AMD Newsletter 29 June 2018
Addressing the needs and concerns of trainees
As I said in my first post, in this column it is my intention to raise issues and solicit ideas to help us find ways for the College to serve its members better. Today, I would like to discuss issues facing trainees. I will summarise my understanding of the main concerns and then provide some thoughts about what we as a College can do about them. I will be grateful for any comments and suggestions trainees and Fellows may have about additional issues that need to be considered and other strategies for action you may like to propose.1
From my conversations with Fellows and trainees, concerns are often expressed about the following:
- Trainee welfare, related to high levels of stress, uncertainty about the future and the risk of mental health issues
- Poor working conditions, including long hours, inadequate support from consultants, hospitals and employers, and exposure to bullying and harassment
- Inflexibility of employment conditions
- Issues relating to education and the examination process, including insufficient time for studying and learning, uneven quality of teaching and uncertainty associated with the sudden death exam
- A perception that the College is often remote, bureaucratic, rigid and unsupportive
- High fees, in the setting of all of the above.
I believe that protecting the welfare of trainees should be the single most important concern of the College at the present time. Stress has increased in recent years, perhaps owing to competition with respect to jobs, which are in short supply, and less congenial working environments. We were all shaken by the deaths by suicide of three BPTs, which have emphasised the urgent need for us to pay closer attention to the pressures to which trainees are exposed and to provide more effective care and support. Mental health issues can take the form of anxiety or depression but may not always be apparent to family, colleagues or even the trainees themselves. Many trainees have experienced bullying, harassment or sexual abuse at work, which has greatly added to the stress to which they are exposed.
The ever-increasing emphasis of hospitals and the health system in general on service delivery rather than education has, in the eyes of many, led to a decline in the quality of the training that is provided. In rural placements in particular, educational opportunities can be very uneven. The sudden-death exam and the uncertainty associated with an inflexible exam cycle adds to stress. On top of all their other commitments, BPTs often find themselves under pressure to undertake research projects in the hope of increasing their chances of being accepted into speciality programs of their choice.
I have been struck by stories from trainees of pressure to work long unpaid hours, outside official timetables, and sometimes at reduced rates and entitlements. The work itself is often emotionally demanding and there may be few formal opportunities to unwind and debrief. In some locations, the transition to a shift work system and the proliferation of covering and relieving roles have reduced opportunities to learn through longitudinal care of patients and have eroded teaching and mentoring relationships. When trainees go on sick leave they may not be replaced, placing additional burdens on their colleagues and leading many to continue to work while unwell. Junior staff often feel unable to voice concerns about their need for increased support and guidance.
Inflexibility of the working environment is also a recurring theme. An inability of workplaces to adapt to the varying needs of trainees, including the desire to start a family or explore non-standard approaches to work, has become a major concern for many. It may be difficult to maintain a conventional full-time hospital training job if one has a small child or is breastfeeding. An apparent interest in different lifestyle choices may be interpreted as lack of commitment to work and may prejudice one’s chances of entering a training program. Job sharing would be an attractive option for many but — at least in the adult medicine domain — appears to have limited support from employers.
In all of this, the College has not always been seen as an ally. It often presents itself as remote overbearing and bureaucratic, focusing more on accreditation than education. Trainees feel that they cannot turn to the College to advocate for them or to provide guidance, care and support if they find themselves in need.
So what can be done to bring about change? This is what we need to consider and the question about which I am seeking your suggestions. Obviously, the College does not control the broader healthcare workforce environment and cannot blamed for shifts in public policy. Nonetheless, we do have significant influence and there are areas in which we ourselves can change.
The College could assume a leadership role to advocate with government and hospitals to protect the interests of trainees and raise the quality of their clinical experience and education. It could provide improved support with respect to work and physical and mental health needs. It could set conditions for hospitals and health services to ensure that education receives sufficient emphasis and is not merely seen as an addition to the provision of services. The College could play a more active role with respect to actual educational content, including lectures, webinars and other materials, which would be of particular help for trainees in remote places.
Advocating or exerting pressure for fundamental workforce changes might also be adopted as a priority. In some other fields of employment flexible job descriptions, training programs and job sharing, and protections against bullying and sexual abuse, are mandated by law. As the representative of a major part of the medical workforce the College could exert significant pressure for changes in these areas. Assistance could be provided to hospitals to enhance support for families and for job-sharing arrangements, and for ensuring that equitable arrangements are observed in relation to overtime and sick leave.
