Cetiscape 3 February 2011

“The world has changed; we are living longer and the burden of chronic illness is rising. A revolution in health systems technology and delivery may be our only hope for future generations.” — so read the banner at the Intergenerational Health Systems Forum, an unprecedented gathering of government, education, community and business groups in western Sydney.

The forum sought a common set of directions to address some of the major issues affecting health and community care, focusing on the potential of digital technologies to better coordinate, integrate and improve services.

In his opening remarks, Professor Glen Maberly, Director of the Centre for Health Innovation and Partnership, reminded everyone that demographic change presented huge challenges for public budgets, as health care costs (already 28% of the NSW state budget) threatened to grow unsustainably. Smarter health care was the alternative.

“I will be happy when we stop talking about technology and start talking about smart systems,” Professor Steven Boyages, CETI Chief Executive, said in his address to the forum. “The technical means for improved health care don’t have to be invented — they are ubiquitous, on the internet, on

digital devices like the iPhone — and what we need to do is take relatively simple steps to connect health workers to the information potentially available to them.”

Professor Branko Celler, Dean of the College of Health Sciences at University of Western Sydney, described the

CLINICAL EDUCATION& TRAINING INSTITUTE

Building 12, Gladesville Hospital, Victoria Road, Gladesville NSW, 2111 Editor: Craig Bingham

Locked Bag 5022, Gladesville NSW 1675 02 9844 6511

p: (02) 9844 6551 f: (02) 9844 6544 e: [email protected] [email protected]


cetiscape Issue 3 February 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 1

Intergenerational health systems: securing a sustainable futureThursday 10 February 2011, John Loewenthal Auditorium, Westmead Hospital

In this issueIntergenerational health systems: securing a sustainable

future 1

Postgraduate clinical placements 2

Above and beyond 3

Scholarships for doctors in rural training 3

Improving care for patients with osteoporosis 4

Coming: 5th NSW Rural Allied Health Conference 5

Coming: NSW Prevocational Medical Education Forum 5

Sepsis kills 6

Safety with injectable medicines 6

Nursing grand rounds via videoconference 7

Emergency department demand increases 7

HSP making a difference 8

Survey of General Practitioner Procedural Training Program 8

Diploma of Rehabilitation 9

Karma – a prevocational general practice placement experience 10

Future thinkers at the forumCentre for Health Innovation and Partnership (CHIP)

Clinical Education and Training Institute (CETI)

Regional Development Australia-Sydney

NSW Government Education and Training

Western Sydney Institute of Technical and Further Education

College of Health Sciences, University of Western Sydney

Penrith Business Alliance

Western Sydney Community Forum

Western Sydney Local Hospital Network

Nepean Blue Mountains Local Hospital Network



When the NSW Health Care Advisory Council met on Thursday 9 December 2010, CETI Chief Executive Professor Steven Boyages and Dr Marie Louise Stokes presented a report on the increasing numbers of medical graduates in NSW requiring placement for clinical training as the new medical schools produce their first graduates.

Provided clinical training opportunities are expanded, there is an opportunity for the increase in medical graduate numbers to address workforce shortages in rural and regional areas, and in disciplines such as general practice, emergency medicine, psychiatry, geriatrics and palliative care. Strategies under consideration to increase postgraduate clinical placements include shift rostering, new models of service, increasing the number of facilities offering placements, and expanding the range of alternative training settings, which could include

general practice, community settings, specialist and private practice and private hospitals.

Several initiatives have already been implemented. Up to 50 prevocational general practice training places in NSW will be funded by the Commonwealth from 2011, based mainly in rural and regional areas. CETI has developed a streamlined accreditation process for general practices and regional training providers wishing to offer clinical placements for junior doctors.

CETI’s Rural Division will centrally coordinate the NSW Rural General Practitioner Procedural Training Program to support the rural GP procedural workforce.

The Health Care Advisory Council reiterated the importance of developing effective strategies to retain the medical graduate workforce in rural areas, and to invest in paediatrics and general practice.

potential of telehealth to empower patients to manage their health from homes with the aid of clinicians connected by phone. He hopes to see a Cooperative Research Centre in Telehealth established at UWS to drive evidence-based adoption of this aid to effective and efficient patient care.

