Trainee News - April 2016

College Trainees' Committee Chair Update

Dr Tina Marinelli

This has been a difficult year for both trainees and the College, the issues with computer based testing being one of the biggest challenges that we have faced. A crisis such as this demands that everyone work hard to get through it and support the best outcomes, from fellow trainees to college staff, health services, DPEs, supervisors and trainees. As a committee we’ve seen a great deal of collegiality and many working additional shifts or offering tutorials to enable the trainees affected to focus on their exam preparation and achieve success.

CTC will be working closely with the RACP to ensure the conduct of future examinations goes smoothly and the well-being of trainees is given even greater focus with every decision. Even more importantly, we need to ensure that candidates for the 2019 written examination have information about the style and format of the examination as soon as possible, so that they can tailor their study and know what to expect. This will in part be determined by the outcome of the independent investigation.

New Zealand Trainees’ Day was held in Queenstown a few weeks ago. As well as providing a fantastic array of speakers, it was a great opportunity for trainees to network and socialise in picturesque surroundings. The Australian Trainees’ Day (New Zealanders welcome too of course!) will be held immediately before Congress in Sydney in May on the 13 May and I am pleased to advise that thanks to the support of our sponsors the price is now $50. I encourage you all to have a look at the program (the speakers look amazing) and consider registering.

We know that value for money is important for our trainees and have been actively advocating for increased transparency. The College has been working on articulating this with the latest breakdown in the annual report. Some of the fees invest in ensuring the quality of our training and accreditation while others are more tangible like the provision of eLearning resources. However, we would like to better understand the breakdown in more detail and will be writing to the FRMC to advocate for this for our trainees.

The College Learning Series is now live. Many of the lectures from the previous lecture series have now been uploaded with embellishments such as key point highlights and review quizzes to complement your learning. The current lectures are mainly focussed on adult medicine, however the plan is to work with Fellows to develop paediatric-specific lectures later this year. This will not only improve this resource but also ensure educational equity.

This will be my last message as the Chair of the CTC, with my term ending in May. I would like to welcome Dr Davina Buntsma as the new Chair of the CTC, who will be supported by Dr Elizabeth Keeling as Deputy Chair. I am confident that the CTC is in good hands and that the trainee voice will continue to be heard throughout the RACP. 

I would like to thank my Deputy Chairs Dr Susannah Ward and Dr Jin Russell for their support over the last two years and for their passion for representing trainees and improving the experience of training. I would also like to thank all members of the CTC and the NZ and state trainees’ committees as well as the hundreds of other committees and working groups that happen behind the scenes. It’s not always easy to find the time to donate to the College, in between fulfilling our own training requirements, sitting exams, working and life in general, and I am sure that all trainees would join me in saying thank you.

Finally, I would like to welcome Dr Alice Grey as the new trainee representative on the RACP Board. Alice will be one of ten Board members under the newly revised governance structure. Having trainee input at the highest level of College governance ensures not only that the current needs of trainees are addressed but also that we are securing a strong future for our trainees, the physicians of the future.

Best wishes.

Dr Tina Marinelli 
Chair, College Trainees Committee


Trainees’ Day

Trainees’ Day - it’s a day run by trainees for trainees and designed to help develop your clinical skills, promote discussion and prepare you for your career as a physician.

This year, Trainees’ Day will be held on Sunday, 15 May 2016 in Adelaide, prior to Congress 2016. The day promises to deliver a program relevant to you, the trainee. 

The sessions have been planned based on your feedback. It’s an opportunity to learn from your peers and hear from Fellows on topics including your health and wellbeing, tips on putting forward your best job application – writing a medical CV and interview skills, and mentoring.

Further details on the topics and speakers for Trainees’ Day can be found on the program.
The annual event provides the perfect lead up to RACP Congress, which we encourage you to stay and attend.

For more information about Trainees’ Day and RACP Congress 2016 visit the Congress 2016 website.

RACP New Zealand Trainees’ Day, 19 March 2016, Christchurch

New Zealand Trainees’ Day was once again a big success, with over 100 attendees, it was an opportunity to network with trainees from across the country. Dr Jin Russell, Advanced Trainee, General Paediatrics & Community Child Health, NZ Trainees Committee Co-Chair (Paediatric), shares her experience of the day.

