A template for the Postgraduate Medical

Council of Victoria (PMCV) to complete its

streamlined intern training accreditation

authority progress report to the AMC

2020 Streamlined progress report – Due 5 October 2020

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About the monitoring process

The AMC monitors accredited intern training accreditation authorities to ensure they continue to meet the Intern training – Domains for assessing accreditation authorities.

The principal monitoring mechanisms are the structured progress reports which are required annually. Other mechanisms include comprehensive reports (due in the third year of accreditation for new authorities and the fifth year for existing authorities) and a full accreditation assessment every eight years.

The cycle for progress reports is:

Reference documents:

• AMC monitoring and progress reporting: Procedures for Assessment and Accreditation of Intern Training Accreditation Authorities by the Australian Medical Council

• Criteria for assessment of intern training accreditation authorities: Intern training – Domains for assessing accreditation authorities.

Monitoring during 2020

In light of COVID-19, and the Medical Board of Australia’s advice to intern training accreditation authorities allowing authorities to defer accreditation of intern programs and posts during 2020, the AMC is requesting a streamlined report from intern training accreditation authorities in 2020. Usual reporting will resume in 2021.

How to submit this report

Please update this template and submit to the AMC in MS Word format (i.e. .doc or .docx).

Attachments should be provided as separate documents, labelled as described in section B above, in either Word or pdf format. Please label each attachment clearly and ensure all attachments are clearly referenced within the body of the report.

Please submit the report electronically via email to prevac@amc.org.au.

If you have any questions about the information required, please contact the AMC Accreditation Section. Tel: 02 6270 9734 or email: prevac@amc.org.au.

Intern authority submits progress report

Progress report considered by reviewer

PreVAC determines:

A) Intern authority continues to meet domains

B) further information needed

C) Intern authority at risk of not meeting domains

AMC provides feedback to the Intern authority

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Please check this information is correct

Organisation Details (please update if needed)

Authority Name: Postgraduate Medical Council of Victoria Inc. (PMCV)

Chief Executive Officer: Ms Julie Faoro

Address: PO Box 13330, Law Courts, Victoria, 8010

Telephone number: 0419 825 141

Email: jfaoro@pmcv.com.au

Officer to contact concerning the report: Ms Monique Le Sueur, Accreditation Manager

Telephone number: 0403 156 204

Email: mlesueur@pmcv.com.au

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Part 1. Details regarding the ongoing work program and resourcing

Ongoing work program

Please outline the intern training accreditation authority’s plans for recommencing the accreditation work program at the end of 2020/in early 2021.

Please include updated details for 2021 and up to the next four years (if available), including number of visits scheduled, and in what categories e.g. new posts, reaccreditations.

Note this information may be detailed below or attached as an appendix.

If 2021 will be an atypical year in terms of the number of accreditation assessments, please explain why and what is a typical accreditation load.

Response

PMCV plans to recommence the accreditation program from 2021.

All survey visits and accreditation reviews (conditions, mid cycle) were cancelled in 2020. Health services due for a visit or review in 2020, will now be assessed in 2021.

Accreditation reviews will commence in February 2021 and survey visits will occur from May to October 2021. Planning is currently underway to arrange hybrid or full virtual visits if survey teams are unable to undertake onsite visits. Accreditation reviews are paper-based and involve a report from the intern training provider and feedback from interns.

PMCV does not plan to postpone or cancel any 2021 visits (at the time of writing this report).

In 2020, PMCV approved extension of accreditation for 12 months for all but two of the health services in Victoria (following advice from AHPRA that this could be done). This means that all accreditation assessments were postponed for 12 months, which was in recognition that PMCV does not have the secretariat resources to undertake two years of accreditation assessments in one year.

PMCV has continued to monitor health services during 2020. Two health services were required to submit Action Plans on implementation of recommendations. Three intern posts, accredited for 12 months at the survey visits in 2019, were reviewed. One intern post was reaccredited as non-core (from core surgery), and the other two posts were reaccredited for the full period. Some health services sought review of COVID changes by the PMCV Accreditation Committee and the committee will follow up whether these changes are proposed to continue into 2021.

The revised four year PMCV accreditation cycle is Attachment A.

In 2021, some form of accreditation assessment (either survey visit or accreditation review) will occur for every health service in Victoria. This will be an atypical year. A summary of accreditation work 2021 is Attachment B.

