Orientation Manual Interns and Residents 2013 / 2014

Orientation Manual
Interns and Residents
2013 / 2014
1
Welcome to the PAH Emergency Department
Your role in the emergency department team is vital.
Orientation
To function effectively in your role you must read / watch the following prior to
commencing your first shift:
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PAH ED General Information
Intern and Resident Orientation Manual
PAH ED Clinical Practice Manual
PAH ED Orientation Videos
These manuals can be found on the PAH ED Intranet site or the emergpa website,
www.emergpa.net .
The Emergency Department has developed an orientation package that is available online
via the internet. The orientation package is available via the online learning platform:
'iLearn@Qhealth'
http://ilearn.health.qld.gov.au/course/view.php?id=275&edit=0&sesskey=pkerWtJp5p
This website has the advantage of being accessible from home (unlike QHEPS), as well as
allowing you to track your progress as you work through the resources available. It can be
accessed at any time of day and at your convenience. We do require that you work
through the learning material prior to starting in the unit.
Your Ilearn@QHealth login will be your surname followed by your first initial.
Your password is currently set as the generic 'changeme'. When you first login to the site
please change your password and please keep this safe.
For example:
Name : John Smith
Login: smithj
Password: changeme
If you forget your login or password you can request a reminder on the login page that will
be sent to your Groupwise email account.
It is vital you undertake the above as there is only a brief orientation to the ED held upon
commencing your first shift. The expectation is that you will have been orientated by
undertaking the above reading.
In addition, at some time during your first shift you will need to make contact with Jillian
Vernon (ED Office Manager), or one of her support staff, to ensure we have your
correct contact details etc.
Learning Objectives
Your term in Emergency Medicine is likely to be the only time during your pre-vocational
training where you have the opportunity to be the first doctor to see patients with
undifferentiated medical problems.
The primary objective of your term is to learn how to safely approach the patient with
undifferentiated illness.
To obtain this primary objective, you will be expected to achieve the following goals:
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Be a member of a resuscitation team, under direction
Understand that management of critical conditions may precede full assessment
Be able to take an accurate, focussed history
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Be able to perform a competent, focussed physical examination
Be able to create a problem list for each patient
Be able to formulate basic management plans
Be able to carry out management plans, with assistance
Be competent at communicating with families, nursing staff, allied health staff and
medical staff
Be a reliable team member
These learning objectives are attainable primarily through seeing patients on the floor.
Your time in formal teaching will be complementary to your experience with patient
management.
Dress Code
Junior medical officers are to dress to the standard they would for other terms within the
hospital. For men, ties are not required.
Communication
The majority of communication will occur via email so ensure you check your GroupWise
account regularly.
Passwords
You need the following passwords to work in the ED:
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Novell Login
EDIS password (will be emailed to you)
Auslab password (Pathology)
PACS password (Radiology)
If you do not have any of these please see the ED Office Manager prior to commencing.
Term Content
Casemix and Workload
PAH ED has a relatively high acuity workload with complex medical cases and multi-system
trauma being a feature. An expansive knowledge and skill set is required with particular
emphasis on acute resuscitative skills.
PAH ED sees approximately 55 000 presentations per year, with a 30% admission rate. A
high proportion arrives by QAS (50%) which underlines the high acuity of the
presentations the ED manages.
Being one of the 3 major trauma centres for QLD, PAH ED attends to a high number of
trauma cases.
With access to interventional cardiologists and a catheter lab, acute cardiology patients are
also a feature of PAH ED.
Mental health patients (8% of PAH ED’s presentations) are catered for by a dedicated ED
Mental Health Service which operates 24/7.
PAH ED has its own 14 bed Short Stay Ward for ED patients and access to Hospital in the
Home and Nursing Home programs.
Expected Level of Involvement
Your role in the team is vital. How to function effectively in your role is outlined in the
PAH ED Clinical Practice Manual.
3
Managing your Workload/ Debriefing
The ED can be a busy and stressful environment. Some adapt more readily than others to
this. To assist in managing your workloads during the term consider the following:



Take your breaks throughout the shift (patients are always arriving and always
waiting to be seen). Allow 30 minutes for lunch and tea. Try to take your lunch
break if you are on a day shift after 13:00 when the evening team commence.
Smaller breaks (5-10 minutes) may also be useful to ‘recharge your batteries’
during your shift.
Try to finish your shift on time. Though it is often busy and you may be requested
to stay back – when possible, aim to leave on time. Thus, avoid picking up
potentially complicated patients within the last hour of your shift – let your
registrar know and they will allocate you an appropriate patient.
Enjoy your days off.
Debriefing is an important part of our support to you. If you feel at all concerned about
anything that happens to you in the Emergency Department please talk to the ED
consultant or registrar or the RN in charge at the time, who will assist you with your
concerns. Otherwise see Dr Tina Bazianas or Dr Jonathon Isoardi, who are the
contacts for resident support issues. Don’t be afraid to ask.
Scope of Practice
Please refer to APPENDIX A, titled “Scope of Practice for Interns Working at the PA
Hospital & Secondment Hospitals” for the Hospital policy on Scope of Practice.
