2020/21 annual summary

A report from the Chair

Issues this year

The Medical Board of Australia is proud to have run another successful Medical Training Survey and we are grateful for the support of doctors in training and other stakeholders. The results will help to improve medical training and the culture of medicine in Australia.

The Board continued its work on the Professional Performance Framework, dealt with a number of issues related to COVID-19, and progressed its policy agenda.

Policy updates

Medical Training Survey

We were delighted to more than double the response rate for the second Medical Training Survey (MTS) compared with the first survey in 2019. More than 21,000 (57%) doctors in training provided feedback about the quality of their training. They told us that there is a lot going well in training, with 87% who responded to the survey rating the quality of their clinical supervision and training very highly, and 81% saying that they would recommend their current training position to other doctors.

Revised questions about the culture of medicine painted a disappointing picture: 34% of doctors in training reported they had experienced and/or witnessed bullying, harassment or discrimination. We all need to do more to build a culture of respect in healthcare.

We asked about the effect of the COVID-19 pandemic. About 80% of respondents told us that the pandemic had had an impact on their training with 46% reporting the impact as a mix of positive and negative, while one-third reported it having had only a negative effect.

Results can be found at www.medicaltrainingsurvey.gov.au. We published more than 30 reports by jurisdiction, specialty and type of doctor. We also have an online dashboard for anyone to produce customised reports and have published case studies about how stakeholders are using MTS data to improve and strengthen medical training.

Professional Performance Framework

The Board’s Professional Performance Framework is a long-term project that, when implemented, will help ensure all registered medical practitioners in Australia practise competently and ethically throughout their careers.

The framework is integrated, builds on existing initiatives and is evidence-based. It has five pillars:

1. strengthened CPD requirements
2. active assurance of safe practice
3. strengthened assessment and management of practitioners with multiple substantiated complaints
4. guidance to support practitioners – regularly updated professional standards that support good medical practice
5. collaborations to foster a culture of medicine that is focused on patient safety, is based on respect and encourages doctors to take care of their own health and wellbeing.

CPD registration standard

The Board submitted a revised registration standard for continuing professional development (CPD) to Health Ministers for approval. The proposed CPD standard includes a requirement for medical practitioners to:

• complete at least 50 hours of CPD each year with a prescribed mix of activities including educational activities, reviewing performance and measuring outcomes
• have a CPD home
• do CPD that is relevant to their scope of practice
• base their CPD on a personal professional development plan. If approved, there will be a long implementation phase to enable the establishment and accreditation of CPD homes and to support medical practitioners to understand what they need to do to meet the standard.

Health checks for late career practitioners

The Board previously announced a plan to require practitioners aged 70 and over to have regular health checks. This was based on expert advice that increasing age is a known risk factor for poor performance. The Board expects that the vast majority of late career practitioners will continue to practise in their usual way. The Board worked on a registration standard about these health checks. It will consult widely with stakeholders about the proposal.

Complementary and unconventional medicine and emerging treatments

Over six months in 2019, the Board consulted on options for clearer regulation of medical practitioners who provide complementary and unconventional medicine and emerging treatments. It looked at options to best protect patients and minimise the risk of harm to them, without stifling innovation, making a judgement about specific clinical practices or limiting patients’ right to choose their healthcare.

The Board received more than 13,000 submissions, the majority of which it published during 2020. The Board considered all the submissions and decided that it will not issue guidelines but rather, continue to rely on the existing standards framework set out in Good medical practice.

Through the consultation feedback it became clear that the proposed solution did not match the problem the Board was trying to solve. The persisting issue of patients being offered high-risk treatments that do not have an evidence base of safety and efficacy is not limited to complementary and unconventional medicine and emerging treatments. Also, the problem of vulnerable patients not being provided with the information they need to give genuinely informed consent is not limited to a specific area of practice.

The Board will continue to refine its risk-based regulatory approach, so that regulatory safeguards match the risks to patients across all areas of practice. This work will not be limited to specific areas of practice and will be developed over time.

Standards, codes and guidelines

A code of conduct for doctors in Australia

The Board issued an updated version of Good medical practice: a code of conduct for doctors in Australia that took effect on 1 October. It describes what is expected of all doctors registered to practise medicine in Australia. It sets out the principles that characterise good medical practice and makes explicit the standards of ethical and professional conduct expected of doctors by their professional peers and the community.

The changes do not significantly change expected professional standards. Updates include:

• strengthened guidance about discrimination, bullying, sexual harassment and vexatious complaints
• an expanded section on cultural safety, including a new definition agreed across the National Scheme
• more information on patient safety and clinical governance
• a new section on career transitions for doctors.