• There will be two additional survey visits in 2021 to intern training programs (ITP) which were not granted an extension of accreditation e.g. eight intern training parent health services (including two new ITPs – one metro and one rural) and two intern rotation training sites will be visited

• There are 24 intern training programs in Victoria (usually 25% survey visit, 25% conditions review, 25% mid cycle review). The extension of accreditation has meant that some health services due for a visit in 2020 have now been postponed to 2021 which would mean their previous accreditation assessment was in 2018. The Accreditation Committee decided that these health services should also be reviewed in 2021 (6).

• New intern posts approved in 2019 and 2020 will be assessed during the 2021 accreditation assessments.

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Resourcing the work program

Please describe the intern training accreditation authority’s resources and capacity to implement the work program in 2021 and into the future, including any challenges in the context of COVID-19.

Response

The 2021 accreditation work program will be a challenge.

Discussions are occurring to ensure the Accreditation Manager has sufficient administrative support to complete the planned program within required timelines.

Part 2. Details regarding the use of the Medical Training Survey data

The Medical Training Survey (MTS) was developed by the Medical Board of Australia (the Board) and Australian Health Practitioner Regulation Agency (Ahpra). It was run for the first time in 2019, with results released early in 2020.

The AMC is considering how the results of the MTS can be used in accreditation and monitoring processes. In this section the AMC is asking the intern training accreditation authority to comment on how it has used, or plans to use the results.

Your feedback on the survey will be shared with the Board and Ahpra for survey evaluation purposes. Please let the AMC know if you do not want your responses shared.

The Medical Training Survey

Please advise if the intern training accreditation authority has investigated, or is planning to investigate the results of the Medical Training Survey.

If yes, please provide details.

Response

An analysis of the 2019 Medical Training Survey (MTS) results was done in early 2020, when the data became available. The analysis included comparison of Victorian and National data as well as by health service where data was available.

The MTS data was compared with data collated by the accreditation secretariat and reported annually in an evaluation report.

It is pleasing that this analysis demonstrates that issues identified in the MTS are being identified in the accreditation processes undertaken be PMCV.

Victorian Health Services – Analysis of 2019 MTS Results – Executive Summary

The Medical Board of Australia conducted The Medical Training Survey (TMS) in 2019 with close to 10,000 doctors in training taking part in the first ever survey of this nature. PMCV have analysed the results for Victoria in relation to accreditation outcomes for the Intern and PGY2 cohort.

PMCV accreditation have found that the outcomes generally align with the feedback from the Medical Training Survey. In some cases, junior doctor feedback PMCV collated in 2018 is not as positive as that collected in the Medical Training Survey in 2019, which may suggest improvements have occurred.

Key findings by Domain

1. PATIENT SAFETY:

MTS data suggests that the majority of respondents feel comfortable to raise concerns regarding patient safety and are confident that these would be deal with proactively by the health service.

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PMCV data, however, suggests that 20% junior doctors believe that workload, support and/or supervision resulted in unsafe patient care.

2. GREATER THAN 85% of respondents at most of the health services analysed were interested in getting involved in medical teaching.

3. GREATER THAN 80% of respondents are concerned they will not successfully attain Fellowship/ meet training requirements/ secure a place in preferred College training program.

4. In regards to CLINICAL SUPERVISION, there are some positives e.g. good results for availability, support and accessibility of senior medical staff and in regards informal feedback. However, Junior Doctor feedback also highlights multiple issues:

a. Registrars seem to provide the majority of supervision for training junior doctors. It is noted, that for interns the AMC requires consultants to sign the performance assessment forms but this data suggests they have limited interaction with junior doctors they are assessing (PMCV survey teams are receiving this feedback too).

b. Conversations regarding learning objectives/ learning plans mostly do not seem to occur. This data aligns with PMCV continuing emphasis on the role of terms supervisors in setting goals, supporting career objectives and performance assessment and feedback.

c. While the Medical Training Survey does not delineate between hospital and unit orientation, the overall rating of 66% SA/A may be due to limited unit orientation as PMCV finds at many survey visits. As a consequence, PMCV also emphasises the role of Term Supervisors in unit orientation including setting clear expectations.

d. While end-term assessments seem to occur consistently, feedback discussions with the assessor (term supervisor) only occurs in about 75% of cases and the Medical Training Survey does not ask about mid-term assessments. PMCV improvement recommendations commonly highlight term supervisor feedback (face-to-face) and mid-term assessments.