The New Zealand Trainees’ Day program was based on the theme ‘Making good decisions: at work and at home’. It offered information and skills development to support you in balancing your physician career with all other elements of life.

The annual event was a collaborative effort between the NZ Trainees’ Committee and College staff. 

This year’s event was held on Saturday, 19 March at the Otago University School of Medicine in Christchurch. 17 speakers (of which 16 were New Zealand Fellows) presented at the event sharing their experience and knowledge with our trainees.
Professor Alistair Woodward, an epidemiologist from the University of Auckland and lead co-author of the human health chapter for the Intergovernmental Panel on Climate Change’s 5th report, delivered the keynote address on the human health impacts of climate change.

The aim of the day was to provide information and skills development to support trainees in balancing their physician career with all other elements of life. Presentations addressed decisions faced by trainees concerning training, careers and wellbeing.

The NZ Trainees’ Committee plays a key role in developing the theme and program for this annual event. The Committee appreciates the huge amount of support from New Zealand Fellows who attended for the day as speakers and to engage with our trainees, in particular the New Zealand President, Associate Professor Mark Lane and New Zealand President-Elect, Dr Jonathan Christiansen.

Seminar Spotlight: Cognitive and emotional biases in medicine

Cognitive errors and emotional biases affect our clinical reasoning every day - no matter how knowledgeable, industrious or compassionate doctors are. This was one of many take-home messages from a fascinating presentation entitled “How doctors think: improving diagnosis, reducing error” given by Dr Ross Nicholson (FRACP) to participants at this year’s NZ Trainees’ Day conference.  


Dr Nicholson drew on research from cognitive psychology and neuroscience to demonstrate how the human mind is prone to making predictable errors in situations requiring complex thinking – such as diagnostic reasoning. Errors are more likely to occur when the mind uses “Type 1” processes – the fast, reflexive thinking processes that enable pattern recognition and swift conclusions. Type 1 processes, although necessary in many situations, create the potential for cognitive biases such as premature closure (shutting down the possibility of alternative diagnoses too early), the availability heuristic (bias towards a particular diagnosis due to recent encounters with these cases), confirmation bias (ambiguous or contradictory results are minimised in order to give undue support towards the favoured diagnosis), and many others. 
By mindfully switching to slower, analytic and critical thinking processes – so called “Type 2” processes – doctors may prevent themselves from making such errors. Strategies such as taking the time to be sceptical, resisting familiar and easy explanations, mindfulness of our own emotional state when diagnosing, and seeking the opinions of others help reduce the risk of cognitive errors. The good physician is one who has learnt to think well, both fast and slow. 

Dr Jin Russell
Advanced Trainee, General Paediatrics & Community Child Health, NZ Trainees Committee Co-Chair (Paediatric)


Further reading:
1. Groopman, J. (2008). How Doctors Think. Boston: Houghton Mifflin Company.
2. National Academies of Sciences, Engineering, and Medicine. (2015). Improving Diagnosis in health care. Washington, DC: The National Academies Press. 
 

New Zealand Trainees’ Committee

The NZ Trainees’ Committee provides a valuable forum for the voice of over 1045 New Zealand trainees. The Committee has representatives from across the New Zealand regions and College Divisions and Faculties, and Basic and Advanced Training. 

The 14 Committee members are active in advocating on behalf of New Zealand trainees at all levels of College governance and in all matters affecting selection, training, assessment, supervision and the overall education experience with the College. Recommendations are also made at a policy level. The NZ Trainees’ Committee is a standing Committee of the NZ Committee and works alongside the College Trainees’ Committee. 

The ​Committee's Co-Chairs are Dr Evan Jolliffe, a trainee representative on the College Board and NZ Committee and, Dr Jin Russell who represents trainees on the College Council. Both Dr Jolliffe and Dr Russell are also members of the College Trainees’ Committee. Other Committee members provide representation for trainees on other College bodies including the NZ Policy & Advocacy Committee, NZ Adult Medicine and Paediatrics & Child Health Division Committees and NZ Māori Health Committee. 

