Cetiscape 7 Oct 2011

This year’s Forum was attended by more than 150 participants, including directors of training, JMO managers, participants, including directors of training, JMO managers, and representatives from general practice training providers, and representatives from general practice training providers, universities, specialist colleges, the Clinical Excellence Commission and the NSW Department of Health. Interstate Commission and the NSW Department of Health. Interstate representatives came from Queensland, South Australia and representatives came from Queensland, South Australia and the Australian Capital Territory.

Part of the objective this year was to give people more actual hands-on training, so Teaching on the Run training sessions were held for 50 people and an online learning workshop for 78.

The online learning workshop featured eight demonstration stations where participants were introduced to a range of technologies and e-learning options. Kate Jurd, our special guest from Toowoomba Hospital, impressed the audience with her highly polished demonstrations of interactive learning modules developed in Moodle using tools such as Articulate and Code Baby. “You have to escape from read-and-click online presentations if you are going to create resources that people really engage with and learn from,” Kate said.

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cetiscapenewsletter of the Clinical Education and Training Institute

Issue 7 October 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 1

Renovation, innovation, inspirationNSW Prevocational Medical Education Forum10-11 August 2011 Stamford Grand North Ryde

General practice is the new blackWhy you need it in your prevocational program

CETI is focused on ensuring that a wide range of high quality training experiences are available to prevocational medical trainees. The Prevocational General Practice Placements Program (PGPPP) is proving to be a significant success in this area, providing JMOs with wide and varied experiences in primary health care in a supportive learning environment.

PGPPP is relatively new to NSW. Almost 50 new general practices came on board last year, due in part to a new and streamlined accreditation process piloted by CETI.

CETI is receiving exceptionally positive feedback from trainees. The key message from both an online survey and telephone interviews was that the trainees found the placement challenging, but that they felt very well supported by the supervision provided in the practices. All the trainees surveyed in Term 1 reported that they would recommend the placement to colleagues. Two thirds said that their skills and confidence as a doctor were “significantly improved”.

A full report on Term 1 is available on our website. Further information: Program Coordinator Sharyn Brown: [email protected]; 02 9844 6525.

In this issueRenovation, innovation, inspiration 1

General practice is the new black 1

2011 CETI Awards 2

Simulation clinical lead appointed to CETI 4

Surgical wetlabs are fun! 4

eHealth: a future reality or a fantastic vision? 5

Surgical Sciences Course accredited by RACS 6

Serious gaming? 6

Interprofessional student unit 7

Bureau profiles demand in NSW hospitals 7

Rural research continues to grow 8

National Stroke Awareness Week in rural NSW 9

Rural and remote scholarship program 10

The Risky Business website 10

Preparation for the FRACP exam 11

The Clinical Ethics Resource website 11

Device wise 12

Harvard course for simulation instructors 13

Telling it like it is supervisor forum 15

Master of Education (Health Professional Education) 16

The beginning: Daniel Stewart 17

SimHealth 2011 18

CETI or HETI? 18

CETI Awards for 2010 were presented at the plenary session of the NSW Prevocational Medical Education Forum.

Dr Steve May won the 2010 NSW Geoff Marel Award and Dr Matt Stanowski won the NSW JMO of the Year Award.

The Awards were announced last year. “We had to wait until now to find a suitably august audience to give the award winners the applause they deserve” said Dr Ros Crampton, Chair of the Prevocational Training Council, at the awards ceremony. In 2011, CETI has added a new JMO Manager of the Year Award.

Look inside to see the 2011 CETI Award Winners! (page 2)

cetiscape Issue 7 October 2011 Promoting excellence in clinical education www.ceti.nsw.gov.au page 2

2011 CETI Awards

NSW Geoff Marel Award 2011 awarded to Associate Professor Michael Agrez

Associate Professor Michael Agrez is highly regarded for his work on behalf of junior medical officers and in particular his passion and commitment to high quality and relevant education programs, his concern for the needs and safety of individual junior doctors and his advocacy for the junior medical workforce.

Michael is a colorectal surgeon with a professional interest in cancer research. He is involved in prevocational training nationally as a member of ACF Project working groups, at a state level with the Prevocational Training Council and the Prevocational Accreditation Committee, at a district level as head of the education subcommittee of the HNE prevocational network, and as a Director of Prevocational Education and Training in John Hunter Hospital. He has a rare flair for systematic approaches to medical education research, and presents findings at the Australasian Prevocational Medical Education Forum every year.

Michael recently climbed Mount Kilimanjaro as a charitable fundraiser for the Care Foundation, raising money for cancer research.

CETI is grateful to Michael for the work he has done with us over many years. He was nominated for this award by a large cohort of the prevocational trainees in his network, which spoke volumes for his qualities as an educator and mentor.

New Award!

NSW JMO Manager of the Year 2011 awarded to Ms Judy Muller

CETI is delighted to announce that Judy Muller, JMO Manager at Hornsby Hospital, is the inaugural winner of this award. It is long overdue that there be an award for JMO Managers, who in NSW play a vital role in supporting the education and training of junior doctors. Judy was nominated

for the award by several of her current cohort of JMOs.

Judy has been passionate about the welfare of junior doctors for 20 years as a JMO Manager at Westmead and Hornsby Hospitals. She has been an active participant in improving the working conditions of JMOs, ensuring safe working hours, adequate orientation, protected teaching times and a variety of clinical experiences, all while ensuring adequate balance of service to the hospital.

Judy has a huge reputation with several generations of JMOs as being tough but fair — a rock in uncertain seas.

Judy is a leader among her peers. For many years, Judy coordinated statewide meetings of JMO Managers which contributed to their professional development and promoted their collaboration across the system. Judy has a legendary reputation as a straight shooter, and her forthright advice has been keenly sought and widely appreciated by clinicians and managers at all levels in CETI and NSW Health.

