Trainee Led Initiatives

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<ul><li>1.Trainee led initiativesin Pre-Vocational Training</li></ul> <p>2. IamtheProgramManagerwithCETIsGeneralMedicalTrainingUnit.ItsoneofthegreatbitsofmyjobtosupporttheNSWJMOForum. 1 3. TheForumisatraineerepresentativeadvisorysubcommitteeoftheNSWPrevocationalTrainingCouncil.Itiscomposedofelectedtraineerepresentativesfromthe15trainingnetworksthatmakeuptheprevocationaltrainingprograminNSWandtheACT.EachyeareachnetworkelectsanewPGY1representative,whowillserveontheForumfortwoyears.WealsoelectruralrepsfromthemajorruraltrainingsitesinNSW,makingabout34or35reps.AbouthalfoftheForumisneweachyear,andhalfarecarryingonfromthepreviousyear,andthissystemprovidesbotharegularflowofnewideasandadegreeofcontinuity. 2 4. Thebasicmessageofourpresentationtodayissimple:JMOsareadultlearnersandenthusiasticemployeeswhohavetheinterest,involvement,ideasandinnocencerequiredtoattemptinnovationsinmedicaleducationandtraining.Itmakesgoodsensepedagogicallyandadministrativelytogivethemaleadingroleinshapingthesysteminwhichtheywilllearnandwork.Iamsurethatmostofyouarealreadyactingonthisknowledgeinsomeways,buttherearealsoplentyofforcesinthesystemthatoperateagainsttraineeledinitiatives.TwoJMOForumrepresentativesaregoingtogiveyoubriefexamplesofwaysinwhichtraineeledprojectscanofferthesystemnewandbetterwaysofdoingthings,achievingresultsthatwouldbedifficulttoreachbyothermeans.3 5. 4 6. TheJMOforumasawholeidentifiedthelackofaconsistentstatewideeducationprocess.Asseenbythegraphicformalteachingvariedwidelynotonlyacroosthe15prevocationalnetworksinNSWbutfromhospitaltohospital.andoverthelasttwoyearstherehasbeenasustainedandconcertedeffortbythetraineestoaddressafewkeyareas.thisfromagroundupdrivenprocesswhichthankstothewholeheartedandinmanycasesoverwhelmingsupportfromDPETsandJMOmanagersAddit:Ofthe27hospitalsrepresentedhereAverageteachinghoursperweek=1.5 24hospitalshave1hourperweek 17hospitalshave&gt;1hourperweek 49%(22/45)arepagerprotected5 7. RatherthanrefertoanexpertpanelwithamultitudeofcommitteeswhichisprobablythemorepoliticallycorrectandacademicallyrigorouswayofdoingittheJMOsintheEducationworkinggroupwentawayandcameupwithwhatweasJuniorDoctorsfeltwasofmostvalueineachtopic6 8. 7 9. Insomewayswewerelikecharginghorseswithblinkers quiteoblivioustotheruffledfeathersorthepotentialfallout8 10. 11outof15hadimplementedAccordingtotheJMOrespondents,ofthe11hospitalsinthispollthathadimplementedtheseries10haddonesoeffectivelyandwaswellreceived.Obviouslythisisasmallsampleanditsearlydaysgiventheproposalwassentoutattheendoflastyear.Wearehopingtorepeatthe2010surveywithamuchlargernumberofhospitalssurveyedlaternextyear.Thisisnottosaythisisaperfectsystem oneofthecommoncriticismsisthatthereistoomuchexpectedfromeachteachingsessionthancanbeadequatelydeliveredWhatitis,isaprimeexample 9 11. In2011ourfocuschangedtoaddresstheoftneglectedpartoftheACFJD 10 12. 11 13. 12 14. SowhybotherwithtraineeledinitiavesWelltheresthechancetoplaygod createtomorrowsachieversinyourownimage13 15. 14 16. 