Training and retaining health professionals: Metropolitan, rural and remote perspectives

1. Training and retaining health professionals: Metropolitan, rural and remote perspectives Dr Alex Markwell FACEM Royal Brisbane and Women’s Hospital and Greenslopes Private Hospital

2. Declaration of Interest • I am currently employed at Greenslopes Private Hospital, a recipient of various Commonwealth grants

3. Acknowledgements • Greenslopes Private Hospital and staff for use of photos • Queensland Ambulance Service for use of photos

4. Overview • Focus on metro and urban setting from clinical educator perspective • Evidence, barriers, solutions • Medical, nursing & paramedic examples

5. Evidence • Cost of health care worker turnover is huge • Estimated in 2004 to be at least 5% of total annual operating budget 1 • ¼ of total cost due to nurse turnover • Medical turnover lower than others but costs much higher 1. Waldman et al. The Shocking Cost of Turnover in Health Care. Health Care Manage Rev, 2004, 29(1), 2-7

6. Evidence- Business • Supports continuing professional development (CPD) & skills development opportunities • Linked with job satisfaction • Part of suite of retention strategies

7. Evidence- Health • Training and skills development is included consistently in retention strategies across disciplines • Little research in urban context • More evidence available in rural and remote settings • Long look programs • Rural clinical schools

8. Evidence • Nursing disciplines • RN, Midwives • ENs, AINs • Allied health • Ministerial Taskforce in Queensland- Full and Extended Scope of Practice in Allied Health • Medicine • Students, junior, rural & senior docs

9. Training -what is it? • Includes informal and formal “in-services” or education sessions • Didactic, small group, bedside, simulation, other modalities • Generally discipline-specific but greater emphasis now on inter-disciplinary learning...

10. Training- Barriers • Cost • Time • Supervisor capacity • Supervisor experience • Matching learner need with training opportunities • Service provision is priority • Culture

11. Training- Barriers • Cost, time (resourcing) • Service provision is priority • IHPA currently undertaking modelling exercise to estimate cost of education and training as part of Activity Based Funding (ABF)

12. Training- Barriers • Supervisor capacity & experience • Matching learner need with opportunities • Culture • More difficult to quantify • Increasing focus on “doctor as teacher” but less so for other disciplines • Reliant on opportunistic access to training

13. Supervisor Shortfall

14. Training and Retaining- Solutions GPH nursing education • Simulation Centre Programs • In-services • Other sessions e.g. Grand Rounds, GP Educations sessions etc

15. Training and Retaining- Solutions Sim Centre Programs • ALS certification and recertification • 12 RNs/week • Midwifery training • Specific obstetric emergencies • MERT scenario training • RNs from different wards in MERT scenarios

16. Training and Retaining- Solutions • Combination of dedicated paid (and protected) education and training time – off the floor and separate to clinical shifts • Safety and Quality aspects and QI • Dedicated nurse educators- supported and resourced

17. Training and Retaining- Solutions Medical Students • Specifically recruited from rural background into rural clinical schools • “Long-look” program- 6-12 month clinical placements in rural facilities (QRME) • Sim scenarios- ward call, MERT, ALS

18. Training and Retaining- Solutions Junior Doctors • CRuSE (Clinical Rural Skills Enhancement) workshops • Intensive 2 day skills & simulation workshop with supporting lecture sessions • “Prepare RMOs for positive short-term placement in rural QLD hospitals” • Monthly sessions • Cunningham Centre partnership with GPH

19. Training and Retaining- Solutions Junior Doctors • ALS training, airway, MERT scenarios • Registrars and residents • Small group sessions • Senior medical facilitators • Dedicated & protected teaching time • Dedicated and funded medical educators

20. Solutions- GPH

21. Solutions- GPH

22. Solutions- GPH

23. Solutions- GPH

24. Training and Retaining- Solutions Rural Docs • Heavily reliant on locums/back fill to access training • Support programs e.g. QLD Country Relieving Doctors Program essential • Prioritised leave cover • Providers such as Cunningham Centre, QRME & Health Workforce QLD are crucial

25. Training and Retaining- Solutions Rural Docs • RDAQ conferences have very strong family programs which enable whole families to attend & helps develop positive teaching and training culture

26. Training and Retaining- Solutions Paramedics • High fidelity in situ training • Real-time critique and feedback • High-stakes scenarios but clinically rare

27. Training and Retaining- Solutions

28. Warning!!!

32. References • Waldman et al. The Shocking Cost of Turnover in Health Care. Health Care Manage Rev, 2004, 29(1), 2-7 • Cunningham Centre: www.health.qld.gov.au/cunninghamcentre • Queensland Rural Medical Education (QRME) www.qrme.org.au/medical-students/