Dr Lucy Cho, Chair of the NSW JMO Forum, is an example of a JMO who goes way beyond what is required in the course of duty. Dr Cho works tirelessly in her local Resident Medical Officer (RMO) Association and as a representative at General Clinical Training Committtee

meetings, where she achieved local adoption of the Unified Lecture Series for JMOs developed by the JMO Forum education group. Lucy is also a member of the AMA NSW Doctors in Training Forum.

As a member of the JMO Forum handover working group, Lucy collaborated with Health Services Performance

Improvement Branch to promote an improved shift handover process for all junior doctors. She led the JMO Forum in conducting an audit of handover across NSW which formed the basis of the Departmental evaluation of the reforms.

Dr Cho has been an active member of the NSW Prevocational Training Council and has contributed to several other NSW health committees and working groups, such as the Acute Care Taskforce and the Intern Summit on expanded settings for training. Her presentation to the summit was a lucid highlight of the day, the product of her personal consultation with JMOs across the state.

NSW Junior Doctor of the Year Award 2011 awarded to Dr Lucy Cho


... Renovation, innovation, inspiration — NSW Prevocational Medical Education Forum (continued from page 1)

David Peterson, from the South Australian Institute of Medical Education and Training, spoke on narrative strategies for effective online learning. Tam Hennessy, from online learning provider PrimEd, outlined strategic choices of technologies and emphasised the importance of adopting and applying a standards-based approach to content development.

Trevor McKinnon, CETI’s Director of Learning Innovation and Future Technology, offered a vision of a health system re-enabled by adopting social media and Web 2 technologies. The risks this might pose to patient confidentiality and information control raised protests from some participants, but Trevor made the point that social media was in use “right here, right now” by clinicians, managers, patients and the community, and that healthcare managers need to consider how to engage with the technology to reap its benefits and reduce its risks.

Jay Jacinto, CETI Program Coordinator in vocational training, brought along a Nintendo Wii and encouraged people to have a go at playing surgeon. It wasn’t all fun and games -- Jay and his co-presenter, Conjoint Professor Jane Conway (University of Newcastle), raised issues of entertainment versus education, and asked participants to consider just what it would really take to engage the gaming generation in e-learning.

Toni Vial, Coordinator of CETI’s Hospital Skills Program, showed just how easy it is to record lectures and presentations using Camtasia, and Sharyn Brown (CETI Program Coordinator, PGPPP) demonstrated an interactive case study created in Moodle.

“Our aim is to show examples that might inspire you to build online learning that works” explained Craig Bingham, convenor of the workshop. “Too much of what is done in this space fails to engage learners. Online learning is more than connecting a learner to a computer. It is about connecting learners to learners and learners to teachers, surmounting barriers of space and time to create learning environments that are interesting and thought-provoking.”

In other workshops on assessment and core competencies for prevocational trainees, participants helped map out new directions for education in the prevocational program. CETI is investigating practical methods for improving the assessment of prevocational trainees, exploring the possibility of specific

workplace-based assessments and a more explicit criterion-based assessment form. The core competencies workshop reached a good consensus on some essential competencies for JMOs to be developed and assessed in specific training terms.

A meeting with JMO Managers led to proposals for a new JMO Manager guidebook. CETI representatives at the meeting were pleased to commit to supporting this project. The JMO managers also wanted to re-establish a regular forum where they can provide support and share expertise within the group.

At the plenary session, Professor Peter Procopis, a member of the Medical Board of Australia, outlined the new proposed national internship standard. Audience members were concerned about the new emergency medical care training requirement, which represented a dilution of the standard currently prevailing in NSW. Others expressed doubts about the new standard’s openness to internships completed in training sites outside Australia.

Dr Ros Crampton, Chair of the Prevocational Training Council, launched a consultation draft of new terms of reference for network committees of prevocational training. The new terms of reference are more explicit about the level of coordination and cooperation required in training networks. They propose that the committee needs to negotiate explicit agreements between network partners covering aspects of trainee management that have been contentious in some networks. The Prevocational Training Council is encouraging network committees to consider and comment on these new terms of reference, with the hope that they may be adopted for the 2012 clinical year.

This year’s conference included a large contingent of general practice educators from the GP regional providers. The Prevocational General Practice Placements Program (PGPPP) is relatively new in NSW (see page 1 story). The GP directors of training brought a valuable new perspective to the conference, with fresh insights into how to train and supervise junior doctors. Supervision is just one area where the GP experience may have lessons for hospital-based prevocational training.

Another workshop at the conference explored the role of vocational trainees in the supervision and training of prevocational trainees. Recommendations arising from this workshop included adapting CETI’s Superguide for the vocational trainee audience and developing specific supervisor training for this group of doctors. CETI has now established a working group to take this concept further.

The Forum achieved its twin goals of providing professional development to the clinicians and administrators who deliver prevocational training in NSW and setting the development agenda for the forthcoming year. CETI thanks all the participants and presenters who helped make the event a success.

Craig BinghamPrevocational Program Coordinator

Save the date

NSW Prevocational Medical Education Forum 2012

Thursday 9 August – Friday 10 August 2012

Jay Jacinto (standing) demonstrates the Nintendo course in surgery -- not really, but how do we create compelling online learning for the Web 2 generation?

For one possible answer, see page 4.


CETI is pleased to announce the appointment of Dr Marino Festa as the Clinical Chair for Simulated Learning Environments (SLE). Rino will chair the Simulation Advisory Committee and provide professional leadership for the strategic direction, statewide coordination and standards of simulated learning environments for NSW Health.

Rino is a well-respected member of the simulation community, both nationally and internationally. He is a paediatric intensive care specialist and clinical lead of the simulation program at the Children’s Hospital Westmead.

Rino currently chairs the Paediatric and Neonatal Special Interest Group of the Australian Society for Simulation in Healthcare (ASSH), is a NSW representative on the Health Workforce Australia Simulated Learning Environments Expert Reference Group and a member of the Clinical Excellence Commission Between the Flags Steering Committee and DETECT Junior Workshop Advisory Committee.