It has been suggested that a system of welfare officers could be appointed to liaise with trainees and look after their well-being. Such officers—who may be based in different states and regions in both countries—could ensure that working conditions are reasonable and be available to provide support and counselling for trainees who are struggling for any reason. They could act as a conduit between trainees and the College, providing feedback about the effectiveness of programs and identifying new or unanticipated problems that need attention.
These are just a few initial ideas about the problems and possible responses to them. I would appreciate your thoughts about whether they are on the right track and if this is the way to move forward. To implement even a few of the above proposals we will need a new, cooperative environment that brings together trainees and fellows under the protection and guidance of the College, and for this, we will have to develop open and transparent avenues for communication about both challenges and solutions. This in turn will require reflection on our organisational processes, and the allocation of some resources.
Please share this article with colleagues and contact me with your thoughts, ideas and suggestions. Feel free to email me personally or, if you wish to talk, to contact me directly by telephone.
Professor Paul Komesaroff FRACP AM
Adult Medicine Division
Telephone: +61 (0)417 55 26 59
1.I would like to express my appreciation to the trainees and Fellows who have shared their thoughts with me as I have been preparing this column.
AChAM President’s Report
The Chapter Committee met on 31 May for the first time since the changeover of office bearers. We are pleased to welcome another new member, Dr Noel Plumley, as the Vic/Tas Branch Chair and announce that Chapter President-elect Professor Nick Lintzeris has recently commenced in the role of AChAM Representative on the College Policy and Advocacy Council.
The new Chapter Committee had a productive meeting, reviewing work completed so far for 2018 and commenced planning for 2019. Key items of work for the Chapter for the remainder of 2018 will be leading the review of the College’s 2009 Prescription Opioid Policy to ensure it is up-to-date and in line with the best available evidence, as well as finalising the Chapter’s Evolve list of low value clinical practices.
The Committee is currently seeking expressions of interest (EOI) from current Advanced Trainees in Addiction Medicine to join the Chapter Committee as the Trainee Representative. The Chapter Committee performs an important role as the authoritative source of advice within the College on all matters relating to Addiction Medicine. I strongly encourage any interested trainees to email AddictionMed@racp.edu.au to obtain an EOI form and I would encourage all supervisors to speak to their trainees about the value of the trainee representation on this committee.
I would also like to remind all Fellows that the 2019 IMiA (International Medicine in Addiction) conference will be held in Melbourne from 1 to 3 March. Please put a note in your diaries to attend what promises to be an excellent conference and we expect the conference website will be updated shortly.
The next AChAM Committee meeting will be held via teleconference on Thursday, 8 August 2018.
Dr Martyn Lloyd-Jones
Australasian Chapter of Addiction Medicine
AChSHM President’s Report
The Chapter Committee met on 20 June for a productive first meeting with its new membership. Planning commenced for 2019, with key priorities including the successful delivery of the Annual Scientific Meeting (ASM) and Trainees’ Day, and supporting Advanced Trainees in Sexual Health Medicine to attend these important educational events.
Following discussions at this recent meeting the Committee decided not to renew its annual subscription to the BMJ’s Sexually Transmitted Infections Journal, and as such the current Chapter login details will no longer be able to be used. The Committee made this decision after considering the substantial subscription fee and very low usage.
On behalf of the Chapter Committee I would like to congratulate President-elect Professor Christopher (Kit) Fairley, who was recognised in the 2018 Queen’s Birthday Honours as an Officer (AO) in the General Division for his distinguished service to community health, particularly in the area of infectious and sexually transmitted diseases, as a clinician, researcher and administrator, and to medical education. The Chapter also congratulates Professor Fairley for being awarded the College’s Eric Susman Prize for 2018 for the best contribution to the knowledge of any branch of internal medicine.
The Chapter Committee will next meet via teleconference on 14 September 2018.
Associate Professor Catherine O’Connor
Australasian Chapter of Sexual Health Medicine
AChPM President’s Report
The Chapter Committee met on 15 June. We are pleased to welcome Associate Professors Brian Le, William Leeroy and Dr Alison White to the Chapter Committee and to welcome back Dr Simon Allan who has rejoined the Committee as the New Zealand representative. I also welcome back to the Committee Associate Professor Peter Poon in his capacity as the palliative medicine representative on College Council.
During the meeting, the Chapter Committee reviewed the 2018 work plan and commenced planning for 2019. Key focus areas for the remainder of the year and into 2019 will be to finalise the Spirituality Training Working Party Recommendation Report and investigate opportunities for taking the report’s recommendations forward, including the recommendation to conduct and evaluate a pilot Spirituality Training Workshop.