5. Junior Doctor feedback indicates that ACCESS TO TEACHING is often prevented by job responsibilities. This is evident from the Medical Training Survey (MTS) as well as feedback collected by PMCV.

MTS data suggests that 50% of respondents work unrostered overtime and that the majority of unrostered overtime is not paid. Such feedback is increasingly being discussed at PMCV survey visits. Formal education programs seem to rate well in terms of availability and learning value but there seems to limited access to simulation training and for developing research skills.

6. Bullying, Harassment and Discrimination is still occurring. For Victoria 31% of respondents had experienced BHD and 46% had witnessed BHD in the last 12 months. Of the nine health services analysed, three had higher than average experiences of BHD – one health service was 55% had experienced and 91% had witnessed BHD. It was pleasing to noted that the majority of respondents knew where to access support if needed.

If the intern training accreditation authority has investigated the results of the Medical Training Survey, please advise if the intern training accreditation authority has explored the survey results with stakeholders, and details of the engagement.

Response

The analysis was shared with the PMCV Board and committees however further engagement with stakeholders did not occur due to COVID.

It was recommended to the Board that PMCV undertake this work:

The development of career road maps that commence in year one and take the doctor in training to Fellowship training. This would require collaboration with the Universities as well as the Colleges. The Victorian Rural Generalist Program is the most logical place to commence this type of program design.

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If the intern training accreditation authority has investigated the results of the Medical Training Survey, please advise if any changes have been made or are planned based on these investigations.

Response

In 2020, a review was undertaken of the PMCV online intern survey, which is conducted to collect feedback for survey visits and accreditation reviews. The revised survey is Attachment C. Additional questions were included in regards to training plans, junior doctor involvement in governance and performance feedback. Questions regarding junior doctor wellbeing and support were changed to align with those in the Medical Training Survey.

In 2021, available data related to individual health services will be shared with survey team members when assessing those health services and with the Accreditation Committee when undertaking accreditation reviews.

The Victorian Rural Generalist Program has commenced with pathways for training being developed all around the State.

PMCV has also implemented a Streamlined Recruitment strategy. The current focus includes three main initiatives: improving the Central Listing Service, establishing the Late Vacancy Hub and the JMO Recruitment Report, and the integration of all services. Enhancements are also planned.

The Central Listing Service (CLS) was established in June 2020 (agreement between PMCV and DHHS) to be a repository of all advertised junior medical staff positions. The primary goals to its long-term success will be encouraging Health Services to utilise the service to update and maintain their listings, as well as its promotion to the JMO staff.

The Late Vacancy Hub (LVH) service will be established to overhaul the management of unmatched positions to ensure that a fair, open and transparent process. The idea is for health services to list their posts centrally and for the process to be driven by JMOs.

A major component of the streamlined recruitment strategy and the visibility of the JMO workforce is the implementation of a state-wide recruitment report for the DHHS. The data will be a ‘snapshot’ scheduled at regular intervals and will be displayed to stakeholders using an online dashboard.

Part 3. Attachments

Please list any attachments referenced in the responses above, using the number format below.

Part 1

Attachment A: Survey Visit Cycle (4 years)

Attachment B: Summary of Work for 2021

Part 2

Attachment C: Intern Online Survey (revised)

2021 2022 2023 2024

Albury Wodonga Health / Mercy Health

HETIAustin Health

Ballarat Health Services /Queen

Elizabeth Centre Bendigo Health

South West Healthcare/ St John of God

Warrnambool/ Portland Health Murray to the Mountains (and 6 GPs)

Echuca Regional Health (Echuca Moama

FMP)

Barwon Health / Grace McKellar Centre/

St John of God Geelong (PGY2 posts

commenced 2018)

Alfred Health Northeast Health Wangaratta (align visit

with M2M) Monash Health

CONDITIONS

REVIEW

Western District Health Service

(Barwon, SVHM) Calvary Health Bethlehem (Alfred) Mildura Base Hospital

Bairnsdale Regional Health Service (and

MSMC/ EGCBI)

MIDCYCLE

REVIEW

St Vincent's Hospital / St George's

Hospital, Caritas Christi Hospice, St

Vincent's Private Hospital

Goulburn Valley Health Melbourne Health/ The Women’s

Hospital (RMH)