The Emergency Department is a highly supervised environment. All invasive procedures,
apart from (most) peripheral IV cannulation, will be supervised directly by a Registrar or
Consultant. Expectations of practice are well described in the PAH ED Clinical Practice
Manual (CPM).
If, at any stage, you are unsure about any aspect of patient care, please ask your
supervisor for help.
Educational Opportunities
The consultants and registrars within the ED place a high priority on resident medical
education. The education provided takes a number of forms.
‘Coalface’ teaching – every patient a resident sees within the ED will be discussed with
senior ED medical staff. This allows for one on one interaction and education with a
consultant or registrar many times throughout a shift. These informal interactions form the
majority of the teaching within the ED. Discussing theory in the practical setting of seeing
a patient is commonly the most productive means of learning and retaining new
information.
MoLIE program (More Learning for Interns in Emergency) – Interns (only) will be
involved in dedicated MoLIE teaching sessions. More detail is provided in APPENDIX B.
Morning teaching sessions – House Officers (only) - At 08:00 Monday – Friday
(except Thursdays) there are 30 minute multidisciplinary teaching sessions run by a
consultant or registrar for the resident and nursing staff on duty. If you are coming on
duty for your shift, delay picking up patients until after the tutorial. Occasionally, due to
excessive activity in the department the tutorial may have to be cancelled. The education
syllabus is based around a weekly educational theme, with daily topics addressing the
week’s theme.
4
Weekly syllabus
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Orientation Week
Acute Cardiology in the ED
Shortness of breath in the ED
Infection in the ED
Shock in the ED
Trauma
Acute Orthopaedics
Acute Neurology
Toxicology and Toxinology
Review Week
Facility Education Program for Interns – The Medical Education Unit in the Hospital coordinates Intern Training on Tuesdays and Fridays from 12:00 to 13:00. If you are not
rostered to work during this time, you are welcome to attend these sessions. The MoLIE
program will thoroughly cover interns’ educational needs during their term in Emergency
Medicine.
EMERGENCY MEDICINE TRAINING – Finally if at any stage before, during or after your
ED term you would like more information about undertaking a career in emergency
medicine please contact Dr Darren Powrie or Dr Jonathon Isoardi (Co-Directors of
Emergency Medicine Training).
Rostering
The roster is a 10 week rotating roster with 4 shifts per week. Day shifts start at 08:00
and end at 18:30. Evening shifts start at 13:00 and end at 23:30. Night shifts start at
22:00 and end at 08:30. MoLIE shifts start at 08:30 and end at 17:00.
Night shifts are split into Monday – Thursday and Friday – Sunday.
Each day there is one person from the ‘day shift’ assigned to remote call after their
finishing time (1830). They are on-call until 08:00 the following morning and may be
called in to assist with excessive department activity.
Week-ends also have an assigned remote-call person to cover for potential sick leave.
Hence, interns will be rostered for 76 hours per fortnight, except during Line A of the
roster (when it will be 78). House officers will be rostered for 80 hours per fortnight.
Any changes to the roster (e.g. swaps, leave etc) must be approved by the Office
Manager, Jillian Vernon. Essentially, swaps in the roster can only occur with people at the
same level (i.e. intern with intern; SHO with SHO) and should only occur within the same
fortnightly pay period. Any changes to the roster (e.g. shift swaps, sick leave) are to be
written on the Roster Adjustment Form which is located in a folder within the medical
write-up area.
An example of the intern roster is attached (APPENDIX C). Please note, this is an
example only. The roster may change from term to term, and even week to week
depending on staff flux. Please use the most recent version of the roster, which will be
distributed by Jillian Vernon, the ED Office Manager.
The House Officer Roster is more complicated and changes frequently for many reasons.
As such, it is not included in the Orientation Manual, but can be obtained from Jillian
Vernon.
Handover
Handover is a crucial part of patient safety in the Emergency Department. It also acts as a
good opportunity for learning.
This topic is covered in the PAH ED CPM under “Finishing your shift”.
5
Other general points
PAY SHEETS
Time sheets are generated for the Pay Office automatically as per your roster. Any
changes to these hours that occur during the pay period need to be documented on a
Roster Adjustment Form (RAF) at the end of each shift (i.e. document un-rostered overtime, sick leave, shift swaps etc). The Roster Adjustment Form is located in a folder within
the medical write-up area.
SICK LEAVE
You must notify the Consultant (or registrar) on the floor (3176 7215) and the Office
Manager (Jillian Vernon 3176 7513 or 0421871368 24/7) as early as possible if you are
unable to attend for your shift due to illness. This allows the remote call doctor to be called
in to cover your shift.
WARD CALL
There is no ward call associated with rotations to ED.
Supervision
The Educational Supervisor responsible for co-ordinating intern and house officer
assessments is Dr Tina Bazianas.
The MoLIE, and House Officer teaching co-ordinator is Dr Jonathon Isoardi.
You can approach any of the consultants or registrars for advice or help.
As previously stated, the Emergency Department is a highly supervised environment.
During your shift, there will always be at least two supervising registrars on the floor. All
the registrars in this department are Advanced Trainees in Emergency Medicine. You will
be allocated a specific registrar to whom you will report, at the start of each shift. From
the hours of 0800 to 2200, there will be at least one consultant on the floor. From 2200 –
0800 overnight, there will be a consultant on call from home.