There is a lot more activity relating to the work of Palliative Medicine. There are more jurisdictions proposing legislation for medical assistance in dying and asking for input. The debate has become ever more pressing and the Chapter of Palliative Medicine has been very active in assisting the College to develop the anticipated position paper. Although this is an issue that will affect all members of the medical profession, it has particular pertinence for those of us practising “at the end of life.” If there is to be legislation, then it needs to protect the vulnerable and allow the best protections for all members of society.
The work of training specialists and generalists in Palliative Medicine is of great interest for the Chapter Committee. The Clinical Diploma of Palliative Medicine is a unique initiative within the College, providing a generalist qualification for physicians and non-physicians to demonstrate increased skills and knowledge in palliative care. This is in addition to the large endeavour of training specialists in Palliative Medicine via the FRACP and the FAChPM pathways.
I attended an Australian Government Department of Health Prescription Opioid Misuse Stakeholder Discussion earlier this month in Melbourne representing the Chapter and Palliative Care Australia (PCA). At the meeting stakeholders were given the opportunity to discuss the issue in detail. I was pleased to be able to represent the views of Chapter and PCA on this complex and challenging issue.
The Chapter Committee will next meet via teleconference on Friday, 31 August 2018.
Professor Greg Crawford
Australasian Chapter of Palliative Medicine
Congratulations to the AMD Fellows recognised in the Queens Birthday Honours
Congratulations to the 21 Fellows of the Adult Medicine Division recognised in the 2018 Queen's Birthday Honours.
Companion of the New Zealand Order of Merit
- Dr Amanda Oakley FRACP
For services to dermatology.
Companion (AC) in the General Division
- Professor Rinaldo Bellomo FRACP
For distinguished service to intensive care medicine as a biomedical scientist and researcher, through infrastructure and systems development to manage the critically ill, and as an author.
- The late Professor David Cooper AO, FAFPHM, FRACP (deceased)
For eminent service to medicine, particularly in the area of HIV/AIDS research, as a clinician, scientist and administrator, to the development of treatment therapies, and to health programs in South East Asia and the Pacific.
Officer (AO) in the General Division
- Professor Christopher Fairley, FAFPHM, FAChSHM, FRACP
For distinguished service to community health, particularly in the area of infectious and sexually transmitted diseases, as a clinician, researcher and administrator, and to medical education.
- Professor Michael Francis Quinlan FRACP
For distinguished service to medicine, particularly through strategic leadership in the development of tertiary medical and social education in Western Australia as an academic and clinician.
- Professor Frank Vajda AM, FRACP
For distinguished service to medical education in the field of clinical pharmacology and the genetics of epilepsy, and to the promotion of humanitarian values.
- Dr John George McHutchison FRACP
For distinguished service to medical research in gastroenterology and hepatology, particularly through the development of treatments for viral infections, and to the biopharmaceutical industry.
(AM) in the General Division
- Dr Noel Bayley FRACP Member
For significant service to medicine in the field of cardiology, and to the diagnosis and treatment of heart disease in Timor-Leste.
- Professor Mark Brown FRACP
For significant service to medicine in the field of nephrology, and to medical research, particularly hypertension in pregnancy.
- Associate Professor Geoffrey David Champion FRACP
For significant service to medicine in the field of paediatric rheumatology, and to medical research and treatment of musculoskeletal pain.
- Professor Arlene Chan FRACP
For significant service to medicine in the field of oncology, particularly breast cancer support, diagnosis and treatment.
- Associate Professor Paul Desmond FRACP
For significant service to medicine in the field of gastroenterology as a senior clinician and researcher, and to professional associations.
- Dr David Hillman, FRACP (Hon)
For significant service to medicine as an anaesthesiologist and physician, to medical research into sleep disorders, and to professional organisations.
- Dr Ian Kronborg, FRACP, FAChAM
For significant service to medicine, particularly gastroenterology, and through innovative substance abuse treatment programs.
- Professor Christine McDonald FRACP
For significant service to respiratory and sleep medicine as a clinician-researcher, administrator, and mentor, and to professional medical organisations.
- Dr Andrew Skeels, FAChPM
For significant service to medicine, particularly in the field of palliative care, as a clinician and educator.
- Professor John Wilson FRACP
For significant service to medicine, and to medical research, in the field of respiratory disease, and to professional organisations.
Medal (OAM) of the Order of Australia in the General Division
- Associate Professor Terry Dorcen Bolin FRACP
For service to medicine in the field of gastroenterology.
- Dr Simon John Grant FRACP
For service to medicine, particularly to endocrinology.
- Dr Michael Miros FRACP
For service to medicine, particularly to gastroenterology.