CETI welcomes Rino to the team and looks forward to his contribution to the simulation learning environments project.

Simulation clinical lead appointed to CETI

The trainees who come together on a Saturday morning for a surgical wetlab are so interested in surgery that it’s a real pleasure to help them gain some skills. As an education support officer (ESO), my role is to co-ordinate the different people who will come together to teach and learn. The collaboration of consultants, fellows, registrars, industry representatives and trainees is truly impressive and inspiring.

Good education programs bring together a number of elements for trainees. The opportunity to reflect on a problem, to collaborate with peers and instructors and to incorporate new skills are three essential elements to help cement knowledge for later use. Surgical wetlabs (in which trainees practise surgical skills on prepared animal specimens) are perfect for all these three elements to combine, providing a great learning experience for all surgical trainees.

When I see them working on their anastomoses, chest drains, sutures or knots, the look on their faces is priceless. They are absorbed in a way I rarely see elsewhere. I know they are learning and thankful for the surgical training program. I also think the wetlabs inspire them to visualise themselves performing these skills independently with real patients in the future.

Like the other surgical skills networks in NSW, we offer more places than we have surgical skills trainees. This allows trainees from other networks to attend. It also makes room for prevocational trainees, who can get a headstart on skills that will enable them to perform better in theatre when the time comes.

More information: Andrew Kemp, (02) 8382-2563, [email protected]

Surgical wetlabs are fun!

Andrew KempEducation Support Officer Eastern & Greater Southern Surgical Training Network


Professor Steven BoyagesChief Executive of the Clinical Education and Training Institute (CETI) of NSW

Recently I attended the Health Support Services Expo in Sydney. As with all these events, it was large and diverse. This year’s theme

was on ehealth and a series of speakers, including myself, debated its virtues and vices. The discussion was frank and robust as we deliberated the merits of a personally controlled electronic health record (PCEHR). We heard about curated electronic records, national identifiers, electronic blue books, and the need to make certain the community was on side.

The discussion wasn’t necessarily new; I chaired the State’s first EHR committee in the year 2000. What is different on this occasion is the momentum and scale of some of the pilot studies that are being proposed by the National Electronic Health Transition Authority (NEHTA). The flipside of all this is the risk of not realising expectations, clinicians and patients not participating and another waste of taxpayers’ dollars. I did get a sense that the audience was not entirely persuaded and was thinking: sounds good, but we will believe it when we see it.sounds good, but we will believe it when we see it.sounds good, but we will believe it when we see it

As I prepared for the panel, I was scrolling through the latest LinkedIn news. There was a report that the UK Public Accounts Committee was about to recommend to review whether the NHS program on IT should be continued.

The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, was quoted: “The Department of Health is not going to achieve its original aim of a fully integrated care records system across the NHS. Trying to create a one-size-fits-all system in the NHS was a massive risk and has proven to be unworkable. The Department has been unable to demonstrate what benefits have been delivered from the £2.7 billion spent on the project so far.”<www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/nhs-it-report-/>.

This report was not a good omen. I sat back and reflected that there was no other topic in health that generated so much heat and passion. Further, there is no other strategy in health that has promised so much and delivered so little. Why is this so?

Is it because of a false belief that in healthcare we are a technologically advanced industry which is at the cutting edge of science and therefore we are able to integrate these sophisticated IT tools just as easily as we introduce new clinical technology? Or is it because we over-sold the promise of health IT to our funders and are now reaping a poor harvest?

The reality is probably somewhere in between. Firstly, health is not a high tech industry. It uses a lot of high tech equipment and relies on high tech procedures; but, the health industry is about

people, it’s about high touch. When things go wrong it’s usually people, it’s about high touch. When things go wrong it’s usually people, it’s about high touch. When things go wrong it’s usually because of a failure of people and process, not machinery.because of a failure of people and process, not machinery.because of a failure of people and process, not machinery.

Secondly, investment in health information technology is Secondly, investment in health information technology is Secondly, investment in health information technology is just that, an investment, but too often we see it as a magical just that, an investment, but too often we see it as a magical just that, an investment, but too often we see it as a magical just that, an investment, but too often we see it as a magical solution. Because of the electronic wizardry of health IT solution. Because of the electronic wizardry of health IT solution. Because of the electronic wizardry of health IT solution. Because of the electronic wizardry of health IT something amazing is assumed will happen to health care something amazing is assumed will happen to health care something amazing is assumed will happen to health care something amazing is assumed will happen to health care delivery without doing the hard work.delivery without doing the hard work.

Unfortunately, this is not the case in health or in any other Unfortunately, this is not the case in health or in any other industry where information technology has been rapidly industry where information technology has been rapidly adopted. Information technology is an accelerator of best adopted. Information technology is an accelerator of best practice workflow and is not a substitute for redesigning practice workflow and is not a substitute for redesigning processes and systems of delivery.processes and systems of delivery.

Too often the introduction of a new IT system without requisite Too often the introduction of a new IT system without requisite Too often the introduction of a new IT system without requisite redesign can lead to a worsening of workflows. My thesis is redesign can lead to a worsening of workflows. My thesis is that we will never fully realise the investment in health IT until we understand how we do our work, Other industries term this workflow or logistics or business process mapping. Information technology systems should emulate and support clinical and corporate processes.

As I sat back on the panel, it reminded me of those early pioneers in any industry who advocated for a new way of doing things. Passion and persuasion will not be enough to get health IT systems across the line. We are only at the beginning of a long journey of discovery that will require an understanding of engineering and redesign principles and how these apply to healthcare delivery.

The greatest value from health IT will be realised when these systems reduce duplication, avoid clinical error, improve patient safety and improve health care worker experience. These benefits will not be derived without investing time and dollars in streamlining and, where appropriate, standardising clinical workflow.

eHealth: a future reality or a fantastic vision?

Social media surveyYou are invited to participate in a survey of the use of social media by Australian healthcare professionals. It will take no more than 10 minutes to complete.