See ATTACHMENT: PAH INTERN SUPERVISION POLICY for the Hospital’s supervision
policy.
Term Assessment
You will have assessments at mid-term (week 5) and end of term (week 10). All
consultants and registrars provide input to your assessment which is conducted with one of
the consultant staff. An assessment form is completed and will be discussed with you. A
timetable for the assessments will be posted around the ED by the Office Manager at the
appropriate time.
See ATTACHMENT: PAH INTERN ASSESSMENT POLICY
If an assessment at mid term identifies some problems / issues resulting in sub-standard
performance, an IPAP (Improving Performance Action Plan) will be formulated during a
meeting between the junior doctor, the Educational Supervisor and a member of the
Medical Education Unit. The goal here is to work together to improve the junior doctor’s
performance towards satisfactory completion of the term.
See ATTACHMENTS:
RESIDENT MEDICAL OFFICER ASSESSMENT FORM
PAH POLICY – INFORMING INTERN OF SERIOUS CONCERNS
6
APPENDIX A
Scope of Practice for Interns Working at the PA Hospital &
Secondment Hospitals
Scope of Practice – What the Intern is NOT able to do
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Initiate patient treatment/management or change patient treatment/management
without discussion and approval from clinical supervisor.
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Obtain consent for surgical operations/procedures with which the Intern is not
familiar (PAH Hospital Wide Policies and Procedures: 01542/v5/02/2008)
Scope of Practice – What the Intern is able to do when rostered to work
1.
Interns must be familiar and act appropriately in accordance with the Queensland
Health Intern Induction and Orientation Program Framework (Integrated Resource
Manual 3.7-12)
2.
Must comply with PAH guidelines/protocols (PAH Hospital Wide Policies and
Procedures 01516/v6/05/2009) for communicating with staff involved in patient
care including informing nursing, allied health and other relevant staff regarding
instructions from the clinical supervisor/s regarding patient treatment and
management.
3.
Must complete documentation regarding patient treatment/management as per the
PAH Hospital Wide Policies and Procedures (60059/v1/09/2007)
4.
Contact directly the Consultant and/or Registrar/PHO re any change in the status
of their allocated patients.
5.
Attend rostered duties in ward, theatre and clinics as appropriate and punctually.
6.
Order tests/investigations as agreed by the Consultant and/or Registrar/PHO.
7.
Access results of patients, review these tests and communicate unexpected
findings to Consultant and or Registrar/PHO.
8.
Prescribe medications as directed by the Consultant and/or Registrar/PHO and
notify if any problems occur as a result.
9.
Complete patient discharge summaries.
10. Carry pagers whilst on duty (other than in ED or off site) and check pager is
working as required.
11. Participate in Rapid Response Team as per roster.
12. Participate in rostered after hours ward call shifts.
7
APPENDIX B
MoLIE (More Learning for Interns in Emergency)
Also known as
BARRIE (Better Arrangements, Resources and Role-Modelling for Interns in
Emergency)
Welcome to the PA and QE2 Emergency Department BARRIE program.
BARRIE has been developed to promote better learning opportunities for interns during
their term in the PA or QE2 Emergency Department.
The program is co-ordinated by:
Dr Jonathon Isoardi
Angela O’Connor
Catherine Weldon
FACEM
Medical Education Officer
Administration Officer
If you have any problems during your Emergency term, please approach one of us
so that we can work together to resolve the issue. We will not be involved in
assessing your performance during the term.
Your week will comprise of three clinical shifts and one BARRIE day. During this BARRIE
day, you will participate in two interactive teaching sessions. The sessions will go from
08:30 – 12:30, and 13:00-17:00. There will be a different facilitator for each session. For
PA interns, you will not be expected to attend BARRIE during your run of nights from
Monday to Thursday (line A of the roster). Otherwise, attendance is part of your job and
hence compulsory. As for your clinical shifts, punctuality is required for BARRIE.
There are 20 modules that will run during your term. They are listed below, and will run in
the listed order.
BARRIE MODULES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
General approach to the ED patient
The patient with chest pain
The breathless patient
Abdominal pain in the ED
Altered level of consciousness
The poisoned patient
The patient with PV bleeding
Collapse and syncope
The multiply injured patient
Minor injuries
ENT and eye complaints
The febrile patient
Resuscitation
Communication in the ED
Paediatrics
Environmental injuries
The patient with headache
The patient with GIT bleeding
The patient with weakness
Case presentations
You will only need to bring yourself and a pen to the sessions. BARRIE will be run in on
eof the Education / Conference Rooms within the ED Administration Area..
No formal assessment will be made of your performance during the teaching sessions.
Please enjoy yourself and the company of your peers. The educational value of BARRIE is
dependent on intern participation, so come prepared to contribute to discussion.
You will be asked to evaluate the BARRIE program and your feedback is greatly
appreciated.
