Quality junior doctor training, improved workforce outcomes and patient safety.

Abstract The intern year is a critical part of medical education and pivotal in provision of health services, especially in tertiary facilities. Training must be integrated with health service needs, as our health service is not well served if junior doctor training creates confidence without competence. Aust Health Rev 2007: 31 Suppl 1: S106-S108 SINCE THE MAJOR CHANGES in medical education nearly 100 years ago, there have been only islands of innovation, with a lack of any agreed strategic development and a poor evidence base to inform the way forward. The over-riding requirement of Australian Medical Council Accreditation is that medical schools produce medical practitioners who are safe and competent to practise as interns under supervision and who have an adequate basis to undertake further vocational training. The objective of the internship is to prepare for vocational training by consolidating the clinical skills acquired and assisting career decisions. How can this best be achieved? What are the current issues that need to be addressed? Are there new models that should be considered? How best to integrate with medical schools, vocational colleges and the health service? Current data In Ireland, 91% of interns report they did not feel prepared.1 They felt reasonably competent at history taking and physical examination, but not in clinical management, emergency medical care, using drugs and communicating with patients (in particular the bereaved). They considered that they were not adequately informed in managing stress, prioritising commitments, team participation or chairmanship and business management. In Australia, 91% perceived that they were prepared for dealing with patients and 70% with relatives; but only 23% with medico-legal issues; 31% with medical emergencies; 40% choosing a career and 45% with practical procedures.2 Graduates commencing internships felt that they were full of knowledge but couldn't use it, and that it took between a few weeks and 2 to 3 months to feel comfortable. The solution is not to revert to the 18th century apprenticeship system, the 19th century discipline-based or 20th century organ system-based models. The exponential increase in required knowledge and skills makes this inappropriate. New solutions for the 21st century health environment are needed. Issues for consideration Future approaches to training doctors must consider the following issues: * Staff development: Interns receive most help from the registrars who are not formally prepared for this role.3 Doctors must be taught to teach.4 * Supervision: Time for supervision should be recognised and resourced as an integral part of the job description for all medical officers. * Integration: Silos between medical disciplines should be broken down to ensure development of a clinical diagnostic model of training interns across disciplines. Training should be integrated into the operations of the health care system. * Orientation: There should be improved and integrated orientation during the last weeks of medical school and early weeks of internship. * Learning environment: The learning environment in hospitals needs to be improved with better role definition, bed management for training as well as service, formal daily or weekly discussion of clinical problems and issues that allows free expression of concerns and improved critical incident analysis. Trainees should develop individual learning plans to address their individual needs. * Clerical commitments: Clerical commitments need to be reduced to foster more teaching time. * Handover: Ensure overlaps of shifts to achieve better handover. * Ratios: Aim for staff-to-trainee ratios that can achieve the objectives. The ratios appear to be better in North America than in Australia, New Zealand or the United Kingdom.5 * Ensuring competence: Introduce strategic assessment of competencies, but not instrumentalised, and only as evidence for a global assessment of level of professional competence. …