Mr Paul Brennan of the Penrith Business Alliance drew attention to the health-care corridor that runs from Westmead Hospital to Nepean Hospital, Penrith, taking in UWS and the western clinical school of Sydney University. This is Sydney’s demographic centre and an area populated with skilled workers who need local employment. Mr Brennan saw the challenges of

the future as an opportunity for the development of a stronger, smarter health care industry in Sydney’s west.

The forum initiated a wideranging discussion about the possibilities for cooperative action to realise smarter health systems, which many participants saw as resting on “power to the people” — more information for health care consumers, and more engagement of consumers in managing their health. The positive benefits and potential pitfalls of a patient controlled electronic health record were debated at length.

A communiqué issued by the forum will be available soon.

Postgraduate clinical placements

The destiny of our demography: from pyramid to ... coffin?A future with more elderly in the population, and a smaller proportion of workers: demographics cited by Glen Maberly from a Productivity Commission report.



Above and beyond“I will go to any lengths looking for a cure for cancer – I’m even prepared to climb mountains!” says Associate Professor Michael Agrez, a colorectal surgeon at John Hunter Hospital, and one of Australia’s most dedicated Directors of Prevocational Education and Training.

In July, Michael is climbing Kilimanjaro (Africa’s tallest mountain) to raise money for the Cure Cancer Foundation.

You can sponsor Michael by visiting <https://www.gofundraise.com.au/AgrezM>.

Cure Cancer Australia commenced in 1967 and is an independent Foundation for cancer research with its own Medical Grants Advisory Committee to select projects with the greatest potential that have been submitted by young post-doctoral researchers.

More information about Cure Cancer Australia can be found at <http://www.cure.org.au>.

Michael is a longstanding member of CETI’s Prevocational Training Council, and has recently joined the Prevocational Accreditation Committee. At John Hunter Hospital, he was an early adopter of the Australian Curriculum Framework for Junior Doctors, piloting implementation of the framework in new term descriptions and reflective portfolios for trainees, and gathering new data about the experiences that trainees gain (or sometimes do not gain) in their core training terms.

Michael’s ambitious climb to conquer cancer is typical of his energy and community spirit, and CETI will be cheering him on all the way.

Michael Agrez, shown here training for the assault on Kilimanjaro in his mountain climbing kit.

Scholarships for doctors in rural training CETI : The Clinical Education and Training Institute (CETI) is a statutory health corporation established by the NSW government to promote excellence in clinical education and training.

CETI collaborates with universities, colleges, clinical leaders, hospitals, health services and the community to achieve better health through education, training and development of a clinical workforce that meets the healthcare needs of the people of NSW.

CETI innovates to improve communication, capacity and competency in health care by promoting blended learning approaches, including face-to-face teaching, simulation and e-learning.




Will you be working in two or more rural terms this year? Are you in a CETI network training program?

If you can answer yes to both questions then you may be entitled to apply for a rural scholarship of up to $6,000, depending on your level of training.

The Rural Scholarship Fund supports medical trainees committed to training and providing patient care in rural locations in NSW.

Prevocational (PGY1 or 2), basic physician, paediatric physician, emergency medicine (new for 2011), pre-specialist surgical and psychiatry (basic and advanced) trainees can apply.

Applicants must complete a minimum number of regional and/or remote terms in NSW Health facilities in the 2011 clinical year as follows:

Prevocational trainees — 2 terms

Basic trainees — 2 3-month terms

Advanced trainees — a full clinical year.

Trainees who will complete the minimum number of terms and are in a CETI networked training program can apply for a rural scholarship. If their application is successful they will receive payments of:

$1500 for prevocational trainees

$5000 for basic trainees

$6000 for advanced trainees.

Applications for the Rural Scholarship Fund open at the end of February and close on 15 April 2011.

For more information, follow the links on the CETI website or contact Andrea Ross (02 9844 6530) or Kirsten Campbell (02 9844 6536) at CETI.



CETI is working with the Agency for Clinical Innovation (ACI) to help bring potentially life-saving preventive care to elderly patients with brittle bone injuries or fractures. Although the risk increases with advancing age, the largest impact on the community is in relation to the relatively young old.

This month ACI and its Musculoskeletal Network launched a new model of care to prevent the risk of repeat fractures in patients with osteoporosis.

The bones of people with osteoporosis are fragile and brittle, with a significantly higher likelihood of fracture from even minimal impact or injury.

It is estimated that 2.2 million Australians have osteoporosis, which affects half of all women aged over 60 and one in three older men. The economic cost was estimated in 2007 at $7 billion, including more than $1.5 billion in direct health costs.

