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Broome May 2013 Minutes

Outcomes from the Meeting

Represented at the meeting:

Adelaide University

Australian National University

Deakin University

Flinders University

Flinders University NT

James Cook University

University of Melbourne

Monash University

University of Notre Dame

University of Newcastle

University of Queensland

University of Sydney

University of Tasmania

University of Western Australia

University of Western Sydney

University of Wollongong

Commonwealth Department of Health and Ageing

University of New South Wales

DAY 1: Thursday, 9 May 2013

Traditional Welcome to Country
Welcome to Broome and the Region
Professor Gavin Frost, Dean, Notre Dame School of Medicine, Fremantle
Welcome and Introduction to the FRAME Meeting
Professor Judi Walker, Chair of FRAME
Brief Update from each RCS
Refer Attachment 1
In summary, challenges relating to Parameter 7 included:
  • Integrating ATSI health across the whole curriculum
  • Indigenous student recruitment - Interviews with indigenous applicants for medicine; difficulties with distance and technology; postgraduate course means double the hurdles
  • ATSI student support and retention – relocation, bursaries & family accommodation; one on one mentoring; culturally safe environment
  • Cultural safety of indigenous staff
  • Establishment & disestablishment of School for Indigenous Health
  • Recruiting academic indigenous health staff
  • RCTS funding allocated to rural activities and difficulty to fund new Indigenous health immersions/clinical placements
  • Enabling local Aboriginal people to educate and assess medical students.
  • Recruitment of Indigenous Academic staff.
 Other challenges facing each RCS and RMS in the last 12 months included:
  • Tracking destinations of RCS graduates
  • Loss of dedicated infrastructure funding
  • New Schools in Faculty – further stretching of resources
  • Dealing with rape of a student
  • Challenge to maintain & enhance partnerships in difficult fiscal times / legal liability concerns with “in-kind” contributions
  • Long term rural workforce strategy – structured postgrad training pathways
  • Adjusting and responding proactively to ongoing university strategic and fiscal demands
  • Threat to reputation of some RCS with bids for new regional medical schools
  • Sustaining a clinical rural workforce for education as well as service
  • Increasing risk adverse concerns in the University impacting on Rural placements
  • Using RCS infrastructure for building rural career pathways
  • Positioning within wider University
  • Increasing rural content into curriculum
  • Recruitment and retention of general practices

Voices of the Region
Dr Kim Isaacs –UWA graduate 2008 / GP Registrar
  • All training completed in Broome. Committed to the region
  • Worked in Aboriginal Medical Services and in private practice
  • Enjoys being a doctor, can make a difference, people are grateful to have a doctor, aboriginal patients like to see aboriginal doctors
  • Outlined the key health issues facing the Aboriginal community in Broome
  • Broome lacks sub specialists. Some fly in / out. Patients do not like having to travel to Perth
  • In 2006 the Yawuru people won Native Title; the Yawuru continue to be traditional people, hunting, gathering and ceremonies
  • It is important for Aboriginal medical students to go home to see family, attend funerals
  • Financial issues are a big problem for both Indigenous and non Indigenous students

Mr Stephen ‘Baamba’ Albert - senior community leader in Kimberley

  • Worked in education and health for many years
  • Pleased to see the increased number of Aboriginal people undertaking tertiary studies
  • Important to have pathways to tertiary education for disadvantaged white Australians as well as for Aboriginal people
  • Education and Health go hand in hand
  • Important for medical students / doctors to understand different ways of communication
  • Eight different language groups in Broome - it could be helpful for doctors to have lists of the different languages spoken in the region

Dr Stephanie Trust - Kimberley Aboriginal Medical Services Council (KAMSC)

  • Long journey to Medicine – Enrolled Nurse, Aboriginal Health Worker, Doctor
  • Regionalisation of services / program delivery
  • Population Health Programs – ensure clinicians on the ground have support needed to deliver

Cultural Competencies in Medical Training
Refer Attachment 2
Dr Catherine Engelke - experiences in medical school
  • Nurse & Midwife in the Kimberley, before studying Medicine
  • Works in a remote clinic 2 days a fortnight; many people come to see the Aboriginal doctor Talk, tell stories, see her as a doctor
  • AMS – is culturally appropriate, culturally safe
  • In the Healthcare system people are caring but many missed the point; suggested other ways of doing things
Cultural Competence Continuum
  • Cultural Destructiveness eg Stolen Generation
  • Cultural Incapacity eg: lice checks different for aboriginal kids and white kids
  • Cultural Blindness eg: Princess Margaret Hospital, nurses believing an Aboriginal mother was neglectful of her 18 mth old baby in hospital, while not understanding that she had 4 other children to care for at home and believed her baby was being well looked after
  • Cultural Pre-competence eg: token Aboriginal person in workforce – employing an Aboriginal Health Worker, but not educating staff at the hospital about their skills (as competent as an EN or RN)
  • Cultural Competency eg: Remote Clinic Pap-athon – run over 3 days with different age groups on each day so that young women do not feel uncomfortable sitting in the waiting room with their mothers and grandmothers
  • Cultural Proficiency – still long way to go, still learning

Assoc Prof Clive Walley - what Cultural Competencies do we want in our students?

