TRAINING AND RETAINING HEALTH PROFESSIONALS: METROPOLITAN, RURAL AND REMOTE PERSPECTIVES Dr Alex Markwell FACEM Royal Brisbane and Women’s Hospital and Greenslopes Private Hospital
Dec 15, 2015
TRAINING AND RETAINING HEALTH PROFESSIONALS: METROPOLITAN, RURAL AND REMOTE PERSPECTIVES
Dr Alex MarkwellFACEMRoyal Brisbane and Women’s Hospital and Greenslopes Private Hospital
Declaration of Interest
I am currently employed at Greenslopes Private Hospital, a recipient of various Commonwealth grants
Acknowledgements
Greenslopes Private Hospital and staff for use of photos
Queensland Ambulance Service for use of photos
Overview
Focus on metro and urban setting from clinical educator perspective
Evidence, barriers, solutions Medical, nursing & paramedic
examples
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
Supports continuing professional development (CPD) & skills development opportunities
Linked with job satisfaction Part of suite of retention
strategies
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
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?
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
Cost Time Supervisor capacity Supervisor experience Matching learner need with
training opportunities Service provision is priority Culture
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- 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
GPH nursing education Simulation Centre Programs In-services Other sessions e.g. Grand
Rounds, GP Educations sessions etc
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- 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- 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- 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- 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- 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- 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- Solutions
Paramedics High fidelity in situ training Real-time critique and feedback High-stakes scenarios but
clinically rare
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/