The 2019 Medical Training Survey results tell the start of an important and emerging national story about the culture and quality of medical training, from trainees’ perspectives. I would like to thank all those doctors in training who participated in the survey. Your feedback is invaluable, and we hope that the results will trigger ideas for positive change. The Board’s job in this project has been to design, develop and implement the survey. Now it's over to the training providers and employers to make a difference, and over to the whole profession to work together on improving the culture of medicine.
Dr Anne Tonkin
Chair, Medical Board of Australia
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Nearly 10,000 doctors in training took part in the first Medical Training Survey (MTS), creating the first national, comprehensive picture of medical training in Australia.
The MTS results provide an evidence base that educators, employers and stakeholders across the health sector can use to improve the culture of medicine and further strengthen medical training. They tell the start of an important and emerging national story about the culture and quality of medical training, from trainees’ perspectives.
Trainee responses are presented in a series of static reports and the data are also accessible through an online reporting tool, accessible from the MTS website.
The Medical Board has prioritised confidentiality and results are only published when there were 10 or more responses. We expect reporting detail to increase year on year, as the MTS is established and trainees gain confidence in its confidentiality and value. The results are reported directly without commentary.
In general, trainees rate their training very highly and there is a lot going well in medical training in Australia. Most trainees rated their clinical supervision and teaching highly. About 75 per cent of trainees work more than 40 hours per week, but many value the training opportunities this provides. Most trainees would recommend their current training post and nearly all intend to continue with their training program. There are opportunities to improve trainee access to health and well-being support programs, and bullying and harassment remain prevalent.
More than one in three trainees report having experienced and/or witnessed bullying, harassment or discrimination. Only one third of those who reported experiencing it, reported it.
There is work to do to better support Aboriginal and Torres Strait Islander specialist trainees and improve their experience of medical training. Survey findings show Aboriginal and/or Torres Strait Islander trainees are nearly twice as likely to have experienced and witnessed bullying, harassment and discrimination in the last 12 months. Data about the experience of Aboriginal and Torres Strait Islander trainees is published in a specific report.
Bullying, harassment and discrimination are not good for patient safety, constructive learning or the culture of medicine. We must all redouble our efforts to strengthen professional behaviour and deal effectively with unacceptable behaviour. We must do this if we are serious about reshaping the culture of medicine and building a culture of respect.
More than one in four trainees took part in the MTS. As far as we know, this is the highest response rate of any published Australian medical online, anonymous survey. MTS results are meaningful, representative and provide fascinating insights.
The Board is reviewing the MTS results in the context of the Professional Performance Framework, which is designed to ensure that all registered medical practitioners practise competently and ethically throughout their working lives. Pillar five of the framework commits the Board to collaborations, like the MTS, that foster a positive culture in medicine and help build a culture of respect.
Reports of the MTS results and the online data dashboard which enables tailored reporting, are published on the MTS website.
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The revised mandatory notifications guidelines are now available and will come into effect early March 2020.
The guidelines were revised by National Boards and Ahpra as part of a scheduled review and following amendments to the National Law.1
The guidelines are relevant to all registered health practitioners and registered students in Australia. They aim to explain the mandatory notifications requirements in the National Law clearly so that practitioners, employers and education providers understand who must make a mandatory notification about a practitioner or student and when they must be made. They also aim to make it clearer when a notification does not need to be made.
Changes to the guidelines include:
Read the revised guidelines for practitioners and for students and the additional resources developed to help explain mandatory notifications.
The Board has approved the following:
Specialist college program of study
Medical school program of study
The Australian Health Practitioner Regulation Agency (Ahpra) has launched a series of podcasts and videos highlighting our commitment to public safety and continuing our conversation about the work of health practitioner regulation in Australia.
‘Taking care’ – our new podcast channel - features a broad range of conversations and interviews with experts from the community, health professions and regulation. A diverse list of guests address myths and common questions about public safety in health care.
The Board and Ahpra are hoping the podcasts and videos help open important discussions about health and the essential role of regulation in protecting the public and supporting the safe delivery of healthcare in Australia.
The conversations are good reminders about what’s important in healthcare. People want to feel like they are being seen and heard when they consult with a health practitioner, and that they’re in safe hands. Practitioners are telling us how it feels from their perspective; including difficulties associated with self-care and what makes it harder for them to do their job.