This survey is being conducted by the NSW Clinical Excellence Commission to gather information about where and how often healthcare professionals access the internet, and if they use social media sites such as Facebook, Twitter and LinkedIn for professional purposes. The information collected will be used for publications.

The survey is open to any registered health professional practising in the Australian healthcare system.

Do the survey at: www.asr2.com/cec/anon/146.aspx


CETI Surgical Sciences Course accredited by RACSIn 2010 CETI worked with the University of Western Sydney to pilot a Surgical Sciences Course. The course was designed as an intensive method of teaching anatomy, physiology and pathology to surgical sciences trainees over two weeks – an alternative to weekend courses for which attendance had become quite variable.

The pilot was repeated this year, with 66 hours of anatomy, physiology, pathology, pharmacology and radiology teaching being covered over 10 teaching days. Attendees also completed 8 hours of trial examinations, anatomy spot tests and assessments. The course required 15 anatomy demonstrators, 5 physiology lecturers, 7 pathology lecturers, a radiology lecturer and a pharmacology lecturer. Examinations were conducted on entry and exit.

The course is the brainchild of Professor Robert Rae who has worked tirelessly to bring this course to where it is today — one that meets the curriculum requirements for surgical science as determined by RACS.

The course will run again in 2012 from Monday 23 January to Friday 3 February and enrolment applications are now open – you need to be quick because places are filling fast and numbers are limited to 30.

More information on the course, the 2012 timetable and application form: www.ceti.nsw.gov.au/surgical

Professor Fiona Stewart, University of New England, takes on the skeleton during the Surgical Sciences Course.

Learning by doing can be very effective, but no one working in the health system wants to make significant errors while learning. On the other hand, every learner wants feedback from an expert about their learning.

iNvestigate is an interactive website which can help junior doctors learn about the rational use of investigations. It provides a simulation environment in which you can learn by doing, but errors do not have serious consequences and you have an opportunity to compare what you did with what an expert regarded as appropriate.

The cases in iNvestigate were selected in discussion with advanced physician trainees and specialists. There are 22 case studies planned that are relevant to PGY1 and PGY2 doctors, of which 17 are already complete.

For each case study, you review the clinical information, prioritise differential diagnoses and then select appropriate initial investigations. When ordering pathology tests, you

are presented with relevant information about their use and interpretation from the RCPA Manual.

A running tally of the estimated cost of all tests is provided, based on the Medicare Benefits schedule. After reviewing the results, you may select further investigations, for up to a maximum of 4 test-ordering encounters. Feedback is then provided, which allows comparison of cost, time to definitive diagnosis, and overall diagnostic strategy relative to an expert.

iNvestigate might be described as a game — and hopefully doctors will find it fun and interesting — but its purpose is absolutely serious! To check it out, go to investigate.med.unsw.edu.au and self-register via the link at top right.

iNvestigate has been developed with funding from the Quality Use of Pathology Program of the Commonwealth Department of Health. The project is a collaboration between UNSW and the RCPA. It is led by Prof Rakesh Kumar of the Department of Pathology at UNSW.

Serious gaming? Go to: investigate.med.unsw.edu.au


The Bureau of Health Information’s latest Hospital Quarterly profiles demand in NSW public hospitals in the April to June, 2011 quarter — showing a shift in the types of pressure being felt in NSW emergency departments.

Emergency department attendances from April to June exceeded 512,000 — up by more than 16,000 or 3% from one year ago but down 23,000 from the two-year peak that occurred during the Christmas quarter last year.

“This represents a decline in the number of people going to emergency departments since the 2010 Christmas peak, but more patients are being admitted from emergency departments to hospital,” Bureau Chief Executive Dr Diane Watson said.

“Emergency admissions of 120,000 represent an increase of more than 1000 since the 2010 Christmas peak, almost 8000 or 7% since one year ago and 10,000 or 9% since two years ago.”

There were 52,000 elective surgery procedures performed in NSW public hospitals.

“What we see is more elective surgery procedures being completed than two years ago but also more patients being seen on time,” Dr Watson said.

“The highest rise was for non-urgent elective surgery with 92% of patients seen within the recommended 365 days. That compares to 85% one year ago and 90% two years ago,” she said.

In NSW public hospitals, there were over 412,000 admitted patient episodes, 12,000 or 3% more than a year ago and 28,000 or 7% more than two years ago.

In this latest Hospital Quarterly, the Bureau reports on emergency department attendances while it considers new ways to report wait-time performance. The Bureau will resume reporting of emergency department wait times in its next Hospital Quarterly due out in December.

“We’ve seen some differences in how hospitals record emergency department information and from what the Bureau has seen so far, the varied recording methods can be clinically reasonable but make it difficult to fairly compare hospitals. The Bureau expects to change the way it reports on emergency departments,” Dr Watson said.

The report and supplements can be downloaded from the Bureau website:

www.bhi.nsw.gov.au

Bureau profiles demand in NSW hospitals

The Royal Rehabilitation Centre Sydney, in partnership with the University of Sydney, has delivered a series of interprofessional clinical placements in 2011.

The final placement for the year is currently underway, and includes nurses, a physiotherapist, occupational therapists, speech pathologists, and a dietitian. These students work together to deliver community-based health care to Royal Rehab clients.

The placement responds to the latest research, which shows that health professionals benefit from learning with, from, and about each other on clinical placement. Students attend tutorials together, set rehab goals together, and practice collaboratively with clients. Students learn to deliver client-centred care, and discover the benefits of teamwork for improved client outcomes.

Interprofessional placements are complex to organise, requiring lots of flexibility to ensure that each student’s placement requirements are met. However, it has been worthwhile to hear the positive feedback from students regarding the unique opportunity to collaborate with their student peers.

As a point of innovation, students are trialing Mobile Learning Stations. Each student is provided with a laptop, webcam,

mobile phone, and mobile internet. These tools are used to plan and deliver client care as well as to augment traditional clinical education techniques. We look forward to evaluating the Mobile Learning Stations and sharing our findings in the future.