8
APPENDIX C
INTERN ROSTER
A
B
C
D
E
F
G
H
I
J
K
L
MondayTuesda WednesThursd Friday SaturdaSundayHours
N
N
N
N
OFF
OFF
OFF
40
OFF
M
E
E
E
OFF
OFF
38
OFF
M
E
E
E
OFF
OFF
38
D® M
OFF
OFF
OFF
D
D
38
D
M
E
E
OFF
OFF
OFF
38
D® E
OFF
M
D
OFF
OFF
38
OFF
E
M
OFF
OFF
E
E
38
D®
38
E
OFF
M
OFF
OFF
D
E
OFF
M
OFF
OFF
E
E
38
OFF
OFF
M
OFF
N
N
N
38
OFF
OFF
M
OFF
D
E
E
38
LSA
OFF
M
D
D
OFF
OFF
38
D
0800-1830
D®
0800-1830 + ON CALL TO 0800
0830-1700
M
E
1300-2330
LSA
1300-2330 subacute
N
2200-0830
9
PRINCESS ALEXANDRA HOSPITAL
PROCEDURE MANUAL
Section: Support
Procedure No. 52046/v2/06/2013
Procedure Title: Intern Supervision – Medical Education Unit
Review Officer: Medical Education Unit
nd
Review Summary: 2 Version
Applicable To: Princess Alexandra
Hospital Intern and training Program
Interns and Supervisors
Last Review Date: 06 2013
Purpose:
To ensure that all Interns are supervised by appropriately qualified
medical practitioners so as to ensure a safe clinical environment for
patients and an effective and safe learning environment for Interns
as they acquire appropriate skills and attitudes in their professional
development.
Next Review Date: 06 2015
Authority: Director of Clinical Training
………………………………………
Signature of Authorising Officer
Authorised to Undertake the Procedure:
Definitions
Supervisors
• Clinical supervisors at the Princess Alexandra Hospital are
Replaces: 52046v1
senior doctors, employed at the level of Principal House
Key Words: Intern, Supervision
Officer/Registrar or above.
• Shift supervisors are senior doctors, employed at the level of
Accreditation Reference:
Principal House Officer/Registrar or above, available in the junior
PMCQ Accreditation Standard and
doctor’s immediate work area during all shifts in which the junior
Guidelines – Function 1 Standard 1,
Function 1 Standard 6, Function 2
doctor is working.
Standard 8.
• Unit educational supervisors are senior doctors responsible for
deciding on whether performance is satisfactory or not
satisfactory. This person may or may not be a clinical supervisor.
• Ward call supervisors may be on-site shift supervisors and/or senior doctors who are also on call in
cases of emergency.
Levels of Intern Supervision
• Level 1 Supervision – The supervisor is physically present with the intern during the performance of the
intern’s duties
• Level 2 Supervision – The supervisor is not physically present, but is immediately available on site if
required by the intern without impediment to access.
Risks and Precautions:
Non compliance with this policy will result in risk rating of EXTREME – immediate action required.
Procedure:
•
•
Interns employed by Princess Alexandra Hospital must be supervised at all times, regardless of which
shift they are working, or the location of their workplace.
The responsibility for ensuring the appropriate level of supervision is provided to the interns lies with the
Executive Director of Medical Services of the facility to which the Intern is allocated.
In Practice
1. Each junior doctor’s clinical and/or educational supervisor will be clearly identified at the beginning of
each term.
2. Supervisors provide overall supervision of the junior doctor’s work performance and training. In this
respect, they are responsible for implementing the Unit’s education programs, and have mentoring,
teaching, appraisal and assessment roles.
3. Supervisors must ensure that supervision of Interns:
Printed version is an uncontrolled copy
1
- Is adequate at all times, to ensure safe patient care; and
- Provides a safe and valuable learning environment for the Intern; and
- Meets the criterion as per the definition of Level 1 or Level 2 supervision.
In considering this, clinical and educational supervisors should be aware of the skills and experience
and workloads of all clinicians who may be providing supervision at any time during an allocated term.
4. Each junior doctor’s shift supervisor will be clearly identified at the beginning of each shift.
5. Shift supervisors provide direct supervision of the junior doctor’s work. They provide mentoring, teaching
and appraisal, and provide appraisal information to the educational supervisor who completes the junior
doctor’s term assessment.
6. Junior doctors on ward call will be supervised by the shift supervisor in the work area to which they have
been rostered. The assessment of performance on ward call is included in the full assessment process.
7. At all times, junior doctors and shift supervisors are able to contact more senior doctors who may or may
not be on site but will be contactable by telephone.
8. Supervisors “on call” must be within thirty (30) minutes from the hospital.
9. Where the Director of Clinical Teaching or Executive Director Medical Services is notified of concerns
regarding the adequacy of supervision of an intern, an investigation is undertaken with a degree of
urgency to:
a) Obtain relevant background detail, e.g. failure to advise of name of delegated supervisor during a
period of absence of term supervisor or failure to advise change of roster in event of notification of
inadequacy of supervision on ward call.
b) Ensure that steps are put in place to provide adequate supervision.
Delegation of Responsibility for Supervision
• If the Interns unit educational supervisor is absent or unavailable then the second educational supervisor
in the unit will supervise the Intern. The unit educational supervisor is always a consultant.
• If the shift supervisor who is a registrar or principal house officer is absent or unavailable, then the
consultant rostered on for the team will supervise.