About half of all patients who have one osteoporotic bone fracture will have another.

In NSW, 35% of patients who were admitted to hospital with a minimal trauma fracture between 2002 and 2008 were subsequently admitted to the same hospital with a refracture. This accounted for 16,225 admissions, with an average length of stay of 22 days. These data do not include patients admitted with a refracture to a different hospital.

Many people who have multiple osteoporotic fractures have ongoing pain and disability, reduced quality of life and die prematurely.

While the increased risk of refracture is well known and evidence-based guidelines highlight the need to intervene at the time of the first fracture, in far too many cases it is simply not happening.

National audits have repeatedly shown that only 20%–30% of female patients, and even fewer male patients, are being identified at first fracture for preventive care. This means that more than four out of five people presenting at health services with an osteoporotic fracture are being denied the health benefits of effective fracture prevention.

The NSW Model of Care for Osteoporotic Refracture Prevention is an easy-to-use guide to best practice care for doctors, nurses, other health professionals and managers across the NSW health system. It aims to ensure that all patients presenting with brittle bone fracture are assessed and offered advice and treatment to prevent further fractures. This may include bone density scanning, measurement of vitamin D levels, assessment of calcium intake and thyroid function, disease management advice and self management support.

High quality services already are in place at Concord, St Vincent’s, Royal Prince Alfred, Royal Newcastle Centre and the Mid North Coast Local Health Network.

CETI is working with ACI to address one of the keys to implementation of the model of care — education and

support for junior doctors at the front line to identify, investigate and treat patients with osteoporosis.

A working group has been convened to develop a curriculum under the leadership of Orthopaedic Surgeon Dr Kerin Fielding, with representation from endocrinology, rheumatology, gerontology, falls prevention, curriculum development and information technology. The web-based curriculum is close to completion and will be available to NSW Health staff online. Users will be able to work their way through topics at their own pace and at any time of the day or night.

The Chief Executive of ACI, Dr Hunter Watt, said the new model of care addressed one of the biggest health issues for elderly people in NSW.

“This is a huge issue. People who suffer osteoporotic fractures often are faced with chronic pain, are less able to manage activities of daily living, and risk losing their independence and developing other chronic conditions because of immobility. Their risk of premature death also is very real.”

“ACI funded this model-of-care project and the Musculoskeletal Network worked with medical, nursing and allied health clinicians and consumers from across the State, as well as stakeholder groups such as Arthritis NSW and Osteoporosis NSW, to make it happen.”

“The challenge now is implementation and we are delighted that CETI is working so closely with us on the need to educate front-line clinicians.”

Professor Lyn March, a senior rheumatologist from Royal North Shore Hospital and one of the authors of the guide, said it was designed to address a very real area of underperformance in the health system.

“It is not acceptable that when the markers are so clear and so much can be done to prevent refracture, so many people with osteoporosis continue to miss out.”

Improving care for patients with osteoporosis

Pictured left to right: Professor Markus Seibel, Professor Lyn March, Robyn Speerin (Network Manager of ACI’s Musculoskeletal Network), The Hon. Carmel Tebbutt BEc MP, Minister for Health and Deputy Premier, and Professor John Eisman. Photo: ACI.



Coming events

Principles and practiceNSW Prevocational Medical Education Forum 11–12 August 2011

At this year’s prevocational forum, medical educators, directors of training and administrators will share their experience, workshop the issues that matter and hear practical advice from leaders in JMO education.

In 2010, CETI commissioned an external review of the prevocational training networks. In November, the review team reported that it “found an extra-ordinary level of commitment of individuals and institutions at all levels to prevocational training across the NSW health system.”

The team delivered inspiring recommendations for renovation of prevocational training that it hoped would multiply the effectiveness of this commitment. During 2011, CETI is working with its partners in the local health networks to unlock the potential identified in the review.

On the agendaThe learning model in prevocational training: who learns

what, when, how.

Tuning the networks for smoother performance

Workable methods of assessing trainees and evaluating programs: building better feedback

Maximising the benefit of general practice training terms

Innovations in training and education.

For more information, please contact Craig Bingham (02 9844 6511, [email protected]) or visit the website <www.ceti.nsw.gov.au/prevocational>.

