Australian Medical Association

The AMA has provided a submission to the Royal Australasian College of Physicians (RACP) in response to their discussion paper Linked Dual-Trained Physician Care in Rural Communities. The AMA supports efforts to improve patient access to to medical care in regional and rural Australia and the RACP model has merit for further development. It needs more detail and refinement to ensure such a model is attractive for potential trainees, effective in delivering care and sustainable in the long term for rural communities.

The theme for the 2012 AMACDT Trainee Forum was ‘Training pathways for the future’ and was held in Sydney on 3 March 2012.

The Agenda included expanding vocational training capacity, teaching and research opportunities for trainees, and global health training.

We encourage you to use the Forum Summary and Outcomes as an advocacy tool.

The AMA submission to the National Prescribing Service (NPS) Prescribing Competencies Project highlights the need for greater emphasis on:

• adequate level of training to meet competency requirements to prescribe; 
• practitioners prescribing within their scope of practice;
• being competent in using knowledge and making judgments on when not to prescribe;
• referring a person to another health professional when that person’s clinical condition is outside scope of practice; 
• referring a person to a medical practitioner if they fail to improve within a specified period of time;
• keeping prescribing and dispensing separate; and   
• effectively communicating in English.

Did you know that the RACGP Vocational Training Standards are changing? The new draft standards involve significant change and a move to an outcomes based approach. Supervisors and doctors-in-training have expressed concern about some elements of the draft standards. Find out what the changes to the Vocational Training Standards could mean for you by reading our submission.

The provision of out-of-hours care is a key part of general practice. The AMA Out-of-Hours Primary Medical Care 2011 position statement has been developed to guide the design of these services, outlining the essential feature of a successful model of out-of-hours primary medical care.

This submission responds to the HWA draft background paper - Rural and Remote Health Workforce Innovation and Reform Strategy released in July 2011 as part of the consultation process.

The AMA believes it is important that the Government gets it right to ensure that the health workforce in rural and remote areas is sustainable and that people in rural communities can access affordable, appropriate health care services when needed.

The AMA has made a submission to the Medical Board of Australia on its Proposed Registration Standard – Granting registration as a medical practitioner on completion of intern training. The Board's proposed standard includes the option for health services to provide interns with exposure to emergency medicine (EM) in a general practice context. Of utmost concern to the AMA is the absence of clear criteria about what would constitute appropriate exposure to EM under this type of arrangement. As a result, the AMA has offered to be part of the team that will prepare guidelines to better define the Board’s requirements. In the mean time, the AMA maintains that all interns should have access to a term in an Emergency Department.

This statement outlines the AMA’s position on the scope and structure of prevocational medical education, which encompasses the period between graduation and the commencement of vocational training. In the case of most trainees, it includes postgraduate year 1 (PGY1), also known as internship, and postgraduate year 2 (PGY2). Doctors at this stage of their training are collectively referred to as junior medical officers (JMOs). The statement provides a position on contemporary as well as emerging issues related to prevocational medical education and training, taking into account concerns raised by junior doctors regarding quality, streaming, competencies and vocational pathways.

The AMA submission to the Department of Health and Ageing on the draft Performance and Accountability Framework which will be used by the National Health Performance Authority urges the Government to undertake a proper consultation process on the performance indicators proposed in the Framework beyond the State and Territory governments.

Interested in working abroad as a junior doctor?  "A Guide to Working Abroad for Australian Medical Students and Junior Doctors" (the Guide) has been developed by the AMA Council of Doctors-in-Training (AMACDT) and Australian Medical Students' Association (AMSA) to meet a strong demand from medical students and junior doctors for evidence based and practical information on studying and training overseas.

Written by eight junior doctors in consultation with a range of Australian experts, the 90 page Guide is the gold standard for any medical student or junior doctor seeking to organise safe and rewarding placements and rotations abroad.

The Guide is available as an electronic supplement to the Medical Journal of Australia (MJA).

The AMA has made an additional submission to the Department of Health and Ageing to raise concerns identified by AMA member junior doctors. This submission:

• emphasises the need to ensure that time-based targets do not impact on the ability of public hospitals to provide quality clinical education and training;
• calls for ongoing resources to support the ability of emergency departments, the hospital and community providers to fulfil education and training obligations; and
• recommends that the monitoring and evaluation of the impact of targets also includes the impact on education, training and junior doctor experiences.

