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Training in Alternative Settings
29 September 2010.
The number of Victorian medical graduates has been forecast to increase from 347 in 2007 to 768 in 2014, an increase of 121 per cent. However, these doctors will not be ready to fully serve the community on graduation. They will require a minimum of five to eight years postgraduate training to become specialists. The significant public investment in medical practitioner undergraduate training is wasted if the support is not available for postgraduate training.
There is a significant opportunity in this growth of medical graduates to promote community-based training. Community-based healthcare providers have a patient base that would benefit from greater interaction with medical specialist care, and medical specialist trainees would benefit from teaching and training in an environment that is closely connected to the community and promotes team-based care.
AMA Victoria recommends:
- Encouraging primary care and specialist care providers to work together through promoting co-location, case conferencing and clinical support services,
- Promoting early life of disease intervention by specialists, and
- Trialling programs for specialists and advanced trainees to provide support through patient self-management programs.
Benefits for health services
There is an opportunity for medical specialists and trainees to build the capacity of community-based care organisations. Through leading team discussions, and being available as a resource to other health professions, patients and carers, specialist skills can be leveraged to improve the skills and knowledge of other staff and of patients and carers.
Training programs in community paediatrics, adolescent medicine, and some physician subspecialties have already placed advanced trainees in community health centres with consultant support. Research undertaken by AMA Victoria suggests these initiatives have proved popular.
Benefits for doctors
Junior doctors would be able to provide much-needed services in community health settings. These services should extend beyond basic clinical services to build the capacity of the community health sector. Community based healthcare providers have a patient base that would benefit from greater interaction with medical specialist care.
Medical specialist trainees would benefit from teaching and training in an environment that is closely connected to the community and promotes team-based care. Further, as the ratio of patients to trainee doctors continues to fall in hospitals, trainee specialists would receive greater and higher quality interaction with patients in a community setting.
Benefits for patients
Encouraging training in alternative settings will also help promote the emphasis we need on preventative and community based healthcare, which will have implications for the health of vulnerable Victorians. Groups that have difficultly accessing mainstream health services, such as the mentally ill, homeless people, Indigenous Australians, and newly arrived migrants could access specialist care that they would normally be ‘shut out’ from.
Chronic disease represents one of the largest challenges facing the health system today; it is estimated to cause about 80 per cent of the total burden of disease in Australia. 1 Improve community access to specialist care will helping tackle the prevalence of chronic disease in the community.
Greater specialist interaction in community healthcare will provide a practical demonstration of the benefits of a generalist approach to preventative direct patient care. Providing and facilitating training in alternative settings will begin to tackle the problem of a large influx of medical graduates into a system that does not have the capacity to train them.
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