Medical Education Registrars and Supervisors: enhancers and barriers to building medical education capacity Karen Roberts Medical Education Coordinator HETI NSW Prevocational Medical Education Forum 9-10 August 2012

the opportunity Registrar – 1.0FTE 6 or 12 months Based in their clinical context Educational development experience for appointee

QLD Medical Education Registrar Scholarship: Program Objectives Develop an understanding of the role and functions of an educational supervisor for doctors in training Gain an insight to educational theory and practice as it pertains to clinical education and training of junior doctors Disseminate knowledge and skills in the area of medical education to senior medical staff, registrars and junior doctors Undertake formal training to develop clinical education skills Contribute to medical education scholarship through leading or participating in an educational or related research project Participate in a min. of one clinical session per week for skills maintenance

program players Registrar Project supervisor Educational supports Formal education studies Participate in junior doctor education activities Participate in one clinical session per week (min) Participate in educational network sessions Contribute to medical education scholarship through leading educational research project

program players Registrar Project supervisor Educational supports Has the time and capabilities to provide senior clinician and educational support to Registrar Holds a strong interest in education In some instances this has required more than one person to supervise

program players Registrar Project supervisor Additional educational support Medical Education Registrar and Supervisor Seminar (MERSS) - QMET Invited presenters Registrars present project progress report MERSS group use ‘step back consultation method’ to develop project ideas Supervisors are encouraged to attend as a valuable professional development opportunity

enhancers - exercise position clinical education in context organisation

barriers - exercise position clinical education in context organisation

evaluation themes (2009 & 2010) Orientation to roles Registrar ‘take the time to adjust to a change from the often very structured clinical role … learn how to structure your own time – it can be challenging initially but it was a valuable experience [R09.1] ‘it took me a significant part of the year to identify people at a senior level who had an interest in education’ [R09.5] ‘adequate…whilst being given enough autonomy to explore and discover avenues on my own [R10.5] ‘give the Registrar permission to have 3 months to simply find their feet … they very quickly find themselves with more than enough to do’ [S10.2]

Orientation to roles Supervisor lack of role clarity; lack of knowledge - ‘to determine the degree of supervision, uncertainty about the supervision I could/ was providing …’ [S09.3] ‘clarify [the supervisor] role from the outset. Have clear goals for the Registrar and continue to reinforce those goals. Meet regularly and frequently both informally and formally’ [S09.1]

Clinical service – education tension ‘when resources are tight the first thing to be sacrificed is education [R09.2] ‘completed the year with 2 important insights; the service – education tension and the challenges for educators, the complexity of educational program development and conduct from operational issues of scheduling, rosters and room bookings to [educational design and the importance of] alignment of learning objectives, activities and assessment [R10.5]

Formal educational studies ‘the studies have deepened my interest and understanding in learning and education and have been the backbone to my job’ [R09.2] ‘the university studies I thought excellently supplemented what I was trying to apply at the coalface’ [R10.1] ‘I found the [course] challenging and rewarding however a significant proportion of semester one was not applicable to education for post- graduate health professionals. It would be interesting to see if other [courses] provided a more clinical focus’ [R10.5]

Registrar – supervisor relationship ‘having informal and regular access to my supervisor was important as a means of debrief [and] useful feedback when trying different approaches’ [R09.3] [a supervisor who was] ‘enthusiastic, encouraging, available, and involved …and reigned in my enthusiasm’ [R09.4] ‘… seeing the amazing things the registrars were capable of doing. I learned so much’ [S10.2] ‘lack of time to adequately supervise, ‘invariably the supervisor position is fractional and thus I was pulled in many directions at once’ [S10.2]

what next … ‘I plan to make medical education an integral component of my long term career’ [R09.5], ‘to progress on a vocational pathway but endeavour to continue education, particularly involving simulation’ [R10.1]

enhancers Factors drawn from their experiences that enhanced the position’s success included: orientation to the roles of registrar and supervisor early negotiation of the project scope and direction the educational studies and opportunity to apply the theory in practice, shared by registrars and supervisors registrar – supervisor collaborative working relationship with sufficient time to meet, discuss and problem-solve.

Projects 2009 R1 - RCH Paediatrics Interns, JMOs, undergraduates POLIE – Paediatric Online Interactive Education – a modularised learning package focused on key paediatric presenting complaints R2 - PAH Emergency Medicine Junior House officer education Case based learning, procedural skills training R3 – RBWH Gastroenterology/ Skills Development Centre Gastroenterology trainees, Networked cased based learning for gastro trainees state-wide Competency assessment in endoscopy R4 - RBWH Neonatology Paediatric trainees and junior medical officers Multi-media resources for neonatology procedures R5 - Townsville Department of Emergency Medicine (district funded) Undergraduates, junior doctors Facilitating bedside and tutorial teaching in ED R6 - RBWH Department of Emergency Medicine (district funded) Vocational trainees Procedural skills program and curriculum

Projects 2010 R1 - Redcliffe-Caboolture – Mental Health Mentoring for junior doctor welfare - Interns, JMOs R2 - TPCH Emergency Medicine ALS simulation training site including Interns, JMOs, and nurses R3 - RBWH Emergency Medicine JMO education Workplace based assessment for Interns R4 – RBWH Gastroenterology/ Skills Development Centre Gastroenterology trainees, Networked cased based learning for gastro trainees state-wide R5 - Townsville Department of Emergency Medicine (district funded position) Undergraduates, junior doctors Facilitating bedside and tutorial teaching in ED Research support ‘club’ for junior researcher projects

Projects 2011 R1 – Royal Children’s Hospital – Emergency Department Development of 12 e-learning modules in paediatric trauma skills in collaboration with Clinical Skills Development Service Development of 3 e-learning modules for core paediatric skills in collaboration with Toowoomba Medical Education Unit R2 – Inner North Brisbane Mental Health Service, Northern Team Introducing an Intern education program for mental health; changing an entrenched culture R3 – Mater Hospital – Adults – Endocrine and Obstetric Medicine Development of content for on-line modules in diabetes care: insulin pumps - introduction & management in hospitalised patients; diabetic ketoacidosis management protocol; preconception counselling in diabetes R4 – Toowoomba Hospital – Emergency Department Team based learning – scenarios for doctors and nurses in the emergency department setting.

take home messages The Queensland Health Medical Education Registrar scholarship is structured as a professional development activity within the registrar’s vocational training program Medical Education Registrars are part of the solution to expanding supervisory capacity in healthcare, and an important step toward developing a community of medical education leaders

contact Queensland Health – Hospital Service and Clinical Innovation Division Queensland Medical Education & Training