This submission supplements the submission lodged by the AMA on 25 May 2011.

Interested in working abroad as a junior doctor?  The AMA and AMSA will launch ‘A Guide to Working to Abroad for Australian Medical Students and Junior Doctors’ at an evening seminar at AMA Victoria on Tuesday 21 June 2011.

Details are as follows:

Tuesday 21 June
1830 (refreshments) for 1900
AMA Victoria House, 293 Royal Pde, Parkville
RSVP to amclennan@ama.com.au or 02 6270 5424

The AMA recently made a submission to Health Workforce Australia commenting on its National Clinical Supervision Support Framework - Consultation Draft. While generally supportive of the principles that underlie the Framework, the submission highlighted a number of core issues specific to medical supervision and training that should be addressed.

The AMA submission highlights that the Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010 already govern the management of health care practitioners who have blood-borne viruses and makes the point that there is no need to de-register a medical practitioner because they have a blood-borne virus.  The AMA has asked the Board to clarify its role in regulating the scope of practice of medical practitioners who are infected with a blood-borne virus in isolation from the way this issue is managed by medical practitioners and the health care organisations in which they practice.  The AMA has suggested the Board undertake a second round of consultation once it has clarified what action would constitute a breach of guidelines and that action the Board might take in such cases.

Pathology services in Australia are amongst the highest quality and the most accessible in the world. However, Government funding cuts to pathology services have had an impact on the quality, accessibility, affordability and safety of pathology services. Government funding changes can also have a significant impact on the sustainability of the pathology sector including the ability to support ongoing training, research and development.

Within the health care team, each professional brings a particular combination of training and experience which defines their role and responsibilities. This AMA Positition Statement outlines the core knowledge, skills and unique qualities of medical practice that make medical practitioners a pivotal part of Australia’s health system.  In this position statement the term ‘doctor’, which is the term in common community use, refers to a medical practitioner and the terms are used interchangeably.

The Health and Wellbeing of Doctors and Medical Students – 2011 replaces the Health and Wellbeing of Medical Students and Practitioners – 2006.

The health and welfare of doctors continues to be a priority for the AMA.  Junior doctors continue to experience distress in their workplace.  This position statement provides a basis for future AMA lobbying and addresses a number of current and topical issues faced by doctors in training on a daily basis.

It includes details on support mechanisms that should be put in place by training providers to address issues related to doctors’ health. The revision of the document also represented an opportunity to include recent developments in doctors’ health such as mandatory reporting.

The AMA is supportive of evidence-based guidelines for the prevention and control of infection that are appropriate for the level of risk applicable to the various healthcare settings.

A national approach must be sufficiently flexible to accommodate the relative risks. The AMA is not in support of an approach where healthcare providers are required to implement infection control guidelines that are beyond the level of risk that occurs in a particular healthcare setting, are not practical to implement, and/or for which there is no evidence to justify adherence to the guideline.

The AMA believes that Health Workforce Australia (HWA) can play a significant role in providing funding support to increase available resources for teaching and training prevocational doctors and vocational trainees.  The attached AMA paper Supporting prevocational and vocational training through Health Workforce Australia puts forward specific proposals regarding how this can be achieved.

The Confederation of Postgraduate Medical Education Councils (CPMEC) has prepared a discussion paper on the structure and content of the internship - the year of supervised clinical training completed by graduates of an Australian Medical Council-accredited medical school.

The AMA Council of Doctors-in-Training has written to CPMEC and given broad support to the discussion paper’s recommendations as they align with the AMA’s position on the duration of the intern year, its core terms and the role of placements in community settings.

Findings of the AMA Junior Doctor Training, Education and Supervision Survey

The consortium of eleven graduate medical schools is seeking the ACCC’s permission to continue its policies and practices for selecting applicants to graduate medical schools. These include the preference policy where applicants submit a single application to the Graduate Australian Medical Schools Admission Centre, and the one interview policy whereby applicants receive only one offer for an interview.

In its submission the AMA has said that, on balance, the public benefits from authorising the graduate medical school consortium to continue these polices and practices outweighs any potential drawbacks;  however, the AMA has noted that where a graduate medical school uses the interview process to look for certain qualities in an applicant, there is the potential for the applicant to be disadvantaged by the interview process in some circumstances. The AMA has encouraged the ACCC to address these issues in the authorisation process.