Strong foundations in shifting sands5th NSW Rural Allied Health Conference The Glasshouse, Port Macquarie, 9–11 November 2011 Proudly presented by CETI’s Rural Division

Rural allied health services bring together a blend of multidisciplinary skills requiring a flexible approach to cooperation, coordination and collaboration. Interdisciplinary rural health partnerships have become strong foundations which will continue to sustain quality care in shifting sands, the transitional period of the current national health reform.

This conference will provide an opportunity for all allied health staff, managers and education providers to demonstrate how collaborative health partnerships create models of care which achieve positive patient journeys.

This conference is designed to attract rural and remote allied health clinicians from new graduates to senior managers, and those who work in partnership with allied health services.

Pre-conference workshops

There will be a choice of pre-conference workshops to attend on Tuesday 8 and Wednesday 9 November. Come along, share experiences and take home some practical information to put straight into practice with your team.

Call for abstracts in March

In March authors will be invited to submit an abstract relevant to the theme Strong Foundations in Shifting Sands, using examples of established rural collaborative partnerships which achieve positive patient outcomes. First time presenters welcome.

For more information please contact Jenny Preece (02 6692 7716, [email protected]) or visit the website <www.ircst.health.nsw.gov.au>.

“That is condemning many thousands of people to a future of pain, inability to perform normal activities of daily living, loss of independence, developing other chronic diseases and dying prematurely.”

“It also means that Australians continue to pay billions of dollars in health care costs and loss of productivity for issues that can be prevented.”

“This model of care has been shown in many trials, including in Australia, to reduce medical complications, reduce readmissions to hospital and reduce the number of premature deaths. It also has been shown to improve quality of life of individuals and their

families. Why wouldn’t you do it? I am delighted that we are now at the implementation stage.”

“Early identification of people in NSW who have osteoporosis is a critical component of the new model of care because it will enable early treatment, which can reduce further fractures by up to 50%.”

îî



Appropriate and timely recognition and management of patients with sepsis is a significant problem in healthcare. Sepsis is associated with high morbidity and mortality; severe sepsis and septic shock have a mortality of around 25%.1 In another study, the mortality rate for patients with septic shock increased by 7.6% for every hour of delay in commencing antibiotic therapy.2

Sepsis has been identified by the NSW Root Cause Analysis Review Committee as a recurrent emerging problem. The Clinical Excellence Commission Clinical Focus Report on the Recognition and Management of Sepsis3 found significant deficits in a range of clinical settings, with a higher proportion of problems being reported in the emergency department.

Key clinicians and other experts have identified improving recognition and management of sepsis as a high priority for local health networks. In response, the Agency for Clinical Innovation and Clinical Excellence Commission are collaborating with the newly-formed Emergency Care Institute on a joint initiative. The project will enable a consensus approach to improving the recognition and management of sepsis at a state level.

The goals for the project are to reduce preventable harm to patients through early recognition of sepsis, appropriate fluid resuscitation and reduced time to administration of antibiotics. Phase 1 of the project will focus on emergency departments and Phase 2 will focus on improving the recognition and management of sepsis for inpatients. Education for junior staff will be a key component of the project.

A generic adult sepsis pathway has been developed following wide clinical consultation. The pathway aims to support recognition of severe infection and sepsis in the emergency setting and to give clear guidelines for notification, escalation and initial management. The sepsis pathway promotes:

early flagging of severe infection and sepsis at triage

involvement of senior clinicians in diagnosis and management

appropriate and timely fluid resuscitation

prompt administration of antibiotics (goal is within one hour of triage)

serum lactate monitoring to assist diagnosis and ongoing monitoring

referral of care to appropriate clinical teams, including retrieval if appropriate.

A pilot study using the draft sepsis pathway and a staff education program has been undertaken in emergency departments at John Hunter, Liverpool, Concord and Prince of Wales Hospitals. Preliminary audit results have been very encouraging, with a marked reduction in time to administration of intravenous antibiotics and heightened staff awareness of sepsis and the need for prompt treatment. There has been wide consultation with rural clinical groups and the pilot study is being extended to a rural site. Staff feedback from the pilot study and audit results are informing the finalisation of the draft sepsis pathway, education resources and project support for the state-wide implementation in May 2011.

For more information please contact Dr Tony Burrell, Director Patient Safety (02 9269 5550, [email protected]) or Mary Fullick, Project Manager (02 9269 5542, [email protected]).

