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

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training and retaining health professionals metropolitan rural and remote perspectives

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

Dr Alex Markwell

FACEM

Royal Brisbane and Women’s Hospital and Greenslopes Private Hospital

declaration of interest
Declaration of Interest
  • I am currently employed at Greenslopes Private Hospital, a recipient of various Commonwealth grants
acknowledgements
Acknowledgements
  • Greenslopes Private Hospital and staff for use of photos
  • Queensland Ambulance Service for use of photos
overview
Overview
  • Focus on metro and urban setting from clinical educator perspective
  • Evidence, barriers, solutions
  • Medical, nursing & paramedic examples
evidence
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

evidence business
Evidence- Business
  • Supports continuing professional development (CPD) & skills development opportunities
  • Linked with job satisfaction
  • Part of suite of retention strategies
evidence health
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
evidence1
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
training what is it
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...
training barriers
Training- Barriers
  • Cost
  • Time
  • Supervisor capacity
  • Supervisor experience
  • Matching learner need with training opportunities
  • Service provision is priority
  • Culture
training barriers1
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)
training barriers2
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
training and retaining solutions
Training and Retaining- Solutions

GPH nursing education

  • Simulation Centre Programs
  • In-services
  • Other sessions e.g. Grand Rounds, GP Educations sessions etc
training and retaining solutions1
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
training and retaining solutions2
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
training and retaining solutions3
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
training and retaining solutions4
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
training and retaining solutions5
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
training and retaining solutions6
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
training and retaining solutions7
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
training and retaining solutions8
Training and Retaining- Solutions

Paramedics

  • High fidelity in situ training
  • Real-time critique and feedback
  • High-stakes scenarios but clinically rare
references
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/