Engagement in education and retention in schooling are a key component in the wellbeing of young people. Kids who stay in education do better - even aside from academic achievements which can create further opportunities, the social connectedness and supports that exist within a school environment can help to build life skills and emotional resilience. This is why programs that promote engagement in schooling for teens who are at a high risk of dropping out, like the program for young parents at The Canberra College in the ACT, are such a good news story.
As a community, we are becoming more aware of how disadvantage can become entrenched in families across generations. Children growing up in a home where there is no role modelling of the positive aspects of education an employment will be more likely to drop out of education and not find stable employment as adults. If we can encourage teen parents to stay at school, not only are the teens more likely to do better as adults their children will see the benefits in the next generation as well.
The Canberra College has a history of innovation and providing programs that deal with the social determinants of health. Several years ago when I was living in Canberra, I was involved in a "full service schools" project at The Canberra College. This was a project which brought in several services (including primary health services, alcohol & drug services, sexual health services, employment services, pastoral care) into the school as a colocation model. The idea was to bring the services to where young people were in order to overcome the barriers that teens may be faced with in trying to navigate some of these systems in the community. It was fantastic working with a school that was enthusiastic about supporting the wellbeing of their students, and willing to innovate.
I'm not surprised to see that The Canberra College are still "kicking goals" for their students. Good on them!
Tuesday, October 26, 2010
Tuesday, October 12, 2010
not enough jobs for junior docs (part 4) ...and yet more Medical Schools...
"CURTIN, Charles Sturt and the University of South Australia will press ahead with their plans to create new medical schools."
In the midst of concerns about intern positions for medical graduates, 3 universities have announced their intent to move forward with plans for more medical schools (and more medical students). Australia is apparently not training enough doctors.
It is undeniable that there is a shortage in the medical workforce, especially in rural areas. However, the bottleneck in training is not at the medical school level. In order to produce doctors that are able to work independently and service areas of medical workforce disadvantage we need to create the supervised junior and training positions to provide vocational training.
Without adequate resourcing of junior medical positions, including indemnity (which is potentially a barrier for moving training into the private sector), and adequate resourcing of the time needed from senior doctors to provide the supervision that junior doctors require, bumping up the number of medical graduates does very little to improve workforce shortages. It makes absolutely no sense to increase the number of medical schools and thereby increase the number of medical students, until the issue of adequate supervised junior positions and vocational training is resolved.
Senior medical folk associated with the universities need to seriously consider wisdom of creating new medical schools at this point in time. If the unit you work in is unable to accommodate any more junior doctor positions (due to funding or availability of adequate supervision) then the rationale for increasing the number of medical graduates is probably difficult to justify.
In the midst of concerns about intern positions for medical graduates, 3 universities have announced their intent to move forward with plans for more medical schools (and more medical students). Australia is apparently not training enough doctors.
It is undeniable that there is a shortage in the medical workforce, especially in rural areas. However, the bottleneck in training is not at the medical school level. In order to produce doctors that are able to work independently and service areas of medical workforce disadvantage we need to create the supervised junior and training positions to provide vocational training.
Without adequate resourcing of junior medical positions, including indemnity (which is potentially a barrier for moving training into the private sector), and adequate resourcing of the time needed from senior doctors to provide the supervision that junior doctors require, bumping up the number of medical graduates does very little to improve workforce shortages. It makes absolutely no sense to increase the number of medical schools and thereby increase the number of medical students, until the issue of adequate supervised junior positions and vocational training is resolved.
Senior medical folk associated with the universities need to seriously consider wisdom of creating new medical schools at this point in time. If the unit you work in is unable to accommodate any more junior doctor positions (due to funding or availability of adequate supervision) then the rationale for increasing the number of medical graduates is probably difficult to justify.
Thursday, October 7, 2010
not enough jobs for junior docs (part 3)
This week, The Australian again reported on the lack of intern places for medical graduates. It is encouraging to see that the various interested parties (students, deans of medical schools, professional organisations) are starting to reach some level of agreement about what needs to happen. Now if only the people who make the decisions will listen...
Creating intern positions involves more than just putting aside money to pay their salaries. Medical interns are just out of university - they have a fair amount of book learning but don't actually have the context with which to use this knowledge safely. They need a hell of a lot of supervision. In order to have interns working safely, there needs to be training and infrastructure to support the senior doctors providing supervision, money to pay for supervisors' time, and adequate senior staffing levels so that supervisors can provide adequate oversight. I haven't heard any murmurings of this happening any time soon.
Creating intern positions involves more than just putting aside money to pay their salaries. Medical interns are just out of university - they have a fair amount of book learning but don't actually have the context with which to use this knowledge safely. They need a hell of a lot of supervision. In order to have interns working safely, there needs to be training and infrastructure to support the senior doctors providing supervision, money to pay for supervisors' time, and adequate senior staffing levels so that supervisors can provide adequate oversight. I haven't heard any murmurings of this happening any time soon.