More info: Beth Causa, Project Manager, Community Based Multidisciplinary Student Clinical Training Program Royal Rehabilitation Centre Sydney ,PO Box 6, Ryde NSW 1680; [email protected]

Interprofessional student unit

Beth Causa (centre) and Annie Roman (on Beth’s left) with students on placement, hearing one of the students give an interprofessional tutorial delivered on a cognitive assessment technique.


Twenty research-ready rural health workers commenced the RRCBP this year, attending the first face-to-face workshop in Sydney in September. This brings the total number of candidates accepted into the RRCBP to 124. The Research Methods Short Course and Project Development Retreat proved an excellent introduction to research methods, conducted by academics from the University Centre for Rural Health (Lismore) and the University Department of Rural Health (Broken Hill) who are passionate about building research capacity in rural health workers.

The highlight of the week was “research speed dating,” which involved each candidate spending 45 minutes with an expert mentor to discuss their research proposals and refine and explore alternative study designs. Special thanks go to the 18 expert mentors who shared their collective brain power and enthusiasm for research with the 20 candidates!

Newsflash — Have you heard?Forty-one candidates have completed their research reports. These can be downloaded from our website: www.ruralceti.health.nsw.gov.au/initiatives/building_rural_research_capacity/2007

The Rural Research Capacity Building Program is a two-year program conducted by CETI Rural Directorate. Applications are called for annually in June (available on our website from April). Check the website for more information, eligibility criteria and contact details. For further information please contact Emma Webster or David Schmidt, CETI Rural Directorate.

Successful candidates 2011Julie Adamson (HNELHD)Patrina Byng (MLHD)Atosha Clancy (NNSWLHD)Rae Conway (NNSWLHD)Emma Davies (Ambulance)Tracey Drabsch (WNSWLHD)Kim Edwards (SNDSLHD)Julie Hilditch (ISLHD)Anne Hills (HNELHD)Deborah Hoban (WNSWLHD)Bronwyn Leon (NNSWLHD)Katherine McQuillan (WNSWLHD)Monica Murray (WNSWLHD)Dean Phelps (NNSWLHD)Kim Riley (HNELHD)Belinda Robinson (HNELHD)Matthew Simpson (Ambulance)Debra Tabor (SNSWLHD)Bridget Thompson (SNSWLHD)Barbara Turner (FWLHD)

Expert mentors 2011Frances Boreland (Broken Hill UDRH)David Lyle (Broken Hill UDRH)Sarah Dennis (University of NSW)Amanda Rosso-Buckton (University of Sydney)Jenni Devine (SNSWLHD)Tod Adams (SESILHD)James Ward (University of NSW)Tony Lower (Australian Centre for Agricultural Health and Safety)Megan Passey (UCRH)Lesley Barclay (UCRH)Jo Longman (UCRH)Tina Navin (NSW Health Bio-statistics program)Dona Powell (NNSWLHD)Stuart Garland (NNSWLHD)Catherine Hawke (University of Sydney, School of Rural Health, Orange Campus)Buck Reed (Ambulance Service of NSW)Pauline Chiarelli (University of Newcastle)Therese Jones (WNSWLHD)

Rural research continues to grow 2011 Rural Research Capacity Building Program (RRCBP)

The 2011 candidates for the Rural Research Capacity Building Program at their workshop in Sydney in September.

Save the date: 7–8 March 2012

Training & Support Unit for Aboriginal Mothers, Babies & Children (TSU) State-Wide Forum, ‘Strengthening Connections’

This forum will focus on raising the awareness of current Aboriginal health initiatives and services. Staff working in Aboriginal Maternal Infant Health Services (AMIHS), Building Strong Foundations for Aboriginal Children, Families and Communities (BSF) programs, and those working in close partnership with these services, will be able ‘Strengthen Connections’ and build professional networks across NSW.

For more details, contact the TSU, Orange, 02 6360 7847.


Stroke affects about 53,000 Australians each year, and is the third largest cause of death and the leading cause of disability in Australia.

In 2007, following an evaluation of rural stroke services, the Rural Stroke Coordinator Network was established to provide a statewide coordinated approach to evidence-based care for rural people with stroke. Evaluation revealed that stroke care in rural hospitals had a low level of compliance with the National Stroke Guidelines and 94% of rural health facilities had no dedicated or organised stroke services.

Know your stroke risk was the community awareness message promoted by the Rural Stroke Coordinator Network across NSW during this year’s National Stroke Week (12 –18 September 2011).

Armidale: Melissa Gill promoted stroke week with a media release from a local stroke survivor. At the hospital, there was a focus on staff with morning tea, stroke promotion and a trivia quiz on stroke knowledge and risk factors.

Tamworth and Narrabri: Rachel Peake coordinated a community stroke forum with a large participation by the Aboriginal Community. An afternoon tea and information stands were held for the nursing and allied health staff at the hospitals. Tamworth also had media releases and editorials in the local newspapers. Armidale, Tamworth and Port Macquarie also had the stroke message as a rolling banner on the staff intranet

Wagga Wagga: Katherine Mohr had an information stand at the local RSL club staffed by the stroke unit staff throughout

the

week. There were also media releases and television interviews with the local neurologist and two stroke survivors.

Orange/Bathurst: Fiona Ryan coordinated media releases in the local papers and an afternoon tea for the hospital staff. Interviews with stroke survivors were played on the radio during the week and the Orange Stroke Recovery Group held a stall in shopping centre to sell ribbons. A healthy afternoon tea was also held at Orange and Bathurst hospitals to promote the message for staff.

Port Macquarie: Kim Parrey continued the awareness message with a bright board outlining risk factors and ways to manage them. Staff were encouraged to attend with fruit salad cups for morning tea, a quiz and a thickened fluids challenge to try and identify which fluid was thickened and which they liked the best? Surprisingly most staff selected the thickened fluid as their preferred taste. Staff were also encouraged to complete the National Stroke Foundation know your stroke risk factors and the local paper published an article on stroke risk factors with a story from one of the local general practitioners, a recent stroke survivor.

