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Surveys across medicine and the wider healthcare sector reveal fault lines in medical culture. Bullying, harassment, discrimination and racism are serious issues in medical education and training, and across healthcare. Strong evidence that poor culture is associated with poor patient outcomes places the culture of medicine firmly in scope for the Medical Board of Australia. Cultural change is complex. No single agency or individual – acting alone – has all the levers needed to achieve positive change. But what we can’t do individually, we can do collectively. Everyone involved can make a contribution and help change the status quo. Fostering a culture of medicine that we can all be proud of is a worthwhile shared goal.
Dr Anne Tonkin Chair, Medical Board of Australia
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The medical profession has a long and proud history of altruism, professionalism and personal sacrifice in the service of the community. The last couple of years has drawn heavily on these qualities.
The stresses on the health system, the health workforce and most particularly on doctors, have been enormous during the pandemic. These pressures remain and perhaps continue to escalate. Clinical demands keep increasing and the challenges facing our profession are well documented. Unfortunately, stress rarely brings out the best in any of us.
Across three years, results from the Medical Training Survey have shown that while medical training in Australia is generally in good shape, there are serious cultural problems in medicine, including bullying, harassment, racism and discrimination. Unacceptably, things are even worse for Aboriginal and Torres Strait Islander trainees.
Results of many other surveys across medicine and the wider healthcare sector reveal similar fault lines in medical culture and are not limited to the training environment: our profession has a longstanding culture of bullying, particularly within medical education and training.
Time alone has not solved the problem, as many of us hoped it might. Lack of trust within teams is a brake on effective clinical discussion and debate, and learning opportunities are lost.
There is now a strong evidence base that poor culture is associated with poor patient outcomes, which makes the culture of medicine firmly in scope for the Medical Board of Australia.
Last month, the Board brought leaders across Australia’s medical community together to build support and commitment to improving the culture of medicine. Our Culture of Medicine Symposium shared evidence of poor culture, but focused primarily on fostering a commitment to positive change. It aimed to build a common understanding of current problems and a shared commitment to enabling a different future.
Collaborations to foster a positive culture in medicine are at the heart of the Board’s Professional Performance Framework, which aims to support doctors to practise competently and ethically throughout their working lives.
Symposium participants identified improved awareness and understanding of cultural safety, meaningful action on racism and collaborations to help effect change as a focus for future effort. We shared ideas about what we might do together to reshape the complex system that creates the culture of medicine in this country.
Many of the biggest challenges rest where accountabilities and responsibilities intersect, and real cultural change will come from agencies navigating jointly, not problem-solving individually.
We need to be open to caring about and respecting each other, as we care for and respect patients. We need to be open to not knowing all the answers, but trusting that together we can build a culture we can be proud of.
Of course, cultural change is complicated. No single agency or individual – acting alone – has all the levers needed to achieve positive change. But what we can’t do individually, we can do collectively. Everyone involved can make a contribution and help improve the culture of medicine.
Symposium participants included representatives from the Australian Indigenous Doctors’ Association (AIDA), the Australian Medical Association Council of Doctors in Training, medical students, specialist medical colleges, postgraduate medical councils, regulators, jurisdictions, employers, advocates, insurers, academics and clinicians.
We are sure that everyone wants to foster a culture that is focused on patient safety. It is good for our patients, our teams, our colleagues and ourselves. The Board is committed to working in partnership with the profession to reshape the culture of medicine and build a culture of respect.
The symposium was held in National Reconciliation Week, with the theme: ‘Be Brave, Make Change’. Imagine what is possible if we all take note. With a fresh approach, and navigating shared and complex dilemmas together, we can map a fresh path forward.
Medical Training Survey (MTS) data from past years is driving positive change. Some recent examples:
The 2022 MTS opens in August, giving doctors in training a voice on their medical training.
Most MTS questions will be the same as in past years, because comparisons are important. Small updates are coming this year to get better data on racism, to support much needed change. We keep refining and streamlining the format and layout to make the MTS quicker and easier to do.
Read more on the case studies page of the MTS website.
The Board publishes data each quarter on the medical profession. Data are broken down by state and territory, registration type and for specialists, by specialty and field of specialty practice. The latest report is available on our website under Statistics on the News page.
It has been a difficult few years for medical students and doctors in training. The impacts of the pandemic, disruptions to training, and increased workloads on the health and wellbeing of our future workforce have been immense, with many of the repercussions yet to be seen.
Navigating the many support services available for medical students and junior doctors can be difficult, with many reporting although they know services exist, when they are feeling stressed and overwhelmed it is difficult to know where exactly to go, and what level of support each service provides.
The Australian Medical Students’ Association (AMSA) and the Australian Medical Association Council of Doctors in Training (AMACDT) have partnered to create a Traffic lights flyer which lists all the support services available for students and junior doctors, and provides recommendation as to which services to access depending on the level of stress, mental illness or acute need the individual is facing.
AMACDT and AMSA vision is for every doctor and medical student to have this flyer saved on their phone, should they or any of their colleagues ever need support. The flyer is available on the Australian Medical Association website.
Ahpra releases fortnightly episodes of the Taking care podcast, discussing current topics and the latest issues affecting safe healthcare in Australia. You can access these on the Ahpra website or listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking care’ in your podcast player. Latest episodes:
There are important lessons in tribunal decisions about registered medical practitioners. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. Recently published decisions include:
The following appeal decisions were published:
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 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 Concerned about a practitioner? page.
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