1 The Australasian Resuscitation in Sepsis Evaluation (ARISE) Investigators and the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) Management Committee. The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand. Critical Care and Resuscitation 2007; 9: 8-18.

2 Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006; 34: 1589-1596.

3 Clinical Excellence Commission, 2009.

Sepsis kills

ACI and CEC joint project to improve the recognition and management of severe infection and sepsis

Safety with injectable medicines New National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines propose standards for handling injectable medicines to ensure that patients are never inadvertently injected with the wrong medicine or injected by the wrong route.

The recommendations and support materials can be found at <http://www.health.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-06_UaLIMFL>

CETI supports this initiative and is consulting with its partners in the NSW health system to ensure that clinical training has embraced the labelling standards.



Nursing grand rounds via videoconference

Jenny Preece Rural and Remote Health Project Officer, CETI Rural Division, Dorrigo Multi-Purpose Service

In 2008, NSW Health Nursing Office, in collaboration with the NSW Institute of Rural Clinical Services and Teaching (IRCST, now the CETI Rural Division) identified mentoring and supervision of rural and remote nursing staff from smaller facilities across NSW as an area to be addressed, particularly where triaging and initial emergency management of patients is frequently undertaken in the absence of a medical officer.

In 2009, IRCST introduced rural and remote nursing grand rounds via videoconference linking nurses from eight isolated health facilities in North Coast Area Health Service (NCAHS) for generalist case presentations and discussion of interesting or challenging patient journeys of relevance to the rural setting. Nurses are rostered monthly to present a patient journey for discussion, with guest speakers presenting a case-based inservice at regular intervals as an educational component. Presentations can involve the use of PowerPoint or simply tell the patient story. Keeping the sessions case-oriented — a rural patient’s story told by rural nurses —ensures that discussions are relevant and meaningful.

Evaluation of NCAHS nursing grand rounds at 18 months has found that networking with peers, nurses educating nurses and sharing experiences in the management of actual cases has been a very practical approach to focusing on best practice. Reflection on team and individual clinical practice and identifying lessons learned from each episode of care has often influenced change in clinical processes. The regular communication between sites has created an accepted form of peer review. Isolated rural nurses feel more comfortable sharing and analysing experiences with professionally isolated colleagues and comment they now feel part of an extended team.

Over time, the operational framework developed in NCAHS was consolidated into an implementation toolkit to enable the spread of nursing grand rounds across NSW.

Rural and remote nursing grand rounds via videoconference have now expanded to include smaller sites across the former Greater Western Area Health and Greater Southern Area Health Services, with Hunter New England proposing to implement the program in 2011.

Emergency department demand increasesThe recent “Christmas rush” in NSW public hospital emergency departments was intense, with the number of patients seen eclipsing those treated at the height of the 2009 swine flu pandemic.

More than half a million patients attended NSW emergency departments from October to December 2010, according to Hospital Quarterly, Issue 3, the most recent report from the Bureau of Health Information. This is nearly 30,000 more than in the previous quarter, nearly 21,000 more than the same time last year, and nearly 18,000 more than in July to September 2009, when the swine flu pandemic was at its peak.

Bureau Chief Executive Dr Diane Watson said attendances during the quarter were at a two-year high, with increased numbers generally seen across October and November as well as a Christmas holiday spike. In the face of extra pressure, emergency departments generally held their performance. Patients were seen within recommended time frames for all triage categories, except triage category 3 (patients with a potentially life threatening condition).

There is typically less elective surgery performed in public hospitals towards the end of each year and this held true in 2010. The proportion of patients receiving elective surgery on time remained stable and there has been a decrease since last quarter in the time patients wait for non-urgent surgery. Wait times for urgent and semi-urgent elective surgery have remained relatively unchanged.

The report and related materials, including performance profiles for individual hospitals, are available at <www.bhi.nsw.gov.au>.

Need the advice, support or creative thinking of a representative group of junior doctors?

Contact the JMO Forum via CETI’s Prevocational Program Coordinator: Craig Bingham ([email protected], 9844 6511).

JMO FORUM

NEW SOUTH WALES



HSP making a differenceDr Simon Leslie, Medical Director at Shellharbour Hospital and Chair of the Hospital Skills Program State Training Council, reports.