15 17. ThanksVikas.IdliketotellyouabouttwomoreprojectsthatthemembersoftheJMOForumhasbeeninvolvedwith.ThefirstoccurredatalocalhealthnetworklevelwheretheJMOForumwasaskedtogetinvolvedwiththeNSWHealthServicesImprovementBranchAcuteCareTaskforcewhowereparticularlylookingatJMOHandover.DrHamishDunnhasalreadydiscussedthecontentofthefindingsinanotherpresentationatthisevent.16 18. InthefollowingyeartheJMOForumundertookastatewideauditofhandover,thedetailsofwhichyoucanseeontheslideandtheresultsofwhichhavebeenusedbyNSWHealthtofocushandoverimprovementacrossthestate.ThepointbeingthattherewasnopossiblewaythisauditcouldhavebeenconductedwithoutJMObuyinandownership.ThiswasacknowledgedbyNSWHealth. 17 19. ThesecondprojectwasdevisedandexecutedbytheCareersworkingpartyoftheJMOForumwhohavecompiledaDoctorsGPSguidebooktonavigatingspecialtytraining.Intheirowntimetheworkingpartymemberscontactedallrelevantspecialtycollegesandhaveputtogetheraonestopshopinformationresourceforinternsandresidentsforallmajorspecialtypathways.ThispublicationisinfinaldraftandwillbepublishedandreviewedbiannuallyasanofficialNSWHealthCETIpublication.18 20. 19 21. TherearenumerousotherJMOledprojectsouttherewhichIdonthavetimetotellyouaboutandwhichImsuremanyofyouareinvolvedin.ThekeypointIwouldliketoreiterateisthattheseprojectsaretheresultofvolunteertimeandenergyandpeoplewhobelieveinwhattheyaretryingtodo.Theyonlyearnabudgetasaresultoftheirqualityandutility.TheyareownedbytheJMOswhoseekinput,feedbackandsupportasneededfrompeoplewhobelievethattheyhavesomethingvaluabletooffer. 20 22. Colloboration,mentoringandempoweringJMOscanonlyresultingood.Evenprojectswhichfailwillensuresomekindoflearningoutcomeforthoseinvolved.Itisimperativethattheideaofinitiative,ownershipandleadershipisnotlostintheJMOexperience.JMOshavespentyearsbeingtrainedtoidentifyproblemsandworktowardssolutions.Itstheirdaytodayjob.Andtheyshouldbedoingitoutsideoftheclinicalarenainordertobecomecompetentprofessionals.21 23. Toooftenweseetheexpectationofsuddengravitasandknowledgefromaclinicalperspectiveinthetransitionfromsubservientresidenttoinchargeregistrar.Thesameappliestoeducationandtraining.Unlessjuniordoctorsareencouragedtoinnovate,toquestion,tolookforbetterwaysofdoingthingsatlocalandsystemlevelsthefuturelooksbleak.Weneedtocreateleadersandchangedriversforthefuturenow otherwisetherewillbenoonetositintheseatsyounowoccupy20or30yearsfromnow.Sometimesconsultationisadirtyword.ItjustmeanstherewasaJMOintheroom.Ifyouhaveaccesstothem,findoutwhattheyactuallyarethinkingandinvolvethem.Theymaysurpriseyou.Iftheycomplainorraiseissues makethempartoftheteamtofixit,evenbettermakethemleadtheteamwithyourbacking.EgRosteringworkinggroups 22 24. JMOsareawidelyuntappedresourceforqualitychangeandinnovation.Weareconstantlybeingchidedforourlackofinterprofessionalismandencouragedtoworkbetterandmorecloselywithotherstaff.Shouldntthesameholdtrueatahealthsystemlevel?JMOsworkingwithUnitManagersandDirectorsofEducation,collegerepresentatives,medicaleducationofficers,medicalsuperintendents.Thegoalsarecommon,sothetracksshouldstoprunninginparallelandstarttoconverge. 23 25. 