AMA Position Statement: Workplace Bullying and Harassment - 2009

There is good evidence that bullying and harassment of doctors occurs in the workplace. One Australian study found that 50% of Australian junior doctors had been bullied in their workplace, and a New Zealand study reported that 50% of doctors had experienced at least one episode of bullying behaviour during their previous three or sixth-month clinical attachment.

Workplace bullying of members of the medical workforce can occur between colleagues students and employees, and any contractors, patients, and family members with whom they are dealing.

The evidence is clear that workplace bullying contributes to poor employee health including the physical and psychological manifestations of stress and depression. Workplace bullying may affect medical students, junior doctors or senior specialists. Workplace bullying and harassment may impact on the training and education of doctors. It creates a poor learning environment due to the continued erosion of confidence, skills and initiative of the doctor, thereby creating a negative attitude towards their chosen specialty.

The AMA has prepared this position statement on workplace bullying and harassment in order to:

• to provide a guide for all doctors, hospital and practice managers to identify and manage workplace bullying and harassment;
• to raise awareness and reduce the exposure of doctors to workplace bullying and harassment; and
• to assist the medical profession in combating its perpetuation.

The AMA Position Statement on Electronic Prescription Transfer Systems – 2009 supports the development of an electronic prescription transfer system as a fundamental building block for a broader eHealth system in Australia. It sets out the high level principles that should underpin an electronic prescription transfer system.

The development of an e system in Australia is supported by:

1. the National eHealth Strategy
2. the KPMG Consultancy in Electronic Prescribing and Dispensing Final Report (commissioned by the Department of Health and Ageing);
3. the National Health and Hospital Reform Commission (NHHRC) Interim Report, including the supplementary paper on person-controlled electronic health records; and
4. commercial vendors actively promoting their prescribing systems.

The AMA position on other aspects of eHealth are set out in the following position statements:

AMA Position Statement – Unique Healthcare Identifiers – 2008
AMA Position Statement – Connectivity – 2007
AMA Position Statement – Safety and Quality of E-Health Systems – 2006

The Federal Parliament's Senate Community Affairs Committee is conducting an Inquiry into the Health Workforce Australia Bill 2009 (the "Bill"). The Commonwealth agreed to establish a new health workforce agency at the November 2008 Council of Australian Governments (COAG) meeting and this Bill seeks to implement that commitment.

The AMA has provided a submission to the Senate Inquiry.

AMA Position Statement: Clinical support time for public hospital doctors - 2009

The AMA defines clinical support time as protected time for duties that are not directly related to individual patient care. Clinical support duties encompass most aspects of the teaching, continuing professional development, clinical governance, administration and research activities undertaken by clinicians in the public health sector.

The purpose of this position statement is to specify a minimum benchmark of remunerated time for clinical support duties for senior and junior clinicians. It includes a comprehensive list of the roles and responsibilities that constitute clinical support time to assist with developing job descriptions and work schedules.

ANZCA is undertaking a review of its curriculum. Based on trainee feedback, the AMA provided a submission to the review. The submission notes that trainees have reported that the College maintains a strong focus on trainee issues and are supportive of the current curriculum. The primary exam and the module-structure curriculum are noted as particular College strengths. The submission provides specific feedback on:

• Access to specialty terms
• Recognition of prior learning
• College fees
• Teaching and supervisory skills
• Educational material
• Final exam syllabus
• Basic training
• Level 1 supervision

AMA Submission to National Health Workforce Taskforce on understanding demand and capacity for undergraduate clinical placements.

The Confederation of Postgraduate Medical Education Councils is developing an accreditation framework covering prevocational training positions across the country. While generally supportive of the concept, the AMA Council of Doctors in Training has expressed concerns at the current draft document that has been released for comment. In particular, the AMACDT believes that the draft PMAF focuses too heavily on general principles and procedures. While there are references to governance and supervisory standards, the document does not outline the applicable standards, and associated criteria and indicators, by which hospitals should be assessed in order to gain accreditation for their clinical training.

The AMACDT has encouraged the CMPEC to involve AMACDT representatives in preparing a revised draft to ensure that the input of junior doctors is properly taken into account.

AMA Position Statement: Hospitalists - 2008