One of our CMOs thanked me yesterday, enthused about the Hospital Skills Program (HSP) and the benefits to him. He had just attended a half day in theatres re-skilling in airway management and could not speak highly

enough of the experience and the benefits to him. He was also full of praise for the education day last week at Wollongong University and also for the simulation course he was sent to attend at Royal North Shore Hospital last year. His face was beaming and he was obviously very excited.

This was a doctor who before the HSP had worked solely on weekends, feeling isolated and even somewhat paranoid because his only contact with “administration” in the past was with regard to complaints about him. His habit was to avoid any oversight or scrutiny and his resultant negative attitude affected his relationship with other staff.

He now feels much less threatened and understands that he is being supported to improve and will not be unfairly judged. He feels part of a group that is learning and improving together. He has greater enthusiasm for work and continuing professional development, he has engaged with other team members and become willing to work at any time of the week.

This is just one example of how the Hospital Skills Program is making a difference for our doctors.

The GP Procedural Training Program is being evaluated through a survey of participants.

The program, now coordinated through the CETI Rural Division, has had 285 participants since 2003. It provides GPs and GP registrars with experience in procedural general practice to equip them to practise in rural NSW. Participants train on a full time, part-time or flexible basis in rural training hospitals in one or more of the following five specialties:

Anaesthetics

Emergency Medicine

Obstetrics

Surgery

Mental Health.

The survey of participants who have completed their training will be conducted by the NSW Health Department’s trained telephone interviewers. The survey asks about:

the trainee’s experience of the program and the extent to which they are currently using the skills gained though the training

how the program has contributed to the GP procedural workforce in NSW

how the program has contributed to participants’ career decisions

suggestions for improving the program.

Feedback gained from the survey will inform the future growth and development of the program, enhancing its contribution to a sustainable rural GP procedural workforce.

Ms Linda Cutler is the Executive Director of the program which was transferred to the Rural and Remote Division of CETI in December 2010. Many will recall that Linda is the former Executive Director of the NSW Institute of Rural Clinical Services & Teaching (IRCST), which has now been brought under the CETI umbrella.

For more information about the survey or the GP Procedural Training Program, contact: Margaret Starr, Program Coordinator, CETI (02 9844 6548, [email protected]).

Survey of General Practitioner Procedural Training Program

Three hundred and fifteen medical officers are now enrolled in CETI’s Hospital Skills Program and are enjoying the benefits of more training opportunities, better recognition and an improved career pathway. For more information, speak to Acting Program Coordinator Alpana Singh (02 9844 6551, [email protected]) or visit <www.ceti.nsw.gov.au/hospitalskills>.

HOSPITAL SKILLS PROGRAM

16th Australasian Prevocational Medical Education Forum

6-9 November 2011 Auckland, New Zealand



The Royal Rehabilitation College has developed a unique, nationally recognised Diploma of Rehabilitation. The diploma provides a practical, multidisciplinary, flexible, accessible and relevant program for those seeking an accredited qualification in rehabilitation.

The Royal Rehabilitation College was able to gain national accreditation for this course because an equivalent multidisciplinary course did not exist within Australia.

The diploma is a self-paced course offered by distance education, which provides the greatest flexibility around participant needs. The course content was developed by experienced rehabilitation clinicians working at the Royal Rehabilitation Centre Sydney. Core units provide the foundation for working in a rehabilitation environment, while there are elective options in spinal injury, neurology, cardiopulmonary, orthopaedics, oncology, community, mental health and aged care. There are also units on goal-directed care, health promotion and prevention and research skills.

The diploma provides an opportunity to refresh and enhance skills or to retrain. It provides professional development with a practical rehabilitation focus and a chance to enhance skills and knowledge of new areas of rehabilitation within an interdisciplinary learning environment. Support for this distance course has come from clinicians working in rehabilitation who are interested in validating their skills or who are returning to the workforce after extended leave, and from others interested in moving into rehabilitation from another speciality.

The diploma also provides an opportunity for specialised training of allied health assistants to meet the increasing demand for rehabilitation services due to the ageing and growing population.

The Royal Rehabilitation College is a health-industry-based private registered training organisation that is part of the Royal Rehabilitation Centre Sydney. The college specialises in the training and assessment of the Certificate IV in Allied Health Assistance, with over 200 participants nationally. This experience with clinicians throughout NSW and Australia has highlighted the need for specific practical training in rehabilitation. The concept, development and accreditation of the Diploma of Rehabilitation is the result of this experience.

