Reflections on prevocational medical training in New Zealand - 21st National Prevocational Medical Education Forum Hobart 2016
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Reflections on prevocational medical training in New Zealand
21st National Prevocational Medical Education Forum
Hobart 2016
Joan Crawford
Strategic Programme Manager
Medical Council of New Zealand
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Prevocational medical education in NZ
• Substantial changes introduced November 2014, further changes
in late 2015
• Prevocational training in NZ has changed very little for decades
• We have been producing high quality doctors
So why change?
Why change?
• To improve the quality of training for doctors addressing:
– Tensions between service delivery and training
– A need for a greater emphasis on broad based core competencies
– To ensure better vertical integration across continuum of training
– A need to have a greater focus on care in community based settings
– To ensure the continuum of quality training in PGY2
– Need for greater accountability by training providers
• To improve the quality of care patients receive
• One of the mechanisms to ensure that doctors are competent
and fit to practise, thereby protecting the public
Prevocational medical training programme -changes • New Zealand Curriculum Framework for Prevocational Medical Training (NZCF) • Framework for assessment • ePort • Training for supervisors • Accreditation standards & processes for training providers & clinical attachments • Extension into PGY2 • Community based experience • Evaluation programme
Prevocational medical training in NZ • 912 interns • 1655 clinical supervisors • 115 educational supervisors • 93 administrators • 41 chief medical officers & clinical directors of training
for interns A record of learning for each intern to: • Capture supervisor feedback at beg, mid and end of clinical attachments • Track progress with attainment of NZCF learning outcomes • Record & track achievement of goals in a PDP • Upload documents, certificates and evidence of learning • Record learning as part of the formal teaching programme • Share information • Apply for general registration
2016 review • Degree of implementation • Are the changes operating effectively? • Are the changes accepted by users (Interns, senior doctors and providers)? • Highlight issues • Recommend to Council potential improvements and solutions
Review group Chair: Dr Ken Clark, Chair National DHB CMO Group • Chief Medical Officers • Directors of clinical training • Prevocational Educational Supervisors • RMO unit managers • Interns • University (Medical School) • DHB GM Human Resources • Council representatives and key staff
Information sourced from • Data from ePort • Information from accreditation processes &outcomes • National DHB groups • Canvassing of members own colleagues and workgroups • Members knowledge, experience and opinions
Meetings with clinical supervisors (2015)
Start Meet Mid Meet
Quarter Intern Ct Start Meet Ct Mid Meet Ct End Meet Ct End Meet Avg
Avg Avg
1 402 344 51 338 73 402 97
2 418 405 29 398 58 417 91
3 444 429 34 415 63 443 92
4 448 442 23 440 48 444 92
Beginning meeting Mid meeting End meeting
(Should occur between (Should occur around 45 days (Should occur around 91 days
1 -21 days) into attachment) into attachment)Real time reporting
Draft findings from the review • ePort has facilitated a greater level of transparency • Access to much more data (quantitative and qualitative) – better informed • ePort is an effective tool and fit for purpose – supports interns & supervisors • Highlighted importance of prevocational medical education to training providers • Appears to be facilitating a change in culture and attitudes to prevocational medical education & training
Draft findings cont’d… • A substantial programme of supervisor training has occurred (almost 700 clinical supervisors & 100 educational supervisors to date) • Formal supervision is supported by the system • Quality of assessments has improved • Recording of meetings between interns and supervisors has improved • End of clinical attachment meetings are more timely • Advisory Panels are functional and are making end of year assessment much more robust
Draft recommendations
• Consolidation of recording of learning outcomes
• Need for greater visibility & clarity in intern recording of NZCF
learning outcomes through:
– demonstrated competence
– participation in learning outcomes
– knowledge through formal teaching or self directed learning
– prior learning in final year medical schoolDraft recommendations cont’d… • Need for separate area for career goals on ePort • National intern feedback tool required (on their learning experience in each clinical attachment) • Continued emphasis and facilitation of supervisor training is required • The concept of a ‘marginal pass’ clinical attachments should change to a ‘conditional pass’ • Focus should continue on all aspects of PGY2 training and assessment, which are ‘work in progress’ • Final year medical students should be encouraged to fully utilise ePort
Next steps for review Report considered by: • MCNZ Education Committee November • Council December 2016 Action recommendations that are accepted by Council in 2017
Changes to come… • ‘App’ for ePort • Multisource feedback • More training of supervisors • Full implementation community based attachments by 2020 • Review of NZCF • Evaluation (2018) – is it all making a difference?
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