morning or afternoon tea – thank you to everyone who took the time to come and have a chat.
Associate Professor Mark Lane
We heard there is a growing desire by our members to address gender equity in the College and in physician practice. We discussed how the College might tackle this, such as: demonstrating gender, ethnic and age diversity in the composition of the Board and College committees, committing to measuring and reporting on this and making our community more aware of systemic bias. It was felt these would be ways in which our College could reflect the gender and ethnic diversity of our trainee and physician community.
To demonstrate our commitment to addressing gender equity, an informal Women in Medicine group met at Congress 2018 and was continued in Congress 2019. We are exploring ways to support and collect more detailed data on the diversity of our members.
We heard that the ways in which our committees conduct business meetings can prevent members with young families with personal responsibilities from participating (e.g. interstate travel). We also heard about the frustration some members experience with the time it takes for a program of College work to come to fruition and this can be a reason not to get involved.
By increasing the use of tele/video conferencing for meetings, travel time has been reduced. We are also undertaking quantitative benchmarking, comparing our operations with similar organisations, and exploring ways to reduce demand on Fellows’ and trainees’ time.
We acknowledge that committee membership needs to be productive and valuable for volunteers, and that sometimes it can feel like progress is slow. Some areas of our work are inherently complex and require extensive consultation and careful long-term planning.
We heard concern regarding trainee numbers, capacity to train and we were asked what the College’s strategy is to address this.
We recognise Fellows are being asked to do more work within our health systems and increasing the number of trainees is another pressure point for Fellows and trainees alike. We have been working for some years on a solution for managing selection into training. Predicting future need for health services and matching training to demand is difficult; demand is modelled at up to twenty-year intervals by the Commonwealth Government in Australia and is particularly challenging in relation to the physician workforce. We participate in national strategic planning forums that look at available data and attempt to forecast medical workforce demand by specialty groups. We hope to achieve more robust modelling through our continuing work with the government which will inform our understanding of the demand for the physician workforce and implications for training capacity.
We also continually review our training site accreditation standards to provide guidelines for safe training. This is the primary influence we can offer at present.
We heard that productivity demand on physicians from health departments coupled with growing service demand is affecting their capacity to train, and there are growing concerns around the system’s ability to deliver the clinical exam. Trainees continue to question the value for money they receive for their training fees.
The unique value of work-based training needs greater protection, and greater recognition by employers. Relying more on Entrustable Professional Activities (EPAs) to measure competency should change the perception of training as it will link assessment more directly to the work trainees do daily. We will be able to explore how our assessments might rely less on an exam format. As our education renewal program rolls out, we will work with health department stakeholders to advocate for the capacity to train to be safeguarded.
We heard about the growing impact of burnout on the medical workforce. Members discussed the need for doctors to “self-change” and personally own the required culture change. They also expressed the need for the Board to advocate and set the tone for all members and committees, with zero tolerance for bullying amongst members whether in College bodies or in the work place.
Work is already underway through the Health and Wellbeing Strategic Roadmap, and the inaugural 2018 Physician Trainee and Educator Survey results raise issues for employers as well as us that require addressing. Results will be released in June 2019
We heard about ongoing concerns related to the Computer Based Exam failure and the Ferrier Hodgson Report. Some spoke of the importance of the findings and the relevance for the College as a whole.
We acknowledge these concerns and we have accepted all of the recommendations made by Ferrier Hodgson and are already implementing many of the them.