Monday, September 20, 2010
The Problem With Acronyms
At some point, haven't we all stopped and looked at a clinical record or a discharge summary and been completely confused about the multitudes of abbreviations? Is "BSE" bovine spongiform encephalitis or is it breast self examination (getting that wrong could be a mite embarrassing)? "NFR" could mean not for resuscitation of no followup required... maybe not so different after all.
Here's a story I heard from a colleague recently... Once upon a time there was a hospital of reasonable size which had all the usual bits that hospitals do including A&E, critical care, orthopaedics, cardiology, renal medicine, etc. It also had an inpatient mental health unit that had an acute unit and an attached longer stay or chronic care mental health unit. Working in this hospital was a psychiatry registrar who was doing the psychiatry on call shift one particular evening.
The registrar was called by a cardiology colleague in relation to a consult request.There was a patient who was in recovery from bypass surgery with a history of depression, and the team was worried that it may take a turn for the worse following surgery. The psychiatry registrar obligingly offered to go and have a chat with the patient in the coronary care unit (CCU) - he informed the nurses in the inpatient acute mental health unit that he would be "in the CCU" if needed as he realised that his mobile phone would need to be turned off in the monitored area.
Unfortunately, in the world of mental health treatment, the term CCU refers to Chronic Care Unit. An incident occurred within the mental health unit that evening, and the nursing staff tried to ring the registrar... the phone was switched off. They contacted the Chronic Care Unit... the registrar hadn't been there the whole evening. The poor registrar had a complaint made against him for not being contactable whilst on call.
It is easy to rely on acronyms as they are much quicker to say and easier to write... but there are risks...
Here's a story I heard from a colleague recently... Once upon a time there was a hospital of reasonable size which had all the usual bits that hospitals do including A&E, critical care, orthopaedics, cardiology, renal medicine, etc. It also had an inpatient mental health unit that had an acute unit and an attached longer stay or chronic care mental health unit. Working in this hospital was a psychiatry registrar who was doing the psychiatry on call shift one particular evening.
The registrar was called by a cardiology colleague in relation to a consult request.There was a patient who was in recovery from bypass surgery with a history of depression, and the team was worried that it may take a turn for the worse following surgery. The psychiatry registrar obligingly offered to go and have a chat with the patient in the coronary care unit (CCU) - he informed the nurses in the inpatient acute mental health unit that he would be "in the CCU" if needed as he realised that his mobile phone would need to be turned off in the monitored area.
Unfortunately, in the world of mental health treatment, the term CCU refers to Chronic Care Unit. An incident occurred within the mental health unit that evening, and the nursing staff tried to ring the registrar... the phone was switched off. They contacted the Chronic Care Unit... the registrar hadn't been there the whole evening. The poor registrar had a complaint made against him for not being contactable whilst on call.
It is easy to rely on acronyms as they are much quicker to say and easier to write... but there are risks...
Thursday, August 26, 2010
not enough jobs for junior docs (part 2)
The AM Program onABC Radio this week discussed how "Medical Deans lament [the] lack of internships" in Australia.
Surely the availability internships should have been a consideration when the deans and senior folk within the Universities were considering starting up the medical schools or setting student numbers in th the first place.
...and surely when the numbers of graduating doctors could have been anticipated (not that hard considering that people can count how many medical students there are in the medical schools years ahead of them graduating) we could have had years of developing models to provide junior jobs instead of going "oops we forgot that they needed internships to get qualified" when they are just about to graduate.
There is now a very short time fram in which to try and build the capacity of the health system to supervise junior doctors. It is all well and good to say - lets put them in private hospitals and general practice. The reality is that interns do require a significant amount of supervision and unless there is funding available for the time of senior doctors to do the supervising, adequate medical indemnity provisions to cover the junior doctors in non traditional settings, adequate scope of pathology and clinical exposure to ensure an adequate training experience, and appropriate administrative support for the private sector to take on junior doctors, this is not going to be a satisfactory solution.
Surely the availability internships should have been a consideration when the deans and senior folk within the Universities were considering starting up the medical schools or setting student numbers in th the first place.
...and surely when the numbers of graduating doctors could have been anticipated (not that hard considering that people can count how many medical students there are in the medical schools years ahead of them graduating) we could have had years of developing models to provide junior jobs instead of going "oops we forgot that they needed internships to get qualified" when they are just about to graduate.
There is now a very short time fram in which to try and build the capacity of the health system to supervise junior doctors. It is all well and good to say - lets put them in private hospitals and general practice. The reality is that interns do require a significant amount of supervision and unless there is funding available for the time of senior doctors to do the supervising, adequate medical indemnity provisions to cover the junior doctors in non traditional settings, adequate scope of pathology and clinical exposure to ensure an adequate training experience, and appropriate administrative support for the private sector to take on junior doctors, this is not going to be a satisfactory solution.