Central Gippsland Health Service, Sale

(and CMC/ EGCBI) SURVEY VISIT

Swan Hill and District Health (SVHM) Eastern Health/ Epworth Eastern

(private) Wimmera Healthcare Group (RMH)

Latrobe Regional Hospital (Gippsland

Rural Intern Training) ISSUES

Werribee Mercy Hospital (SVHM,

Western) Northern Health Peninsula Health

West Gippsland Healthcare Group

(GRIT/Monash)

Peter MacCallum Cancer Centre

(RMH/SVHM)

Grampians Health Services/ St John of

God Ballarat and 3 GPs (Ararat,

Nightingale, Clarendon)

Western Health/ Djerriwarrh Health

Services (PGY2) Royal Children’s Hospital (SVHM, RMH)

COBURG MEDICAL CENTRE

PMCV ACCREDITATION SURVEY VISITS CYCLE -

Bass Coast Health

(Peninsula/Monash)

Goulburn Valley Health -

(Gippsland

Rural Intern Training)

Latrobe Regional Hospital

2021 ACCREDITATION WORK PLAN

Survey Visits ITP: Intern Training Program

HEATH SERVICE Review (new posts) Visit

Portland District Health ITP for two interns May

Werribee Mercy Hospital ITP including new core medicine intern post May

Swan Hill District Health (rotation site) May

Goulburn Valley Health June

Albury Wodonga Health (and Mercy Health) July

South West Health (and St John of God, ACCHOs) Indigenous ITP including new ACCHO July

Latrobe Regional Hospital (and two new GPs) new general practice intern posts (2) August

Western District Health Service (rotation site) August

St Vincent's Hospital Melbourne (3 sites) 4 intern posts September

Barwon Health (including St John of God) October

HEATH SERVICE Review (new posts)

Mid Cycle Reviews

Ballarat Health Services 2 intern posts

Murray to the Mountains (including six GPs)

Northeast Health Wangaratta

Mildura Base Hospital

Melbourne Health

The Women’s Hospital (rotation site)

Wimmera Healthcare Group (rotation site)

Peninsula Health

Western Health

Conditions Reviews

West Gippsland Healthcare Group (rotation site)

Central Gippsland Health

Bairnsdale Regional Health Service

Bendigo Health

Royal Children's Hospital (rotation site)

Monash Health 4 intern posts

Echuca Regional Health

Other Reviews

Alfred Health new intern posts (6) core medicine posts

Austin Health

Bass Coast Health (rotation site)

Eastern Health 2 intern posts

Grampians Health Services

Northern Health 5 intern posts

THIS SURVEY IS CONFIDENTIAL.The Postgraduate Medical Council of Victoria (PMCV) is seeking feedback from you on yourexperiences in rotations you have completed. We would appreciate any comments or suggestionsfor improvement in relation to your experience of the education and training program. PMCV is the lead organisation in Victoria that supports state and national initiatives in relation tojunior doctor training.All facilities in Victoria which offer intern/PGY2 training programs and posts must be accredited byPMCV. We value the feedback we receive from junior doctors.If you would also like to provide feedback directly to PMCV, you are welcome to contact theAccreditation Manager, Monique Le Sueur, by email: mlesueur@pmcv.com.au or on 03 9670 1066.

Intern/ PGY2 rotations: LIST ALL SITES

PMCV INTERN (PGY2) SURVEY - HS/TP 2020 (template)

Provided with relevant teachingMet the requirements of my training

planAble to attend educational

opportunitiesA range of opportunities to develop

clinical/ procedural/ non-clinical skills

Emergency(site)

GeneralMedicine(site)

GeneralSurgery(site)

Comment on the types of learning opportunities you have accessed (please give details and indicate the relevant rotation)

1. CLINICAL LEARNING: Please rate each statement in the table below for each rotation you completed(select answer from dropdown box)

1

I knew my term supervisor with whom I

interacted regularlyI had access to an appropriate clinical

supervisor at all timesAfter-hours support was accessible

with clear clinical escalation proceduresExpected to do work I do not feel

confident doing

Emergency(site)

GeneralMedicine(site)

GeneralSurgery(site)

Comment on who mainly provides your day to day supervision: Specialist, Registrar, Other doctor, Nurse, Other (please give detailsand indicate the relevant rotation)