• If the ward call supervisor who is a registrar or principal house officer is absent or unavailable, then the
consultant on call or consultant for the patient must be contacted for supervision.
• The Medical Superintendent on call must be contacted by an Intern if no other supervisors are available.
Evaluation Method:
General Clinical Education Committee will evaluate this procedure against feedback provided by Interns
each term. Recommendations will be forwarded to individual Term Supervisors and Medical Services
Directors Committee.
HYPERLINK TO: Medical Education Unit Procedures
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2
PRINCESS ALEXANDRA HOSPITAL
PROCEDURE MANUAL
Section: Support
Procedure No. 52044/v2/06/2013
Procedure Title: Intern Assessment – Medical Education Unit
Review Officer: Medical Education Unit
nd
Review Summary: 2 Version
Applicable To: Interns, Intern
Supervisors, MEU Staff
Last Review Date: 06 2013
Next Review Date: 06 2015
Purpose:
To ensure that appraisal (formative assessment) and assessment
(summative assessment) at Princess Alexandra Hospital provide
ongoing constructive feedback to Interns, so that each Intern’s
training and professional development objectives are met and that the
requirements of the Medical Board of Australia are satisfied when
considering an application for removal of probationary conditions.
Authority: Director of Clinical Training
………………………………………
Signature of Authorising Officer
Replaces: 52044v1
Key Words: Assessment
Accreditation Reference:
PMCQ Accreditation Standards and
Guidelines – Function 1 Standard 3,
Function 2 Standard 9.
Definitions:
Intern Education and Training Program (IETP)
The Intern Education and Training Program is the organisation’s
medical education and training program for Interns, which should
comprise a formal alignment or rotation of Terms and the Facility
Education Program (FEP). Assessments of the intern in the rotation
of Terms are collated to provide evidence to the Medical Board that
an intern is suitable to be fully registered in Queensland.
Assessment
Assessment is a crucial component of the Intern Education and
Training Program (IETP) and essential for Intern learning and development. The Princess Alexandra
Hospital and affiliated Metro South Hospitals are responsible for ensuring that the Postgraduate Medical
Council of Queensland (PMCQ) state-wide assessment process is implemented and has a process for
distributing the assessment tool to supervisors and Interns and for return of these forms to the Director
Clinical Training (DCT) for review. The process of review of these assessment forms should also be clearly
identified including remediation processes should problems be identified.
Assessors
The designated educational supervisors gather information on an intern’s performance during their term
allocated to a specific unit. Performance is assessed by direct observation, and from reports provided by
other supervisors (as listed below) and from nursing and allied health staff.
Educational supervisors are senior doctors, employed at the level of Principal House Officer/Registrar or
above, in Hospitals within the Metro South Health Service District and elsewhere. If an Intern is allocated to
a primary care setting off campus in a non compulsory term supervision is provided by a vocationally trained
General Practitioner.
Shift supervisors are the senior doctors available in the junior doctor’s immediate work area during any
rostered shifts. They provide information to the educational supervisor about the intern’s performance.
Ward call supervisors may be on-site shift supervisors and/or senior doctors who are also on call in cases
of emergency and who are responsible for assessment of the intern while on ward call.
Feedback
Interns receive appraisal on their performance from their supervisor/s at mid term and an assessment of
performance in a formal interview process at end of term. The midterm feedback process is necessary to
provide a learning opportunity for Interns, enabling them to review and adjust their performance, and
provides the Intern with an opportunity to strengthen skills before the end of term summative assessment.
Risks and Precautions:
Non compliance with this procedure will compromise accreditation status of the Facility and/or unit and
compromise the Intern’s full registration with the Medical Board of Australia.
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Procedure:
Assessment refers to the process of describing monitoring, reviewing and reporting on the performance of
interns employed within the Metro South District. Assessment comprises an appraisal of performance at mid
term and a summative assessment at the end of a term. The Postgraduate Medical Council of Queensland
(PMCQ) state-wide assessment form is utilised for the purpose of documentation. The Princess Alexandra
Hospital utilises an electronic database called PROSE (Princess Alexandra Hospital Resident Medical
Officer Online System of Assessment and Evaluation) for this purpose. Some hard copy assessment forms
are submitted.
The completed assessment form must be viewed by the Intern and the Intern be given an opportunity to
provide written comment.
Where Princess Alexandra Hospital Interns are allocated to terms off campus, there will be a Memorandum
of Understanding which outlines specific obligations of the Facility in terms of supporting Interns with
supervision, assessment and feedback and a description of how this information is given to the Interns and
provided to the Primary Allocation Hospital.
Where Princess Alexandra Hospital Interns are rostered to ward call they are assessed using a Ward Call
Assessment Form which is completed by the clinical supervisor for the shift. Intern performance is assessed
as satisfactory, unsatisfactory or unable to be assessed. The level of contact upon which the assessment is
based is also noted by the clinical supervisor. The Intern also has an opportunity to evaluate the level of
support received on the shift and if perceived as unsatisfactory, comments can be made by the Intern.
When an assessment indicates that an Intern’s performance requires assistance through the development of
an Improving Performance Action Plan (as per Postgraduate Medical Council of Queensland Guidelines), the
process should involve the Intern, Medical Education Officer, Director of Clinical Teaching and Executive
Director Medical Services if necessary.