Monday, August 16, 2010
not enough jobs for junior docs
Unsurprisingly, the media is reporting on a shortage of junior doctor jobs for the 3000 or so medical students about to graduate from Australian medical schools.
Lets go back in time to the '90s... all the rhetoric in the early '90s was about the oversupply of doctors. The Medicare budget was blowing out, and the clever bean counter types looking at the supply and demand equation were convinced that this was due to too many doctors spruiking for business. There were 10 medical schools in Australia and there was a rumour that there were plans to decomission one of them bringing the number back to 9; the government of the time put caps on vocational training places (particularly in general practice). This, of course, was a bit of a surprise to the doctors out in the commuity who were having diffculty recruiting other doctors to work with them and hadn't had a holiday for years because of lack of cover.
It didn't take long for the real truth to emerge in the numbers. Far from an over supply of doctors, there was actually a shortage. This was brought to a head by the limitations in training places. All over the country, communities were reporting difficulties accessing medical care (general practice and specialist). Demographers started to pay attention to the aging medical worrkforce.
Lets fast forward a little - a decision was made to open up medical school training places. This would supposedly produce all the doctors we need to fix the shortage... The universities were more than happy to put their hands up to run medical training; after all medical schools are prestigious things for universities to have. More and more universities started announcing medical schools, and the number of medical graduates has more than doubled.
Somebody forgot to consider that, for doctors to be able to work in unsupervised in the community where they are needed, a they need a period of vocational training in supervised jobs. So here we are in the ludicrous position of simultaneously having ongoing medical shortages in the community and a shortage of supervised junior medical jobs.
The sad thing is that this was not unexpected. For several years there have been senior doctors expressing concerns about the rapid expansion of medical schools in Australia and the capacity of the system to take on junior doctors.
What's the best way forward?
The government is keen on expanding training outside of the major public hospitals. As a concept this is laudable - the test will be putting it into operation and ensuring that the quality of supervision and the adequate safety measures are not compromised. Will smaller private hospitals (the bigger ones already take junior docs) and nursing homes have sufficient numbers of medical staf around to ensure adequate supervision? Will the breadth of clinical presentations and scope of practice provide enough valuable experience for junior docs? Will there be enough support for training within the infrastructure of these organisation?
Time will tell.
It is a difficult time to be a new graduate. My thoughts and sympathies are with all my junior colleagues out there about to take on the big adventure of meidcal practice.
Lets go back in time to the '90s... all the rhetoric in the early '90s was about the oversupply of doctors. The Medicare budget was blowing out, and the clever bean counter types looking at the supply and demand equation were convinced that this was due to too many doctors spruiking for business. There were 10 medical schools in Australia and there was a rumour that there were plans to decomission one of them bringing the number back to 9; the government of the time put caps on vocational training places (particularly in general practice). This, of course, was a bit of a surprise to the doctors out in the commuity who were having diffculty recruiting other doctors to work with them and hadn't had a holiday for years because of lack of cover.
It didn't take long for the real truth to emerge in the numbers. Far from an over supply of doctors, there was actually a shortage. This was brought to a head by the limitations in training places. All over the country, communities were reporting difficulties accessing medical care (general practice and specialist). Demographers started to pay attention to the aging medical worrkforce.
Lets fast forward a little - a decision was made to open up medical school training places. This would supposedly produce all the doctors we need to fix the shortage... The universities were more than happy to put their hands up to run medical training; after all medical schools are prestigious things for universities to have. More and more universities started announcing medical schools, and the number of medical graduates has more than doubled.
Somebody forgot to consider that, for doctors to be able to work in unsupervised in the community where they are needed, a they need a period of vocational training in supervised jobs. So here we are in the ludicrous position of simultaneously having ongoing medical shortages in the community and a shortage of supervised junior medical jobs.
The sad thing is that this was not unexpected. For several years there have been senior doctors expressing concerns about the rapid expansion of medical schools in Australia and the capacity of the system to take on junior doctors.
What's the best way forward?
The government is keen on expanding training outside of the major public hospitals. As a concept this is laudable - the test will be putting it into operation and ensuring that the quality of supervision and the adequate safety measures are not compromised. Will smaller private hospitals (the bigger ones already take junior docs) and nursing homes have sufficient numbers of medical staf around to ensure adequate supervision? Will the breadth of clinical presentations and scope of practice provide enough valuable experience for junior docs? Will there be enough support for training within the infrastructure of these organisation?
Time will tell.
It is a difficult time to be a new graduate. My thoughts and sympathies are with all my junior colleagues out there about to take on the big adventure of meidcal practice.
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