- Dr Jacqueline (Jackie) Kim Mein FAChSHM, FAFPHM
For service to medicine, and to community health.
View RACP Congress 2018 resources
Videos of selected shared sessions and all presentations from RACP Congress 2018 are now online.
Browse through a range of thought-provoking material to stimulate, challenge and inspire you and your work.
The RACP has permission to share all material with you and if a presentation or video is not available it is because permission has not yet been received.
Access these resources
Mid-year registrations for Basic Training are open
Registrations are now open until 31 August 2018 in Australia and until 31 July in New Zealand for mid-year registrations for Adult Medicine and Paediatrics Basic Training.
If you have only registered for the first half of the year, we remind you to prospectively register terms for the remainder of the year via our online registration system.
Please note that any prospective registrations not submitted by 31 August (Australia) and 31 July (New Zealand) will result in unapproved training time which will extend the length of training programs
College Learning Series job opportunities
The College invites all AMD Fellows across Australia and New Zealand to become involved and help shape the College Learning Series for 2019 and beyond. See the links below for more information or forward to other Fellows who may be interested in these opportunities:
The closing date for Expressions of Interest is Friday 13 July.
Presentation on adolescent sleep by Professor Sarah Blunden from ASA
When: Wednesday, 11 July 2018 5:00 PM (Canberra, Melbourne, Sydney)
Topic: Adolescent Sleep - The Good, The Bad and The Ugly
Presented by: Professor Sarah Blunden from the Australasian Sleep Association
Why understanding adolescent sleep is so important? Because, when considering developmental change, adolescence is second only to early childhood with significant changes in physical, psychological and psychosocial domains.
Underlying all these domains is sleep. Sleep is the foundation of all health as without good sleep all other health issues can be negatively impacted. So, when sleep changes during adolescence, everything can change. Furthermore, when sleep improves negative health outcomes can be reversed. Understanding adolescent sleep is a recipe for understanding how we can maximise good health and wellbeing for our young people.
This webinar will present the latest evidence about sleep in adolescence, what is good about it, what can be bad about it and what can be the ugly consequences of poor sleep.
But most importantly how you as primary health care professionals, can help manage it.
This webinar is part of the Specialty Society Webinar Service pilot being undertaken by the RACP in partnership with its affiliated specialty societies.
Special advance registration is available and following registration you will receive a confirmation email containing information about joining the webinar.
Alfred Chest Ultrasound Course opportunity
You are invited to attend an introduction to pleural and lung ultrasound in Melbourne on Friday, 24 August 2018.
Highlights and benefits include:
Find out more
- essential physics and knobology
- hands-on scanning
- live patient demonstrations
- real-time needle guidance
- a large video clip library
- small group learning.
Expand your end-of-life care knowledge
To help you improve your skills in end-of-life care, the RACP is offering free access to an online course on the topic.
The course begins on Wednesday, 18 July.
Find out more
New benefits website
Same benefits, same savings, new design.
The new member lifestyle benefits website has been re-designed to offer improved navigation and functionality while allowing you to see the full benefit range on offer.
Access to your benefits directly.
Reminder on scholarships and grants opportunities - closing soon
It’s not too late to apply for research funding or study grants. Now is also the time to think about a mentor or colleague who deserves to be recognised for their contributions and achievements.
Nominations are now open for a number of College and Congress Prizes.
More than $2.5 million worth of Fellowships, Scholarships, Grants and Prizes — to support RACP Members at various stages of their career and training — are offered every year by the RACP Foundation.
Applications are closing soon in the following categories:
- Research Entry Scholarships for 2019 – closing date 16 July
- Research Development Scholarships for 2019 – closing date 30 July
- Travel Grants for 2019 – closing date 6 August
- Educational Development (Study) Grants funding round 2 - closing date 6 August
Nominations are now open for some of the College’s most prestigious Medals and Prizes. These awards acknowledge the outstanding achievements and contributions made by Fellows and trainees in their respective fields and are presented at the RACP Congress.
If you know of, or work with someone whose contributions and achievements you feel are worthy of recognition why not nominate them for one of these prestigious awards.
There are other awards and prizes offered by the Divisions, Faculties and Chapters in Australia and New Zealand. All details are available on the Foundation webpages.
For more information please contact the RACP Foundation at email@example.com or call +61 2 9265 9639.
Expressions of Interest (EOI)
All Expressions of Interest
Conferences and events
The RACP publishes notices of events and courses as a service to members. Please note this does not constitute endorsement or mandating these events or courses.
Alfred Chest Ultrasound Course 2018
View all events related to Adult Medicine here.