4 minute read
President’s message
Training and assessment: Getting the balance right
In this Spring edition of the Bulletin I will focus on issues relating mainly to anaesthesia trainees but with some relevance for all fellows and specialist international medical graduates. I would like to address our training assessments, particularly the primary and final exams, the trainee selection process and bullying, discrimination and harassment (BDH). These topics have recently generated intense discussion both within and around the college.
TRAINING ASSESSMENTS
We are extremely lucky to have in our college many fellows with a high degree of educational knowledge and an excellent team in the Education and Research unit.
The recent COVID-19 pandemic has put our exams under pressure and scrutiny and while we were able to sucessfully continue, other colleges had spectacular failures and, in some instances, overseas, examinations were cancelled while trainees still progressed. Inevitably this has led to a discussion about the future of these high stakes pass/fail summative assessments in medical education.
When I was a trainee many years ago, we sat the primary and final exams, did a special project in our provisional fellowship year, and had few other assessments. The exams are still there but now we also have workplace-based assessments including direct observation of procedural skills, case-based discussions, mini clinical evaluation exercises and multi-source feedback.
What is the right balance of assessments during training? Even as a non-educationalist I can see the progress of medical education is probably moving away from summative single point exam-type assessments towards a more programmatic approach that is less stressful, more clinically orientated, provides greater opportunity for learning and feedback and may allow trainees to proceed at their own pace. I can also imagine a future where, as an assessment, trainees would walk into a virtual reality enabled OR and hear “Glad you’re here. The patient has just arrested”. These changes are still down the track and I believe our current assessment framework serves us well. In the meantime, we will continue to improve the fidelity of our already highly performing examinations and look at ways of minimising the stress associated with these.
TRAINEE SELECTION
The second item I would like to discuss is trainee selection and in particular the issue of independent trainees. The specialty of anaesthesia is popular with many more doctors applying than current training positions available. The college has a policy that forms the basis for trainee selection but each state and region have their own system. Many states have one selection process, while some states and New Zealand have multiple training programs, usually administered out of a major tertiary centre. These state and regional processes are very competitive and involve written applications, interviews and other forms of assessment.
Until 2004 ANZCA accredited individuals but since then we have moved to accrediting hospitals for training so employees at these institutions can apply to be an ANZCA trainee. The reason for this change relates to concerns around having ANZCA trainees and non-trainees in identical roles within a department without allowing specialty progression for the non-trainee. The advantage for those who are selected into a training program is that access to all the specialty study units is usually guaranteed whereas independent trainees must negotiate their own access to these terms creating difficulties for the bottleneck sub-specialties. There is also some concern about equity and access to teaching and exam preparation although analysis demonstrates independent trainees have only a marginally prolonged training time and only slightly worse exam outcomes. In response to comments from our recent Australian Medical Council review and, as part of our training program evolution, we have formed a trainee selection working group, chaired by Dr Kara Allen, that will review all aspects of the trainee selection process including monitoring, evaluation and oversight, inequity, consistency and the role of the independent trainee. This is a timely review that will give us some guidance into the future of this important area. BDH
Our CEO, Nigel Fidgeon, and I recently attended a “Culture in medicine” symposium organised by the Medical Board of Australia in response to the trainee survey of 2021 highlighting high levels of bullying, discrimination and harassment (BDH) in the workplace. Many specialty colleges, associations, trainee groups and health department organisations attended. We heard both expert opinions and harrowing first-hand accounts of the extent of BDH and the consequences and poor outcomes in those subjected to this behaviour.
BDH is not new and was probably worse when I trained but it remains a stubborn, festering wound for the medical community that needs to be addressed.
The problem is complicated by the relationship between ANZCA and the workplace where BDH mostly occurs. As a college we have limited ability to investigate and manage these problems but can do more to ensure that every department has a framework for addressing this issue. Ideally each department should have staff who are anti-BDH champions, a mechanism for allowing confidential, safe and non-judgemental reporting of incidents and a measured, fair and graded response to handle these. Ideally this should be managed within departments with HR approval and oversight in more severe and repeat episodes. The anti-BDH champions should be respected members of the senior staff, not necessarily the head of department or supervisor of training, who may have other roles in investigating and managing such incidents. This is a complex problem we cannot resolve overnight but it is time we started making progress. Take care as we hopefully emerge from this pandemic again!
Dr Chris Cokis FANZCA ANZCA President