During the last year, a key focus for this Committee has been the well-being of trainees. This was reflected in the theme for the 2015 New Zealand Trainees’ Day, ‘Live Well, Work Well’. The Committee has been working to identify and develop initiatives to encourage trainees to take care of themselves, to improve the mentoring culture in New Zealand, and to provide better support to trainees in difficulty. Work is happening not just at the local level but also more broadly to provide input to these issues at a College-wide level.

The NZ Trainees’ Committee is currently seeking several new trainee representatives to serve on the Committee, in particular representatives from Basic Training, smaller centres, and the South Island. Please refer to the Expressions of Interest notice in this newsletter.

The NZ Trainees’ Committee is always interested in hearing from New Zealand trainees on matters that trainees feel are important to them. We understand that, especially for new trainees, learning what the College does and how it serves its members can be overwhelming. We are here to help and support trainees. Contact us at traineescommittee@racp.org.nz
 

Policy changes affecting all trainees: Revisions to the Progression Through Training and Flexible Training policies

The Progression Through Training and Flexible Training Policies were reviewed in 2015 through a member-led policy revision process. As a result, there are a number of changes to examinations that will impact trainees from 1 January 2017. Advanced Trainee in General Paediatrics and Community Child Health Dr Jin Russell, Trainee Member of the 2015 Flexible Training and Progression through Training Policy Review Working Group, explains.

From 1 January 2017 the newly revised Progression Through Training and Flexible Training Policies will come into effect. These two policies are frequently referenced by trainees and supervisors. They govern many aspects of training such as a trainee’s eligibility to sit examinations, time limits to complete training, and provisions for part-time training and interruptions.
     
For adult medicine and paediatric and child health basic trainees, a key change is a decrease in the number of attempts allowable to pass the written and clinical examinations from five attempts at each exam to three attempts at each. 

While the time limit to complete Basic Training remains unchanged at eight years, this time limit now includes successful completion of the Divisional Examinations. In other words, both the written and clinical examinations must now be completed by the end of the eight year time limit on basic training. 

Under the old policies, the exams were excluded from the time limits. Basic Training could be extended almost indefinitely as trainees who had completed their Basic Training time but had yet to pass the exams could take several years to work through their exam attempts. While this has not been ideal for the trainees themselves, this situation has also contributed to bottlenecks at accredited Basic Training sites making progression for more junior trainees difficult.  

The vast majority of trainees will pass the exams within three attempts. For example, in each year from 2012 to 2014, 97-98 per cent of the candidates who passed the Divisional Written exam were attempting for the first, second or third time. A limit of three exam attempts is also comparable to requirements of other medical colleges. These policy revisions thus encourage timely progression and completion of Basic Training. The new policies will no longer contain information regarding exam eligibility or attempt limits for each division or faculty – these details will now be included in each of the relevant training program handbooks. 

Another key change is the introduction of a five year time limit for interruptions between Basic and Advanced training programs during which trainees must register with the College annually and spend no more than two consecutive years away from clinical work. Breaks of this sort are not uncommon as trainees may take parental leave, wait for a position on an advanced training program or pursue higher studies. Under the old policies there was no time limit or requirement to keep in contact with the College during a long interruption between programs. The new policies reflect a desire to encourage currency of knowledge and skills, while maintaining enough flexibility to allow trainees the time to pursue other opportunities.
 
A number of minor changes have also been made to the revised policies which are not covered by this article. 

Many trainees, particularly basic trainees, will be eager to know how the revisions will affect them personally. Transitional arrangements for the new exam attempt limit will be in place so that when the policy comes into effect 1 January 2017, trainees will be able to easily determine how many exam attempts they have remaining, based on their unique circumstances. The transitional arrangements take care not to disadvantage trainees who commenced Basic Training under the older policy versions.  
Many aspects of the two policies have not been changed: generous parental leave provisions remain excluded from the training time limits, part-time training remains a possibility at 0.4FTE (or even less in some circumstances), and multiple interruptions to training continue to be accommodated. 