All summative assessment forms must be returned to the Medical Education Unit in a timely fashion to
enable completion of the annual Intern Reports for the Medical Board of Australia.
In Practice
1. At the beginning of the intern year, the Assessment procedure and the process of assessing interns both
within the Facility and within affiliated South Metro facilities where the intern may be seconded, is to be
outlined.
2. The Orientation Assessment package is to contain copies of:
- The end of term assessment form,
- The Assessment procedure document and process for assessing interns,
- The process for assessing clinical skills,
- The Supervision Procedure,
- The Grievance Procedure,
- A list of possible advocates for interns.
3. At Term orientation Interns receive:
- An outline of the assessment processes of that particular Term,
- A date of mid-term Assessment (if longer than five weeks),
- Identification of the educational Supervisor,
- Identification of ward call supervisors and shift supervisors,
- A copy of the ward call assessment form and process,
- A list of the personnel responsible for giving feedback and appraisals, and how this information will
be collated, e.g. direct observation, reports from supervisors, and information from co-workers
such as nursing and allied health staff.
4. Feedback sessions should be incorporated within a shift where possible as part of debriefing and should
include feedback by others (e.g. nursing and allied health staff) observing the doctor’s performance.
5. Where ward call is allocated ensure that the assessment process addresses the following:
- The clinical supervisor for ward call is included in the full assessment process.
- The Intern is aware of any change in assessment procedures.
- The educational supervisor for the compulsory term liaises with both shift and ward call
supervisors.
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6. The process for instigating the Improving Performance Action Plan (IPAP):
- A junior doctor who has been rated on any two of the criteria on the assessment form as
“Requires further development” (RFD) or any one “Requires substantial assistance” (RSA), is to
be informed of the need for the development of an Improving Performance Action Plan. The
Director of Clinical Training or the Medical Education Officer in the Medical Education Unit is to be
involved in this process.
- An Improving Performance Action Plan (IPAP) identifies problems/issues and includes strategies
to assist the Intern and the supervising clinician to improve the Intern’s performance. The Intern
must agree to the Improving Performance Action Plan before signing the Improving Performance
Action Plan Form.
- The objective of the Improving Performance Action Plan is to improve the likelihood that an
“unsatisfactory progress” at mid term may become a “satisfactory progress” at the end of term.
- If at the end of a term, a junior doctor receives an “unsatisfactory progress”, an Improving
Performance Action Plan is to be completed and discussed with the Clinical Supervisor in the next
rotation.
- An “unsatisfactory progress” at the end of a term may delay general registration for an Intern.
- All “unsatisfactory progress” reports for junior doctors will be notified to the Executive Director of
Medical Services by Medical Education Unit (MEU) staff.
- Where the Intern has an Improving Performance Action Plan and is allocated to a term off campus
this information will be shared with the Director of Clinical Training (DCT) at the secondment
facility.
7. Confidentiality of intern assessment data must be safeguarded. The Medical Education Unit will retain a
copy of the form for registration, reference and ongoing performance management purposes. The
assessment forms will be stored as confidential documents in a locked location.
8. The Medical Education Unit at the Princess Alexandra Hospital provides notice of impending end of term
or mid term assessment via email. Assessments returns are recorded in an electronic data base and
reports generated from this are presented at the General Clinical Education Committee.
Evidence
1. End of term/mid term assessment form.
2. Assessment Process.
3. Assessment form returns report.
4. Copy of policy for informing Intern of serious concerns.
5. Copy of process for assessing clinical skills and records kept.
Evaluation Method:
The General Clinical Education Committee will evaluate this procedure against feedback provided by
General Clinical Education Committee Members.
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3
RESIDENT MEDICAL OFFICER ASSESSMENT FORM
Postgraduate Medical
Education Council of Queensland
(Queensland)
Medical Board of Queensland
The information on this form contributes to decisions on registration for interns (PGY1) and International Medical Graduates
on conditional registration. It also provides RMOs with feedback each term on their performance and professional development.
The criteria listed on the form can be used as the basis for discussing goals and objectives at the start of term.
It is suggested the criteria listed on the form be used as the basis for providing a formative assessment at mid
term. Preferably the form should be completed at that time and signed by both the supervisor and RMO.
At the END OF TERM ASSESSMENT, this form must be completed by the clinical supervisor, with input from
other members of the team where appropriate. The form must be signed by both supervisor and RMO.
•
•
•
Clinical Supervisor/s to tick (√) appropriate boxes in columns
Ticks in the shaded areas require comments by the clinical supervisor on page 2
One criterion assessed as “requires substantial assistance” (RSA), or two assessed as “requires further development”
(RFD) must trigger development of an Improving Performance Action Plan (IPAP) (page 3)
RMO Name ………………………………………………
Term Unit………………………………………………………
Hospital /Facility .....................................................
Term Dates…………………………………………………….
Please tick the relevant boxes below.
Position
PGY1 (Intern)
Start of term unit orientation
PGY2 (JHO)
YES
PGY3 + (SHO/PHO)
NO
Expectations of RMO discussed
Assessment process & learning objectives discussed
End Term Assessment
Mid Term Appraisal
CRITERIA
AMC Candidate
Requires
substantial
assistance
Requires
further
development
Consistent
with level of
appointment
Performance
better than
expected
Performanc
e
exceptional
N/A
Not
observed
CLINICAL
Knowledge base. Demonstrates adequate
knowledge of basic and clinical sciences.