2011 National Stroke Awareness Week across rural NSW

Jenny PreeceCETI Rural Directorate

Narrabri: Rachel Peake, Rural Stroke Coordinator, Renee Watmore (student nurse) and Bill Toomey (stroke survivor).

Tamworth: Staff afternoon tea at Tamworth Base Hospital.

Narrabri: Rachel Peake, Rural Stroke Coordinator, Renee


The Rural and Remote Scholarship Program provides financial assistance for rural and remote health service staff to attend state, national or international conferences, workshops / seminars, and to assist in writing up research. The program began in January 2009 to address gaps identified in an audit undertaken in 2008.

Providing scholarships is one means by which CETI’s Rural Directorate supports a sustainable workforce and promotes excellence in rural and remote health services.

Since the inception of the program, 229 scholarships have been awarded, totalling $262,568. This has enabled rural and remote health service staff to attend a wide variety of educational forums, increasing exposure to best practice and new ideas, improving skills, providing opportunities to showcase achievements, strengthening professional networks and earning valuable continuing professional development (CPD) points.

Scholarship applications are predominantly for financial assistance to meet registration, travel and accommodation expenses, which can be prohibitive to rural staff accessing educational opportunities.

In 2010/11, 84 scholarships totalling $89,316 and four applications for discipline-specific group educational activities totalling $45,729 were awarded. Of these, 18 recipients had abstracts accepted for presentation at international or national conferences.

The Table gives a summary of scholarships by local health district for 2010/11

To date all evaluations received have indicated that individual learning objectives were met, with clinicians reporting the application of new skills and knowledge in the workplace and the sharing of outcomes with colleagues. Several recipients have reported that new skills acquired through attendance at workshops/courses have had direct

impact on decreasing the length and frequency of clinical sessions needed to successfully treat clients, while outcomes for others have been more in reflective practice, reducing feelings of professional isolation and increasing networking and peer support opportunities.

Rural and remote scholarship program – a year in review

Jenny Preece and Karyn Sherman Rural and Remote Health Projects, CETI

AHS/LHDScholarships

awardedGSAHS Workshop 11

National conference 2

State conference 1

Total GSAHS (incorporating MLHD and SLHD) 14

GWAHS Workshop/seminar 11

International conference 3


State conference 4

Total GWAHS (incorporating WLHD and FWLHD) 23

HNEAHS Workshop/seminar 14


State conference 6

Total HNEAHS 27

NCAHS

International conference 1

State conference 8

Workshop 7

Total NCAHS (incorporating NLHD and MNCLHD) 16

SESIAHS State conference 1


Workshop 2

Total SESIAHS (incorporating ISLHD) 4

Total 2010/11 scholarships84

($89,316)

Worth a lookThe Risky Business website is non-profit collaborative venture between:

Great Ormond Street Hospital for Children NHS TrustChildren’s Hospital of BostonCincinnati Children’s Medical CenterChildren’s Hospital of PhiladelphiaNational Patient Safety Agency (United Kingdom)The Clinical Human Factors Group

The NHS Institute for Innovation and Improvement

The British Medical Journal

The site provides a range of fascinating talks on themes related to risks, errors and the measures we can take to reduce costly mistakes in patient care. There is plenty here to inspire discussion and local initiatives for patient safety. www.risky-business.com


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In preparation for the FRACP exam which of the following is the key to success?

a) Sitting in a room on your own in the small hours of the morning memorising Harrisons and the last five years of NEJM articles.

b) Working with your study group through strict 18 month timetable of topic summaries.

c) Doing endless past exam questions until you can recite them in your sleep.

d) Going to the pub after a long day on the ward and debriefing about the patients you saw.

e) All of the above.

This year a group of first-year basic physician trainees from the Northern Sydney Central Coast Training Network, a paediatrician and a director of physician training spent some time thinking about the answer to this question.

To find out more about ourselves as learners we used the Myers Briggs Personality Type Indicator (MBTI). The MBTI identifies preferences for where we focus our energy, how we take in and process new information, how we make decisions and how we order our lives.

We used the MBTI to look at our learning preferences, including learning environment, interactions with teachers and other learners, how we look for new information, plan and organise our studies, and our keys to motivated learning.

We asked questions such as:

1 When learning something new do I

a) prefer to talk through my thoughts as they come to me and try out new ideas straight away

b) take time to myself to work through the ideas, read about them and reflect.

2 I do my best learning with teachers who

a) organise the material in logical systems, use a cool and objective approach, and give feedback that shows what I do and don’t accomplish

b. focus on relationships with the learners, foster a harmonious learning environment, and give feedback that shows appreciation of me as a person.

And finally we felt confident to answer our first multiple choice question:

e) All of the above.

We concluded that we all learn differently, we all have different learning preferences and that the real key to success is to understand our own learning preferences.

Junior doctors are expected to learn and apply vast amounts of knowledge both in their everyday work and also in preparing for college assessments. However, learning is not just the realm of the junior doctor — we all need to be good learners.

Preparation for the FRACP exam

Muh Geot Wong Director of Physician Training RNSH

Emma McCahon State Chair Paediatric Training, Clinical Lead Leadership Programs, CETI

Worth a lookThe Clinical Ethics Resource provides an extensive range of sources addressing the ethical and legal issues experienced by those working in clinical environments.

The website was developed by the University of Sydney and is funded by NSW Health. http://clinicalethics.info/


In 2009 the NSW Department of Health entered into an infusion device contract which resulted in the worlds largest roll-out and hence standardisation of its kind. In the background, NSW Health Support Services web portal, CiAP (www.ciap.health.nsw.gov.au), was also quietly making history with the world’s first and largest standardisation of device instruction manuals, including the Frasenuis Kabi Injectomat and Volumat pump instructions manuals.