Ahpra and the Board are listening to what the community and registered practitioners have to say about their interactions with us as regulators and are committed to improving their experience. Public safety is always the lens we look through.
Find out more about safe healthcare in Australia by downloading our podcasts including:
Subscribe to Ahpra’s ‘Taking care’ podcast channel to access interesting conversations about the latest issues affecting safe health care in Australia. New episodes released fortnightly. Available on Spotify, Apple Podcasts, and the ‘Taking care’ show page on Whooshka.
Two new policy directions from the COAG Health Council reinforce public protection as the core focus of Ahpra and National Boards.
The two directions, published in early 2020, prioritise public protection in our regulatory work and mandate consultation with patient safety and health care consumer bodies on any new and revised registration standards, codes and guidelines.
The COAG policy directions articulate what National Boards and Ahpra must take into account when determining whether to take regulatory action about a health practitioner, and when developing or revising registration standards, codes and guidelines. There is a specific new requirement that Boards consider the impacts of any proposed new or revised registration standard on vulnerable members of the community and Aboriginal and Torres Strait Islander people, and prepare and publish a ‘patient health and safety impact statement’ with each new or revised registration standard, code or guideline.
The policy directions are available on the Ahpra website.
Ahpra made this media statement this month:
Fake doctor convicted of Ahpra charges – A Victorian man has been convicted of falsely claiming to be a medical practitioner when he has never been registered with the Medical Board of Australia and does not have qualifications as a medical practitioner.
The Board is sharing the following information about SafeScript on behalf of the Victorian Department of Health and Human Services. This information is relevant to medical practitioners practising in Victoria.
SafeScript, Victoria’s real-time prescription monitoring system, is an important clinical tool that helps medical practitioners make safer decisions when prescribing high-risk medicines. SafeScript facilitates early identification, treatment and support for patients who are developing signs of dependence. It will be mandatory for medical practitioners practising in Victoria to check SafeScript before prescribing a monitored medicine from April 2020.
SafeScript provides red, amber and green pop-up notifications to prompt medical practitioners about information in the system and possible clinical risks that have been identified which should be reviewed and managed appropriately. It is important that clinicians understand that a red notification does not automatically mean that you should stop prescribing.
Good professional practice involves ensuring that appropriate continuity of care is provided for patients. Refusing to prescribe medications to patients who have been taking high-risk medicines over a long period without any consideration for their ongoing care plan may be contrary to patient safety. For the patient, there are implications to discontinuing some medicines too quickly. For example, sudden withdrawal of benzodiazepines may result in rebound insomnia, anxiety, or seizures.
With over 20,000 health practitioners registered with SafeScript, now is the time for all medical practitioners practising in Victoria to start using SafeScript to enhance patient care.
Victorian clinicians are strongly encouraged to complete the comprehensive training on SafeScript implementation, which has a focus on enhancing clinical and counselling skills. The Victorian Department of Health and Human Services’ SafeScript page provides access to:
There are services available to support medical practitioners in the safer management of patients taking high-risk medicines. These include the SafeScript GP Clinical Advisory Service, a peer-to-peer service helping GPs to support patients with prescription medicine concerns and complex needs (1800 812 804). Secondary consultation services are also available through Reconnexion (1300 273 266), specialising in anxiety disorders, depression and benzodiazepine dependency.
There are important lessons for registered medical practitioners from tribunal decisions. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. This case was published recently:
Ahpra, on behalf of the 15 National Boards, publishes a record of panel, court and tribunal decisions about registered health practitioners.
When investigating a notification, the Board may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing. Under the National Law, panel hearings are not open to the public. Ahpra publishes a record of panel hearing decisions made since July 2010. Practitioners’ names are not published, consistent with the National Law.
Summaries of tribunal and court cases are published on the Court and tribunal decisions page of the Ahpra website. The Board and Ahpra sometimes choose not to publish summaries, for example about cases involving practitioners with impairment.
In New South Wales and Queensland, different arrangements are in place. More information is available on Ahpra’s website on the Make a complaint page.
Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.
Comment on the Board newsletter is welcome and should be sent to firstname.lastname@example.org.
For registration enquiries or contact detail changes, call the Ahpra customer service team on 1300 419 495 (from within Australia).