Clinical skills. Elicits and records accurate,
complete history and clinical examination
findings.
Clinical judgement/decision making skills.
Applies knowledge base and clinical findings in
organising, synthetising and acting on
information.
Emergency skills. Acts effectively, and when
appropriate acknowledges own limitations and
seeks help.
Procedural skills. Performs procedures
competently.
COMMUNICATION
Patient and Family. Interacts effectively and
sensitively with patients and families/care givers.
Medical Records/Clinical Documentation.
Provides clear, comprehensive and accurate
records.
PERSONAL AND PROFESSIONAL
Professional Responsibility. Demonstrates,
appropriate attitudes and behaviours, including
punctuality, reliability, honesty and self-care.
Teaching. Demonstrates commitment to
learning, reflective thinking, and teaching
others.
Time management skills.
Organises and prioritises tasks to be undertaken.
Teamwork and colleagues.
Works and communicates effectively within a
team.
PMCQ RMO Assessment Form updated 12 Mar 07
1
Supervisors are required to comment on the following:
Describe strengths:
.....................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
List areas for improvement/advancement
.......................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
If ticked ‘Requiring substantial assistance’ and/or ‘Further development’, give specific examples, and complete
Improving Performance Action Plan on attached page, in consultation with DCT and Medical Educator(s).
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
Please tick (√) appropriate box
Satisfactory progress for this term
Unsatisfactory* progress for this term
* If assessment includes “requires substantial assistance” x 1 (or more) or “requires further development” x 2 (or more)
Has the RMO had a formal feedback session about this assessment?
Yes
No
Comments by Resident Medical Officer
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
..........................................................................................................................................................................................................................................................................................................................................................................................
RMO
............................................………….
Name (please print)
Clinical Supervisor….. ..............................................
Name & Position (please print)
.................................................
…………………..
Signature
Date
…………………………………….
………………….
Signature
Date
Director of Clinical Training .......................................
Name (please print)
........................………………..
Signature
…………………
Date
Director of Medical Services ......................................
Name (please print)
........................……………….
Signature
…………………
Date
PMCQ is the authorised accrediting body of the Medical Board of Queensland
PMCQ RMO Assessment Form updated 12 Mar 07
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Improving Performance Action Plan (IPAP) to Address Identified Issues
(Please refer to IPAP Guidelines)
To be completed by the Clinical Supervisor, in consultation with Medical Education Staff and the RMO.
The Director of Clinical Training has responsibility for ongoing implementation of Action Plans.
Name of Resident Medical Officer: ……………………………………………………. Unit: ………………………………
Term: …………………………………………………
Issues related to
criteria
Term Dates: …………………………………………….
Actions/Tasks
Timeframe
Review Date
Dates and Notes/Comments by DCT at Interview/s with Resident Medical Officer
Signatures:
Clinical Supervisor ……………………………………………………………….
Date ……../……../……..
Director of Clinical Training……………………………………………………..
Date ……../……../……..
RMO ………………………………………………………………………………….
Date ……../……../……..
Endorsed by PMCQ, the authorised accrediting body of the Medical Board of Queensland.
PMCQ RMO Assessment Form updated 12 Mar 07
3
PRINCESS ALEXANDRA HOSPITAL
PROCEDURE MANUAL
Section: Support
Procedure No. 52041/v2/06/2013
Procedure Title: Informing Intern of Serious Concerns – Medical Education Unit (MEU)
Review Officer: Medical Education Unit
nd
Review Summary: 2 Version
Applicable To: Princess Alexandra
hospital Intern Education and Training
Program Interns and Supervisors
Purpose:
To ensure that Interns are informed of serious concerns in a
systematic, transparent and documented manner to ensure a safe
learning environment for Interns as they acquire appropriate skills and
attitudes in their professional development.
Last Review Date: 06 2013
Next Review Date: 06 2015
Risks and Precautions:
Authority: Director of Clinical Training
Non compliance with this procedure will result in risk rating of
EXTREME – immediate action required.
………………………………………
Signature of Authorising Officer
Replaces: 52041v1
Authorised to Undertake the Procedure:
Definitions:
Supervisors
Accreditation Reference:
• Clinical Supervisors at the Princess Alexandra Hospital are
PMCQ Accreditation Standards and
senior doctors, employed at the level of Principal House
Guidelines – Function 2 Standard 9.
Officer/registrar or above.
• Shift supervisors are senior doctors, employed at the level of
Principal House Officer/Registrar or above, available in the junior doctor’s immediate work area during all
shifts in which the junior doctor is working.
Term Supervisors are senior clinicians responsible for deciding on whether performance of a junior
doctor is satisfactory or not satisfactory. This person may or may not be a clinical supervisor.
Ward call supervisors are on-site shift supervisors.
