Safety pun

1. Cultural, clinical and personal safety in remote Northern Territory Prevocational General Practice Placements Dr Jacqueline Murdoch, Dr Sally Banfield, Dr Rosie Rock and Dr Pasqualina Coffey NT JMO Forum So was anyone eaten by a croc? Whether formally or informally, there are some interesting and innovative supervision models being used in remote placements. Supervision over the phone or by case conference - for at least part of the placement - was common. The data suggest that JMOs are generally happy with these approaches, and that they are realistic about the difficulties of remote areas. It would be interesting to survey the supervisors themselves on the perceived success of these arrangements and their impact on stress levels, flexibility and time commitment. These alternative arrangements have potential value for the future with the sharply increasing JMO workforce. Perhaps these models could be used in supervising JMOs in peripheral hospitals or rural settings. Although this is a limited data set, the results indicate that JMOs undertaking remote placements do not feel that their personal safety is at risk (and thankfully, that no one was eaten this year). The results also indicate that the orientation program is doing an excellent job in preparing JMOs for what can be quite significant culture shock. This is an ongoing survey which will continue throughout the next year. NTGPE already collect their own data for monitoring but we hope that this data will contribute to quality and safety improvement from a JMO perspective. Enough Ps in PGPPP? There was a 68% response rate (25/37 participants), of whom the vast majority (72%) were in PGY2 (fig. 2a). Only forty per cent (10/25) came from the NT teaching hospitals (Alice Springs Hospital and Royal Darwin Hospital) (fig. 2b), however despite this, 68% (17/25) of the respondents had lived or been placed in remote areas before, mostly in the Northern Territory (11/25). Safety pun Spending thirteen weeks working as a Junior Medical Officer (JMO) in a remote location in the Northern Territory is intimidating to say the least. It can also be immensely rewarding - and can even change career paths - but only if the JMO feels that they are safe in their living and working environment. There have been anecdotal reports in the Northern Territory that JMOs’ experiences of feeling unsafe during their remote term is having a negative impact on their decision to pursue a career in remote practice. Northern Territory General Practice Education (NTGPE) and their Prevocational General Practice Placements Program (PGPPP) terms have undergone some significant changes in 2012 in an effort to address some of these concerns. The aim of this survey was to see if JMOs doing their PGPPPs in the Territory felt culturally, clinically and personally safe during their placements. Many JMOs had non-traditional supervision arrangements, such as being supervised by telephone, or by case conference. Figure 3. Only 56% (14/25) of respondents had someone on site to supervise them at all times. Of those not supervised on site (fig. 3), 77% had a supervisor available over the phone. All except one respondent were happy that they knew how to call the District Medical Officer or hospital for help if needed. Despite not necessarily knowing of their supervision arrangements in advance (30% said that they were not aware of them prior to arrival), almost everyone (91% or 21/23) was happy with the arrangements (fig. 4). All respondents indicated that they enjoyed the independence of general practice. Figure 2b. Respondents came from 11 different hospitals in NSW, Vic, SA as well as the NT. Figure 2a. The majority of participants in PGPPPs are PGY2 Figure 4. JMOs were happy with the supervision received. Figure 5. A clinic room, NE Arnhem Land. There is still no consensus on whether there are enough Ps in PGPPP with respondents being 50/50 on the question. Interns do not yet participate in PGPPP in the Northern Territory but may do so in 2013 JMOs were generally happy to be flexible with their supervision arrangements when working in remote areas. Three quarters (18/25) of the respondents were placed in a remote Aboriginal Medical Service with only five respondents being placed in larger metropolitan settings (Alice Springs or Darwin). Two were placed in regional hospital settings. Figure 1. Yirrkala, NE Arnhem Land. A typical street scene that a JMO would encounter on arrival at their placement in remote NT. Monkey magic The survey consisted of 30 questions covering a range of safety issues related to orientation, education, supervision, accommodation and wellbeing. We also collected demographic data on the participants and their career intentions. The survey was published on surveymonkey.com and a link to the survey was distributed via email. It was sent to all 37 PGPPP participants in the Northern Territory who completed their placements from July to October 2012, including JMOs from NT hospitals and those from other states. The surveys were returned electronically via the surveymonkey.com website. Data were analysed using the surveymonkey.com analysis tools and Microsoft Excel. JMOs reported good access to safe exercise conditions (95%), healthy food (95%), someone to socialise with (100%) and someone to debrief challenging situations with (91% in person, 9% over the phone). Accommodation was more of an issue, with 23% (5/22) of respondents reporting that their accommodation was inappropriate or unsafe. Cheers We would like to thank NTGPE for their cooperation with our survey, Shirley Bergin and Vanessa Lew Fatt from NTPMC for their continued support and patience, the survey respondents for their prompt and frank replies, and the members of the NT JMO Forum for their enthusiasm and feedback in the face of teleconferences. Figure 3. JMOs attended 3 day orientation sessions. Respondents were largely very happy with the orientation provided by NTGPE with 88% (fig. 3) thinking there was the right amount of information provided on cultural safety. The 12% who thought there was too much information on cultural safety were all from Northern Territory hospitals. Want more? We collected data on more than just safety! For information please contact the NT JMO Forum jmo.ths@nt.gov.au. More information on the JMO Forum and the NTPMC can be obtained at www.ntpmc.com.au. Further information on PGPPPs with NTGPE can be found at www.ntgpe.org. Figure 5. JMOs were more likely to want to work in the NT in the future after their placements.