This information system means that throughout NSW Health, clinicians can access manufacturer-supplied information on medical devices at the point–of-care.

This standardisation has many benefits for patient safety, developing user competence, managing consumables and accessories and reducing total costs of ownership. However, the medical equipment world is supplied by thousands of small manufacturers, with many innovations, transfers of ownership and changes of branding, so keeping device instruction manuals up-to-date is a perpetual challenge.

It’s quite common to compare safety in healthcare to the commercial airline industry, but with respect to measuring and monitoring equipment, BOEING and AIRBUS operate on the basis that suppliers need to customise their products and services for them — which is extremely unlikely ever to be the case in healthcare.The NSW infusion pump contract management could only select from a pre-existing range with very limited options to customise.

Propriety features built into the devices by manufacturers place more responsibility on the user to know the equipment by make and model. Having a good working knowledge of the general principles of devices will allow most people to get by under normal circumstances, but with compromised patients, time constraints and pressure of work, technical competence needs to stepped up a notch.

The Clinical Equipment User Manual Library, accessible via the CiAP Web Portal ( under Clinical Tools) gives clinicians precise guidance to devices by make and model.

Nursing staff are the custodians of medical equipment in hospitals. They are ultimately responsible for its readiness and spend more time in front of it than any other discipline. Rather than wait for a crisis, CiAP’s access to the Clinical Equipment

User Manual Library is a proactive step to support tech-savvy clinicians and help them to develop skills which are irreplaceable when things go wrong, when questions need answers instantly, when you don’t get a second chance.

Food for thoughtInquest into the death of Oliver Steven McVey. www.

courts.qld.gov.au/ [Search for “McVey”] (limited make and model experience [pp 10 & 27] may have contributed to a death).

Story of Bethany Bowen. www.risky-business.com/talk-18-story-of-bethany-bowen-2.html?channel_id=5 (a case of not following the manufacturer instructions – using a device without training).

Just a routine operation. www.risky-business.com/talk-89-just-a-routine-operation.html (nursing staff stepping up to the plate with respect to “readiness”).

Device wise

George KoningBioClinical Services [email protected]

Clinical Equipment User Manual Library in CiAP: search by make.

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April 04, 2011 Makes » Fisher & Paykel Healthcare » Humidifiers

name descriptionAirvo Series Humidifier Hospital Use Operating Manual Hospital Use Operating Manual

Bubble CPAP System Quick Guide Quick Guide

HC100 Respiratory Humidifier Operating Manual Rev 1 Operating Manual

HC150 Respiratory Instruction Sheet Instruction Sheet

HC500 Respiratory Humidifier Operating Manual Operating Manual

MR410 Respiratory Humidifier Operating Manual Operating Manual

MR480 Respiratory Humidifier Operating Manual Operating Manual

MR630 Dual Mode Respiratory Humidifier Operating Manual Operating Manual

MR700 720 730 Respiratory Humidifier Operating Manual Operating Manual

MR810 Respiratory Humidifier Instructions Sheet Rev C Instruction Sheet

MR850 Respiratory Humidifier Instructions Sheet Rev D Instruction Sheet

MR880 Respiratory Humidifier Instructions Sheet Rev C Instruction Sheet

OXYFLO Oxygen Therapy RT 308 Guide Guide


A new postgraduate degree in health professional education has been introduced at the University of Sydney. The Master of Education (Health Professional Education) is a bold approach to preparing future educators across the health professions.

The program aims to equip health professionals with a deeper understanding of contemporary educational pedagogies and practices that underpin health professional teaching and learning. Core content includes clinical teaching, clinical reasoning, assessment, simulation-based learning, and the scholarship of teaching in health professional education.

The MEd (HPE) is based on an interdisciplinary framework in two ways:

It recognises the importance of students from across the health professions learning together. Students are health professionals engaged in developing and delivering education in a range of health-related settings including hospitals, clinics, professional organisations, staff development centres, and higher education institutions. Current students include clinical nurses, nurse educators, medical staff specialists, surgeons, physiotherapists, orthopists, and health lecturers.

It is collaboratively managed by staff across multiple disciplines. The degree is coordinated by the Faculty of Education and Social Work and draws on teaching expertise and resources from Sydney Medical School, Sydney Nursing School, and the Faculty of Health Sciences at the University of Sydney.

The program is underpinned by adult learning principles, in that learners are considered proactive participants in constructing their own learning, and students’ prior knowledge and experience informs what and how they learn. The MEd (HPE) curriculum is aligned with students’ educational needs in classroom or clinical settings. The program is delivered in a blended mode and includes both face-to-face and online learning.

More details about the MEd (HPE) program are available at

sydney.edu.au/education_social_work/future_students/postgraduate/med/health_professional_education.shtml

Preparing future leaders in health professional education

Master of Education (Health Professional Education)

Koshila Kumar, Sydney Medical School, [email protected] Gordon, Sydney Nursing School, [email protected] Roberts, Sydney Medical School, [email protected] Walker, Faculty of Education and Social Work, [email protected] Neville, Faculty of Health Sciences, [email protected]


The patient’s headache remained as severe as it had been when I first introduced myself. Simple analgesia, Nurofen and Panadol, might as well have been distilled water for all the good they had done. Poor girl, she’d had a lumbar puncture a week earlier and the small change in pressure had likely precipitated the worst headache she’d ever known. Apparently ‘LP’ headaches are particularly painful and so far I’d seen nothing to suggest otherwise. In an effort to establish some control of the pain I’d ascended the analgesia ladder and prescribed some intravenous morphine to be given alongside IV fluids.

And here I was, sitting behind the desk, staring across the floor at the patient with the damp towel across her head, wondering if the morphine and fluids were starting to work. They should work, if not to extinguish the pain entirely then certainly to bring it down a notch or two. At the moment the patient would be happy with a single notch, she could barely open her eyes and nausea frustrated all her attempts to eat and drink. How she managed to answer my questions at all intrigued me; she must have possessed some measure of inner strength hard to perceive from a casual glance, or perhaps she felt I’d be the one to make the pain go away.