24 26. ThanksLucy.Inpursuingtheirprojects,theJMOForummembersarelearningleadershipskills,communicationskills,professionalpracticeskills.NSWHealthrunsanumberofleadershipprogramsforclinicians,butIthinktheJMOForumisoneofthebestleadershipprogramsyetdevised.Theyarelearninghowthehealthsystemworksandhowitcanbetopositivelyinfluenced.Astheylearn,theyarehelpingtobuildthefuturestrengthofeducationandtraininginhealth.Thisworksbecausethesystemhas 25 27. 1Madespacefortraineestotalk2Givenpermissionfortraineestoact3Adoptedanexpectationthattraineerepresentativeswillbetraineeactivists.Arethererisksassociatedwiththisprocess?26 28. Riskofrevolution?Willtraineesforgetwhoisincharge?Notlikely.Endorsementandsupportbyseniorclinicianstendstobeoneofthefirstthingstraineesseekfortheirprojects,asitisessentialiftheyaregoingtogetpastsquareone.Ratherthanrevolution,Iwonderabouttheoppositerisk thatifwedontencouragetraineestoinnovate,initiateandlead,wemaydevelopamedicalworkforcethatistoopassiveinthefaceofacceleratingchange,andnotsufficientlyadaptedtotheideathattheyhavetomakethingsbetterforthemselvesandtheirpatientsthroughtheirowninitiatives. 27 29. Riskofpatientharm?Wehaventseenthis mosteducationandtrainingprojectsareoneortwostepsremovedfrompatientcare,leavingplentyofroomforreviewbyseniorcliniciansbeforetherecouldbeanyunintendednegativeconsequences. 28 30. Thebiggestrisk thatIhaveseenwithtraineeledinitiativesisthattherewillbeinadvertentmiscommunication,becausetraineesarenotfullyawareofthelabyrinthinedepthsofthesysteminwhichtheywork,andtheyarenotpractiseddiplomats.Wording,timing,toneandaddressallmatter. ThereisariskthatJMOswillputpeopleoffsidebecausetheyhavenotusedtherightchannelortherightlanguage,orkissedtherighthand.Thereissometimesaroleforpeople(likeme,andtheChairofthePrevocationalTrainingCouncil,anddirectorsoftraining)inprovidinganinterpreterservicethathelpstranslatebetweenthesystemandtheJMOs,sothattheirbigideasarenotmisconstruedorlost.29 31. So,ifthereistime,herearemythreefinaltips:Subtledifferencesinorganisationandexpectationscanleadtoprofoundlydifferentoutcomes. Forexample,twoyearsagothethenchairoftheJMOForumreorganisedtheforumintoworkinggroups,eachonewithaspecificfocusandaprojecttocompletewithintheyear.Thiscreatedanexpectationoneveryforummemberthattheywouldgetsomethingdoneatthemeetings,notjustmeetandtalk.Whathasresultedhasbeenafloweringoftraineecreativity.Committeeswithtraineerepresentationneedtoexpecttraineeactivism: dontjustticktheboxbyhavingsometraineesshowuptothecommittee;raisetheexpectationthattraineeswillbeactivemembers.Givethemjobstodo,dontjustaskthemtobethere.Thismakesbeingonthecommitteesomuchmoreworthwhilethatitmakesitmucheasiertogettraineeinvolvement.Buildlinksbetweentraineesandhigherlevelsofthesystem: InNSW,CETIadvertisestheexistenceoftheJMOForumtootherNSWHealthorganisationsasaresourcethatcanhelpsolveproblemstheyareworkingon.Itcanreallyworkwelltolinkthetraineerepresentatives 30 32. tothehigherlevelchangeagenciesinthesystem.Thisunionofshopfloorandboardroomcanmakeproposedchangesmorerealisticandincreasestakeholderengagement. 30 33. 31 </p>