PRIME is the Queensland Health Clinical Incident management system. It is an on-line system for
reporting and managing clinical incidents involving all Queensland Health staff. Identifying that an
incident has occurred, deciding on its significance and reporting the circumstances around it provide the
organisation with a process and opportunity to effectively manage outcomes in a timely and effective
way. Collected data is used to assist the organisation and individual patients through identifying and
analysing systems and processes needing change to prevent or minimise the reoccurrence of the
incident type.
IPAP – The Improving Performance Action Plan – The Australian Health Practitioner Regulation Agency
(AHPRA) endorsed process for managing substandard performance of junior doctors. The process is
triggered by a team supervisor’s assessment of the Junior Doctor as unsatisfactory. This allocation of
responsibilities for implementation of the remediation plan and timeframe for review. The process should
involve the Intern, Medical Education Officer (MEO), Director of Clinical Training (DCT) and if necessary
the Executive Director Medical Services (EDMS).
DCT – Director of Clinical Training – Are medical practitioners appointed in each facility to support the
training of junior doctors.
MEO – Medical Education Officer – An experienced educationalist employed to assist the DCT in
developing educational processes and procedures supportive of the Intern Education and Training
Program (IETP).
Key Words: Intern, Serious Concerns
•
•
•
•
•
•
Procedure:
Statement:
In the context of the process of an Intern’s performance assessment by the term supervisor:
• The assessment form to be completed by the term supervisor is the form endorsed by Australian Health
Practitioner Regulation Agency (AHPRA) and the Post Graduate Medical Education Council of
Queensland.
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•
•
•
•
•
•
•
•
•
An intern rated:
- On any two of the criteria on the assessment form as “requires further development” (RFD); or
- On any one of the criteria as “requires substantial assistance” (RSA)
is to be advised that such an assessment is considered unsatisfactory, and must trigger the
development of an “Improving Performance Action Plan” (IPAP).
The supervisor is to provide the Intern with details as to the reasons for the ratings in a formal feedback
session.
The Intern is given an opportunity to make comment on the assessment (utilising the section on the
assessment form).
The Director of Clinical teaching (DCT) or Deputy (DDCT) and/or the Medical Education Officer (MEO) in
the Medical Education Unit (MEU) is to be informed of the outcome of the assessment in a timely
manner.
An Improving Performance Action Plan (IPAP) is to be developed in consultation with the intern, the
supervisor and the Director of Clinical Teaching (DCT) or Medical Education Officer (MEO).
An IPAP generated at mid term of a full ten or twelve week term is to be utilised for the purpose of
providing support for the intern. Such support should be aimed at maximising the opportunity for the
intern to achieve the level of “satisfactory progress” for the term by the end of the term. The DCT is to be
responsible for ensuring the action plans related to the issues identified on the IPAP are implemented.
An Intern rated as not achieving a satisfactory level of progress at the end of an allocated term must be
provided with this information in a formal feedback interview. An IPAP is to be developed utilising the
process mentioned above. Details regarding prior term performance may be provided to the supervisor
of the following allocated term. From the commencement of the following term, issues identified in the
IPAP are to be addressed utilising an agreed action plan and, as previously, the process is to be
overseen by the DCT.
An intern who has not achieved a “satisfactory performance” by the completion of a term is to be
informed of the possibility of a need to extend the period of internship and hence the potential need to
defer a request to the Australian Health Practitioner Regulation Agency (AHPRA) to consider the lifting of
probationary conditions. A term assessment rated as unsatisfactory may also trigger a change in
allocations to ensure the intern is allocated to a Unit in the primary allocation facility for the subsequent
term.
The Executive Director of Medical Services is to be provided with timely reports on interns who are not
achieving a satisfactory level of performance. The EDMS is to ensure that an intern working within the
dictates of an IPAP is to be provided with appropriate support and mentoring throughout the period and
beyond as long as is deemed necessary by the DCT.
In the context of the global assessment of performance of an intern:
• The DCT is to be provided with any report where concerns about the professional behaviour or clinical
practice of an intern has led to its generation.
• A report may initially have been forwarded to Patient Safety via the PRIME system. In other instances
concerns regarding an intern may have been brought to the attention of the DCT in an informal manner.
• Dependant on the content of the report, the intern is to be contacted and interviewed by the DCT or
Deputy and/or the MEO. Notes of the interview are to be filed and the Intern is to be advised that
records are kept by the DCT. The Intern is advised that an advocate or support person may be with the
Intern at the interview.
• Where an intern is the subject of multiple reports as upon investigation there is cause for significant
concern, the intern is advised of the need for remediation.
• An appropriate programme is to be developed with a mutually agreed timeframe for completion and
evaluation. An IPAP for may be utilised for this process.
• The intern is to be advised of the necessity to involve the term supervisor.
• The DCT is to ensure the EDMS remains apprised of all relevant detail in a timely manner.
• Where it is suspected that substandard performance or inappropriate behaviour is the result of
substance abuse or mental health problems, the Intern is not to be managed by an IPAP but referred
directly to the EDMS.
Evaluation Method:
•
General Clinical Education Committee will evaluate this procedure against feedback by interns each
term. Recommendations will be forwarded to individual Term Supervisors and Medical services Directors
Committee.
HYPERLINK TO: Medical Board of Australia
Post Graduate Medical Education Council of Queensland (PMCQ)
Printed version is an uncontrolled copy
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