Thus my train of thought continued, as I sat in the office chair that swivels while she reclined on the mattress that sags, both of us focused on the same entity, her pain. By now, if the “morph” were going to work, it would have done so. “Somebody should check and see if it has,” I thought. And then, in a decidedly underwhelming manner, that which could not or had not been taught during four years of medical school came to me like a cut-out pass to the unmarked winger; it was my job to go and check on the patient, because she wasn’t just a patient, she was my patient.

Only death or dementia will wrest that moment from my mind’s grasp. The moment when the role and the responsibility intertwine, daring me to accept the new paradigm, questioning my readiness. Doctor in name but not yet in nature, still with a misplaced sense of comfort that “someone else” would take responsibility, still maintaining the distance. We’d spent so much time at medical school learning what not to do, courtesy of a professional development curriculum written by a lawyer, that “the distance” was something that kept me safe. Naturally the distance had to go, and so it did.

I rose, and asked how the pain was.

I was now at the centre of a relationship I’d never been in before, where the half-closed squinting eyes simultaneously pleaded with me to help and thanked me for what little I’d done so far. It was now incredibly important that we, the patient and I, get on top of this pain and “win”. The pain was a little better, but that didn’t mean much as the drip had only just been connected and needed some time before we could establish its effectiveness. In the meantime I went back and

reviewed the previous notes, I checked the blood results as they came in and cast an eye over the brain CT from the week before. There was nothing to find, but at least I was looking.

It’s not much, checking to see if a patient’s pain had subsided to a more manageable level, offering what I could, then reviewing the background history. I’d done it dozens of times before for dozens of other patients, but none of them were mine, and that’s what made it special. No doubt some of my contemporaries will scoff at how I laud the experience, but there will be others, some junior and some senior, who will remember forever the moment they actually became a Doctor too. The moment when you no longer have someone to check and correct, the moment when you assume the identity that comes with the role; the moment when “the patient” becomes “my patient”.

The pain did eventually get better, as a consequence of good painkillers, fluids and time; but I wasn’t around to see. My shift had finished and I’d gone home. I had wished my patient farewell upon my departure and reassured myself she was at least a little better as a consequence of my bumbling care, then left.

Medical school finished months ago and since then my friends and family have delighted in giving me the moniker “Dr Dan”. Hardly original, certainly catchy, and the appeal seems to lie predominately in the alliteration. I didn’t mind and smiled politely whenever it was thrown my way, but I didn’t believe it. I’d earned it by virtue of passing a few tests and spending a few years living and studying off the public purse, but the prefix “Dr” means so much more to the community than a passing mark, and so I’d refrained from using the term for no particular reason other than I felt something was missing.

In a very small way a part of what was missing emerged the day I rose from my swivel chair and closed the distance. I may be an Intern, and I may be just a Junior Doctor, but I’m still a Doctor and that means something.

In practice

The beginning

Daniel StewartIntern, Network 1, based at Dubbo

Thanks Daniel — Editor.

We’d like to invite all clinicians to send us stories from their experience for our “In practice” column.


Contributing to [the newsletter]This newsletter is published by email and online: www.ceti.nsw.gov.au/cetiscape

We invite contributions on all aspects of clinical education and training, in particular:

Short news stories: achievements, launches, events. (100 to 300 words, photos and illustrations desirable)

Reviews or editorials commenting upon issues related to health workforce education, training and development (300 to 1000 words, photos and illustrations desirable).

The submission deadline for each issue is the middle of the month. Articles can be submitted as Word documents. Pictures and logos should be sent separately, using the best available file. For logos, this is often an EPS file. Picture files should be sent at the highest resolution available. Articles are subject to editing (proofs are shown to the authors).

To subscribe or unsubscribe: email [email protected]

SimHealth 2011

CETI was a gold sponsor for SimHealth 2011, the annual conference of the Australian Society for Simulation in Healthcare, held at the Sydney Hilton Hotel last month. More than 300 keen educators, policy developers, clinicians and researchers gathered to explore the theme of “patient-centred simulation,” with keynote addresses from expert international and national speakers including patient safety expert Dr Amatai Ziv. CETI’s Chief Executive Professor Steven Boyages spoke on the final day about creating a modern flexible health professional workforce.

This conference is an interesting blend of hands-on workshops, free papers, plenary sessions, roundtable discussions and poster presentations. One of the highlights included a moulage workshop which allowed the participants to make and take home reusable wounds for use in their manikin-based simulations. SimWars, in which teams competed in their management of simulated emergency room clinical situations was again very popular, with our own Stephanie O’Regan playing a key role in this event.

SimHealth will be held again in Sydney next September. Details, including a call for abstracts and photos from this year’s conference, can be found at www.simhealth.com.au

CETI or HETI?

As we go to press, the Clinical Education and Training Institute is on the verge of a change of name and about to become the Health Education and Training Institute.

The planned change was announced by the Minister for Health, the Honourable Jillian Skinner, some time ago, but it has yet to be made official. It reflects a planned extension in the responsibilities of the current organisation to include education and training for all NSW Health workforce, non-clinicians as well as its clinicians.

The next issue of our newsletter will include more information about the change and the new programs of work that HETI will be undertaking.

A minor casuality will be the name of this newsletter. While “cetiscape” was fun, “hetiscape” doesn’t have the same ring to it. We will have to think of something new.

If you have any suggestions for a new name, or comments to make on the newsletter, please let me know.

Meanwhile, be assured that [the newsletter] still needs your contributions and will continue to appear.

Thank you,

Craig BinghamEditor, cetiscape

Program Manager General Medical Training Unit

CETI [email protected]

CETI’s simulation learning and teaching coordinator, Stephanie O’Regan, lends a hand during SimWars at SimHealth 2011.

Health & Medicine

Cetiscape 7 Oct 2011