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

Supervisor Shortfall

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

Solutions- GPH

Solutions- GPH

Solutions- GPH

Solutions- GPH

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

Training and Retaining- Solutions

Warning!!!

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/