2. CLINICAL SUPERVISION: Please rate each statement in the table below for each rotation youcompleted (select answer from dropdown box)

The rostered hours were sufficient to

complete the work expectedThe expectations of the rotation were

clearly explained (unit orientation)Clinical Handover processes are

structured and safe

My views are sought on thestructure/content of my training

program

Emergency(site)

GeneralMedicine(site)

GeneralSurgery(site)

Comment (please give details and indicate the relevant rotation)

3. WORKLOAD/OTHER: Please rate each statement in the table below for each rotation you completed(select answer from dropdown box)

During the term I experienced bullying,harassing or discriminatory behaviour

Wellbeing and work/life balance aresupported

Workload, support and/or supervisionissues resulted in unsafe patient care

I am provided with access topsychological and/or mental health

support services

Emergency(site)

GeneralMedicine(site)

GeneralSurgery(site)

If you did have any experience(s) of inappropriate behaviour (BHD) or unsafe patient care please give details and indicate therelevant rotation. Did you report it?

4. JUNIOR DOCTOR WELLBEING AND SUPPORT: Please rate each statement in the table below foreach rotation you completed (select answer from dropdown box)

2

I received a mid-term assessment I received an end-term assessmentI received informal feedback from

my supervisors regularly

Emergency (site)

General Medicine (site)

General Surgery (site)

Comment (please give details and indicate the relevant rotation)

5. PERFORMANCE ASSESSMENT: Please rate each statement in the table below for each rotation youcompleted (select answer from dropdown box)

The feedback was relevant to my

trainingIncluded an opportunity to discuss

feedback with my supervisorProvided me with useful feedback on

my progress

Emergency(site)

GeneralMedicine(site)

GeneralSurgery(site)

Comment (please give details and indicate the relevant rotation)

6. PERFORMANCE FEEDBACK: Please rate each statement in the table below for each rotation youcompleted (select answer from dropdown box)

Reliable internet fortraining purposes

Education resourcesWorking space such as

desk, computerTeaching spaces

Emergency (site)

General Medicine (site)

General Surgery (site)

Comment (please give details and indicate the relevant rotation)

7. AMENITIES: Please rate each statement in the table below for each rotation you completed (selectanswer from dropdown box)

3

General Medicine (site) Gastroenterology (site)

Assessing, admitting patients with a broad rangeof acute medical problems incl history, examination

Developing management plans, orderinginvestigations, monitoring progress of acutemedical patients

Managing inpatients with a range of commonacute and chronic medical conditions, inclcomplications

Gain understanding of long term management ofpatients incl effects of disease over time

Clinical experience managing critically illpatients at presentation/deterioration duringadmission

Comment (please give details and indicate the relevant rotation)

8. MEDICAL TERMS: Rate your experience of these mandatory intern training requirements for eachrotation you completed in the table below (select answer from dropdown box)

General Surgery (site) Orthopaedics (site)

I regularly attend and actively participated in atleast one operating theatre session per week

Clinical exposure to a broad range ofemergency, acute, elective surgical conditions/cases

Exposure to patients with common features ofsurgical illness - trauma, shock, neoplasia

Exposure to pre-operative aspects of surgicalmanagement

Exposure to post-operative aspects of surgicalmanagement incl discharge planning

Comment (please give details and indicate the relevant rotation)

9. SURGERY TERMS: Rate your experience of these mandatory intern training requirements for eachrotation you completed in the table below (select answer from dropdown box)

Emergency (site1) Emergency (site2)

A clinical supervisor was available at ALL times/ALL my patients were reviewed prior to discharge

I am familiar with protocols and can initiatemanagement of common/life threatening conditions

I was not expected to manage OBS patients orchildren <2 years old without direct supervision

Exposure to assessment/management of patientswith acute undifferentiated illness AND acutely ill

Opportunities to assess patients are firstpresentation/ Emerg Resusc involvement/procedural skills

Comment (please give details and indicate the relevant rotation)

10. EMERGENCY TERMS: Rate your experience of these mandatory intern training requirements for eachrotation you completed in the table below (select answer from dropdown box)

4

Yes No

General Medicine (site)

General Surgery (site)

Emergency (site)

Comment (please give details and indicate the relevant rotation)

11. Would you recommend this rotation to colleagues?

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