The Royal Rehabilitation Centre Sydney provides specialist rehabilitation and disability services for people with complex and long term health care needs, traumatic brain injury and spinal cord injury. Royal Rehab engages in extensive education and research to improve the rehabilitation outcomes for its clients and, as a teaching hospital, Royal Rehab has strong partnerships with the University of Sydney’s academic units.

Registrations for the Diploma of Rehabilitation are now open for 2011. For further information on this fantastic learning opportunity contact Royal Rehabilitation College (02 9808 9626, [email protected]) or see <www.royalrehab.com.au/college/courses.html>.

New Diploma of Rehabilitation

Sue Steele-Smith Education Consultant and Manager, Royal Rehabilitation College Royal Rehabilitation Centre Sydney

Spinal rehabilitation.

Rehab in action.



Stella Tang was a Resident Medical Officer at Westmead Hospital when she did a term in general practice. She is now a general practice registrar in Westnet network.

The first day of my PGPPP term I found myself wondering if I had made a HUGE mistake in choosing a general practice rotation. The last two years of my hospital training had disciplined me into an efficient and effective discharging machine moulded by the likings of

consultants and their specialities. The words “follow up with your GP”, “that’s something your GP can look into”, “discuss that with your GP, it’s not an emergency problem”, “Your GP can refer you”, flashed before my eyes, and I began to wonder if this was Karma.

As inconceivable as it may be to some, I found myself being drawn into the complexities and value of community-based teaching in my placement at Toormina Medical Centre (TMC). Now I wonder why general practice isn’t a core rotation, as it is the only “speciality” that treats the patient as a whole, not just in bits. General practice is the integral hub that interacts with all these specialities (the ‘bits’). It’s the speciality that witnesses a patient’s journey from birth to death and the speciality that has the privilege to treat all the generations of a family at one time.

Our core population in healthcare is ageing day by day as our advances in medical intervention continue. This means that our patients not only have multiple morbidities, but require

complex care that demands medical prioritisation of their chronic conditions. How can someone learn this without the exposure and the appropriate guidance?

My time at TMC provided broad-based teaching and insight into how our health care system works. It encompassed more dedicated one-on-one teaching by passionate mentors on a vast range of medical subspecialties than any other medical terms I have experienced. This was surrounded by a familial environment of comradeship and up-to-date medical practice in weekly clinical “grand-round” meetings of case presentations, in addition to access to quality nursing and allied health services on site (diabetic educator, podiatrist, psychotherapist, mental health nurse). This was a term that developed my confidence in patient management and also fine-tuned my clinical and interpersonal skills in diagnosing, interpreting and managing common medical problems.

I found it rewarding to see the outcome of my decisions through continued and ongoing patient care, but my term in general practice also emphasised the importance of establishing a good work and life balance. The freedom it provided with organising my own patient load, having devoted lunch breaks and the regularity of working “normal” office hours was a stupendous luxury after the last two years of unrostered overtimes. All in all, I cannot fault this rotation and regardless of what “specialist” training you are endeavouring to strive towards “holistic” patient care such as I was learning and practising at TMC is what good medicine is about, and good medicine is what good doctors practice.

After all, there’s Karma …

cetiscape is published monthly by email and online: www.ceti.nsw.gov.au/cetiscape

Contributions: cetiscape invites contributions on all aspects of clinical education and training, in particular:

Short news stories: achievements, launches, events. (100 to 300 words, photos and illustrations desirable)

Reviews or editorials commenting upon issues related to health workforce education, training and development (300 to 1000 words, photos and illustrations desirable).

The submission deadline for each issue is the middle of the month. Articles can be submitted as Word documents. Pictures and logos should be sent separately, using the best available file. For logos, this is often an EPS file. Picture files should be sent at the highest resolution available. Articles submitted to cetiscape are subject to editing (proofs are shown to the authors).

To subscribe or unsubscribe: email [email protected]


Building 12, Gladesville Hospital, Victoria Road, Gladesville NSW, 2111 Editor: Craig Bingham

Locked Bag 5022, Gladesville NSW 1675 02 9844 6511

p: (02) 9844 6551 f: (02) 9844 6544 e: [email protected] [email protected]

Karma — a prevocational general practice placement experience

Date post:	16-May-2015
Category:	Health & Medicine
Upload:	health-education-training-institute
View:	386 times
Download:	2 times

Cetiscape 3 February 2011

Health & Medicine