Guidelines for advertising regulated health services

Jointly with the other 14 National Boards, the Medical Board developed Guidelines for advertising regulated health services that were issued on 14 December. The guidelines were developed to help practitioners and other advertisers understand their obligations when advertising a regulated health service.

National Boards and Ahpra also published other useful information about advertising for registered health practitioners and consumers in the Advertising hub on the Ahpra website.

Standards: Specialist international medical graduates

Revised standards to guide how specialist medical colleges assess international medical graduates (IMGs) took effect on 1 January.

The updated Standards for specialist medical college assessment of specialist international medical graduates aim to improve transparency and procedural fairness and make the requirements of the assessment clearer. They do not significantly change the previous approach to the assessment of specialist IMGs.

Consultation: Endorsement of registration for acupuncture for registered medical practitioners

Medical practitioners who want to use the protected title ‘acupuncturist’ must have their registration endorsed for acupuncture by the Medical Board of Australia, or also be registered with the Chinese Medicine Board of Australia. The Medical Board’s registration standard for Endorsement of registration for acupuncture for registered medical practitioners defines the requirements for granting endorsement of registration for acupuncture to medical practitioners.

The Board consulted on a revised registration standard as the existing standard was due for review.

Regulatory responses to COVID-19

The Board acknowledges the important role and enormous contribution of doctors as they deal with the COVID-19 pandemic.

Most of the Board’s regulatory responses to COVID-19 were made early in the pandemic and aimed to alleviate some of the bureaucratic burden on practitioners. The Board has:

• extended the pandemic response sub-register for a further 12 months at the request of the Australian Governments, to support the national COVID-19 vaccination effort
• with Ahpra and the other National Boards, published a position statement about COVID-19 vaccination
• introduced flexibility for 2021 interns whose internship has been disrupted directly as a result of COVID-19
• confirmed that international medical graduates who were scheduled but unable to sit an examination or assessment from March 2020 will not have their registration refused solely because they have been unable to sit examinations and assessments in 2020.

Stakeholder engagement

Newsletters for medical practitioners

The Board published 10 regular editions of the Medical Board Update and one newsletter dedicated to the Medical Training Survey and its results.

Newsletter for medical students

The Board published its first edition of a medical student update in April. This is part of a broader engagement strategy with students. The newsletter included information about student registration, the Medical Training Survey and the importance of looking after yourself.

Media

The Board responds to many media requests for comment on a range of issues. We also receive requests for comment about individual practitioners, but the information we can provide is limited by law.

Meetings with stakeholders

The Board has an active program of stakeholder engagement that includes regular meetings with the:

• Australian Medical Association (AMA)
• Australian Medical Council (AMC)
• Medical Council of New South Wales
• Medical Council of New Zealand
• specialist colleges through the Council of Presidents of Medical Colleges.

The Board held a forum with stakeholders about the results of the MTS and also met with all the professional indemnity insurers. We held our regular annual meeting with representatives of the AMA to discuss initiatives introduced to improve the notifications process.

Internal engagement

The Board has a program of internal stakeholder engagement to promote consistency of decisionmaking and respond to feedback from our decisionmakers. This includes regular meetings with the Chairs of state and territory boards and the Chair of the National Board visiting each state and territory board.

Accreditation

The Board considered each of the AMC’s accreditation reports and decided whether to approve the relevant accredited program of study for registration.

Managing complaints

The Medical Board and Ahpra appreciate the enormous stress that many medical practitioners experience when a notification (complaint) is made about them.

The Board has been working with Ahpra to improve the notifications process and, where possible, to deal with low-risk matters quickly to allow us to focus on highrisk matters and to reduce the duration of stress for practitioners.

We employ medically qualified clinical advisors who review all complaints early and apply a clinical lens to each complaint. We also schedule six meetings each week of the Notifications Assessment Committee, which includes medical practitioners and community members, and can deal with notifications quickly.

The Board worked with Ahpra on a revised approach to notifications. While the most serious of cases continue to be investigated in the traditional way, the new approach for lower risk matters (which are the majority of cases we receive) involves speaking directly to the practitioner so we can gather early information about the practitioner’s individual practice, reflection and their actions in response to notified events.

We assess the notification before deciding whether there is ongoing risk that requires regulatory intervention. We also commissioned Professor Ron Paterson, who authored the 2017 Independent review of the use of chaperones to protect patients in Australia, to assess what had been achieved and identify what more could be done to improve the handling of sexual misconduct allegations. Professor Paterson reported that the processes had greatly improved over the past years.

Dr Anne Tonkin