As a trainee member of the working group that revised these policies, I’ve been encouraged by the College’s ability to balance timely progression through training with its commitment to flexibility and supporting trainees in the myriad of life pathways we find ourselves on. I’d encourage all trainees to read these documents thoroughly to see how the changes may affect them. The two policies are a mere 12 pages long when combined and easy to read. 

For more information, go to the College website where you will find the revised policies, 2016 Trainee and Supervisor Guide, At a Glance sheets and other information. Trainees can also contact their local Educational Supervisor or Director of Physician Education, Education Officers or Member Service Officers. The College call centre will also be able to help trainees who require assistance: contact them via Member enquiries: memberservices@racp.edu.au or on (AUS) 1300 697 227 or (NZ) 0508 69 7227. 

Dr Jin Russell
Advanced Trainee in General Paediatrics and Community Child Health
Trainee Member of the 2015 Flexible Training and Progression through Training Policy Review Working Group

Training Support Pathway

The Training Support Pathway, is a new policy and pathway introduced by the College on 1 January 2016, to assist trainees who encounter difficulty during their training. 

This new, structured training support, provides a clear pathway and supporting resources for trainees, and their supervisors, to address difficulties at an early stage, and in a fair, transparent and confidential manner. Training difficulties can relate to trainee progression, the training setting or the trainee/supervisor relationship.  

There are three stages of the Training Support Pathway, starting first at a local level, with additional support offered through a supervisor.

Key steps include early intervention, transparent communication, regular performance feedback, and setting clear learning actions and expected outcomes.

Further information on the three stages can be found on the RACP website or by contacting the Training Support Unit: TrainingSupport@racp.edu.au or on +61 2 9256 5457 (Aus) and TrainingSupport@racp.org.nz or on +64 4 460 8159 (NZ).

Expressions of Interest

College Trainees’ Committee Representatives

The College Trainees’ Committee (CTC) is the peak College body representing the interests of trainees and has 16 representatives from our Divisions, Faculties and regional Trainees Committees’ throughout Australia and New Zealand.

The CTC champions the trainee perspective and ensures the trainee voice is heard across our College. It is seeking applicants for representative positions from Tasmania, the Northern Territory and a representative who identifies as Aboriginal or Torres Strait Islander. 

Being a part of the CTC provides a unique opportunity to engage with the College and represent the needs and voice of trainees on key matters such as selection into training, assessment and overall education. Trainees who are interested in applying for membership of the CTC are invited to submit their Expression of Interest form and CV to TraineesCommittee@racp.edu.au by 5.00pm (AEST) Monday, 25 April 2016.
 

Trainee positions on a range of assessment and examination committee

Applications are invited for a range of positions on College assessment and examination committees.   

A new model of governance for assessment has been approved by the College Board. This new model includes the establishment of a College Assessment Committee, reporting to the College Education Committee, and the establishment of a range of other assessment and examination committees. 

The College is currently in the process of establishing all committees in the new model and we are seeking EOIs for the following trainee roles: 

  •  a trainee member – College Assessment Committee
  •  a trainee member – Adult Medicine Division Assessment Committee
  •  a trainee member – Paediatrics & Child Health Division Assessment Committee 
  •  an advanced trainee member – Written Examination Committee (Adult Medicine Division)
  •  an advanced trainee member – Written Examination Committee (Paediatrics & Child Health Division).

Positions will be appointed for an initial term of two years, with opportunity for renewal. 

To request a copy of the Board Approved Model, including Terms of Reference for the committees above, please email clare.leroy@racp.edu.au  

Interested trainees should submit an application, together with their CV, to Professor Tim Wilkinson, College Censor via email: education.governance@racp.edu.au 

Closing date:  COB Tuesday, 26 April 2016

Events

Trainees' Day, 15 May 2016, Adelaide

The College Trainees’ Day will take place on Sunday, 15 May, in Adelaide, South Australia. 
Date: 15 May 2016
Venue: City Room 1 and 2, Adelaide Convention and Exhibition Centre
Time: 7am for yoga, 8am for Trainees Day until 3pm. 
Registration: Registration, speaker and program details on the Congress 2016 website.

This event runs in conjunction with the RACP Congress, Evolve, Educate, Engage.

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