What support is available for the wellbeing of Fellows and trainees?

The RACP has a number of support mechanisms for trainees. We recognise that providing support is not simply about developing resilience in trainees but also involves the much broader, long term task of collaborating with sector partners in improving training environments and medical professional culture.

In terms of direct support, the College offers:

• confidential 24/7 counselling service to all members through Converge International
• eLearning modules on Self-Care and Wellbeing and Creating Safe Workspace
• Training Support Unit coordinates additional support for trainees to keep them on track in completing their training requirements
• additional information and resources through our website on physician health and wellbeing

The College has developed a statement on Respectful Behaviour in College Training Programs (PDF), which provides advice to supervisors and trainees about bullying, discrimination and sexual harassment.

What is the process for providing feedback to trainees on their progress and exam results, in particular, for those who find the requirements particularly challenging or have not passed their exams?

The College has a number of avenues for trainees to receive feedback on their progress. For progress in workplace aspects of training, feedback is provided on an on-going basis by supervisors as part of their day-to-day workplace training. Trainees also receive formal feedback through reports completed by the Directors of Physician Education (DPEs) and Training Supervisors.

Trainees who are assessed in these reports as performing below the expected level are referred to the Training Support Unit which initiates support to improve their performance and reach the expected level.

The College runs a total of twenty-one exams with the clinical examinations in Adult Medicine and Paediatrics and Child Health being the largest, with over a thousand candidates. The process for providing examination feedback to candidates who fail the exam is as follows:

• The candidate completes a ‘reflection feedback’ form following the examination and prior to their meeting with a College Fellow (usually a senior examiner or in some cases, their Director of Physician Education)
• They then meet with the Fellow in person where a written report, including scores and commentary on each patient case is provided from each examiner.
• At this meeting the candidate has an opportunity to discuss their scores and their own reflection on their performance.

The Training Support Unit co-ordinates support to assist trainees who have failed an examination two or more times to prepare for their next attempt. If a trainee fails their last allowable attempt at an examination the Training Support Unit arranges support from a supervisor or mentor and the RACP Support Program to assist their career transition.

What training and support is available to supervisors to ensure they have capabilities in teaching and training and also in recognising and dealing with the welfare of trainees?

The College recognises that supervisors play a central role in facilitating learning and setting the culture for learning within health care settings. The College has recently released a comprehensive Framework for Educational Leadership and Supervision (PDF). The framework explains:

• the roles and structure of educational leadership and supervision, the RACP standards for educational leadership and supervision
• supervisor accreditation, selection and appointment processes
• evaluation of educational leadership and supervision.

The College’s Supervisor Professional Development Program supports our supervisors in developing their skills in these important roles. The program comprises three workshops: Practical Skills for Supervisors; Teaching and Learning in Health Care Settings; and Work-based Learning and Assessment.

We have developed a Supervisor Handbook providing all information important to the role of a supervisor. The handbook, which will be published in October, will bring together and signpost key information, resources and guidance relevant to the supervisory role and provide practical tips, tools and strategies for supervisors to implement in their own practice.

In March 2017, the College convened a workshop at the request of supervisors and Directors of Physician Education in New South Wales to discuss the issues and challenges in relation to health and wellbeing of trainees.

In May 2017, the College launched an online resource on Physician Self-care and Wellbeing. The learning outcomes of the resource are to:

• understand how self-care and wellbeing impact physician practice
• form relationships and networks to support personal and professional wellbeing
• establish appropriate self-care strategies to increase self-awareness and better manage and regulate your wellbeing and physician practice.

Are there programs in place to support members suffering from distress, burn-out or mental illness?

The College offers a confidential counselling service for all members. Members are able to talk to a consultant about a range of issues from interpersonal conflict and tension, to alcohol and drug related problems, bullying and harassment, grief and their mental health.

What is being done to alleviate the pressure of having only one written examination per year?

The College is investigating increasing the frequency and availability of examinations. This includes delivering the written examination on a computer based platform and the development of online sample examinations.

What support is available to trainees struggling to complete their training requirements?

The Training Support Unit coordinates additional support for trainees to keep them on track in completing their training requirements.

As has been observed with difficulties in other settings, early engagement with the support unit and self-referral to the unit are likely to lead to better outcomes.

The unit encourages supervisors and trainees to implement a plan to support the trainee as soon as possible. The unit’s strategic intent is to prevent trainees repeating periods of training by initiating support for ‘at risk’ trainees. To date 80 per cent of trainees to enter this program have been satisfactorily remediated.

How do we address the issue of job shortages for physicians?

The RACP does not and cannot influence or control specialist physician workforce numbers. We do conduct workforce analysis, and we work with government to help our members make more informed choices about their training.

Creation of senior medical staff positions and recruitment into them are the responsibility of government workforce planners and employers, and are often significantly constrained by health service budgets, even where there is a clear need for the clinical service.

As with many other professions, there is very strong competition for training and specialist positions in major cities, but there are more opportunities in the outer metro, regional and rural settings.