TRAINING AND RETAINING HEALTH PROFESSIONALS: METROPOLITAN, RURAL AND REMOTE PERSPECTIVES Dr Alex Markwell FACEM Royal 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 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

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:  Queensland Rural Medical Education (QRME)