  • Distinguish between Aboriginal and Torres Strait Islander people
  • Start developing relationships
  • Good doctors / Principled approach / Include community perspectives
  • Experiential Learning - Rural, remote and urban immersion
  • Work with allied health professionals – colleagues
  • Understand language groups / kinship groups
  • Strong sense of professionalism and social responsibility
  • Learn from mistakes
Prof Lyn Henderson-Yates – How important is institutional governance in the attainment of these competencies? A regional university perspective
  • Important for Universities to mandate cultural competencies - Secures integration in delivery of program
  • Graduates competent to practice medicine and work with ATSI people
  • Listen, understand, practice compassion and commitment
  • Respond to health needs of ATSI people
  • 47.7 % of the population of the Kimberley are Aboriginal; 200 communities, 34 languages
  • Serious disadvantage and health issues / Unmet health needs
  • Treating using western methods alone won’t improve Aboriginal health
  • Central to improving health is Aboriginal culture - Ngarlu – treat whole person

Professor Sarah Strasser - Assoc Dean Flinders NT - the experience in other medical schools

  • NT program is what success is all about
  • Positive affirmation for Indigenous students
  • Aboriginal Health in the NT is mainstream

Fiona Pacey – Faculty Manager, University of Western Sydney - The experience in other medical schools

  • Rural program and Indigenous health placement developed alongside the course
  • Wonderful and exciting being involved in a community
  • Family structures / history and policy and how influences health
  • Treat person not the issue; allow patients time to tell their story

Panel discussion: what policy changes are needed to progress cultural competencies in RCSs?

Key Points

  • Speak up when see people missing the point
  • Acknowledge diversity of Aboriginal and Torres Strait Islander people / dangers of stereotypes
  • Graduates should be able to work in all forms of health care in culturally appropriate way
  • Importance of treating the whole person – mental, physical, spiritual health - Ngarlu

Engagement: Placements with Aboriginal and Torres Strait Islander People
Prof David Atkinson & Dr Christine Clinch - ways to make the placement a positive one – a Western Australian perspective
  • UWA - Aboriginal Health specialisation unit – elective; vertical & horizontal integration of aboriginal health throughout the medical degree
  • Students, unique and intimate engaging placement within Aboriginal community and organisation
  • Interest for specialisation begins in 2nd year; semester long unit
  • 3rd yr – placement; if urban setting, one afternoon a week or 2 weeks during holidays
  • 4th yr – whole general medicine rotation undertake case study of Aboriginal patient; students have to talk with patient, complete medical and social history, examination, pick one topic and do a clearly referenced paper
  • Can follow up with Aboriginal health research topic chosen by CAMDH; approved by University
  • Kimberley established with partnership with AMS; deep immersion in Aboriginal health
  • Reciprocal relationship between KAMSC and University; Kimberley wanted more doctors and RCS wanted something student placements in AMSs
  • Vertical integration very important; core is to improve rural medical workforce and aboriginal health medical workforce
  • Select Aboriginal students who could succeed and prepare them so they can succeed; plenty of ability – need to recruit, nurture and support
  • CAMDH & School of Indigenous Studies – strength in co-location
  • Start young. Health career workshops - Yr 8 Discovery day; follow the Dream, Yr 10 camp, Yr 11 – 12 guide pick the right streams
  • Aboriginal specialisation - clarity around expected outcomes – not a clinical placement, learning from ground up, dealing with Aboriginal people
  • Opportunity for Aboriginal health / transferable to other indigenous groups internationally - biennial conference; representative nations Canada, New Zealand, Hawaii, North America

Key Point

  • If you can get it right for Aboriginal people you can get it right for anyone, no matter what skin colour, language, race.

FRAME Business Meeting
Commonwealth Department of Health and Ageing (Padmaja Jha, Director Regional Training Models)
Review of Health Workforce programs - Independent review of DoHA Health Workforce Programs by Jenny Mason has been submitted to the Minister and is under consideration
  • Key Issues - integrated regional training network / vertical integration model / RA Classification system

RCTS Program

  • Minister has agreed to a 1 year extension of RCTS program; RCSs will be offered a Contract Variation until June 2015
  • End of Year Reports all in on time; currently being assessed and payments released accordingly
  • RCTS program generally held in high regard
  • Marked improvement on all parameters
  • Parameter 4 - Responded to concerns / Looking good for 2013; 2012 nearly 30% rural intake.
  • Parameter 7 – High on government’s agenda; RCSs looking for better ways of reporting all areas of activity
  • Parameter 8 – acknowledgement that it’s a long term investment; success of the program / students returning to practice in rural areas
  • Need to standardise data; analyse trends – MSOD data, AHPRA website
  • Unspent Funds – RCSs are encouraged to ensure funding is spent in the financial year; difficult to carry over funding from one year to the next
  • No increases in funding for infrastructure in current climate
  • No change to parameters in extension of contract
♦ DoHA to liaise with FRAME to develop Template to report on Parameter 7 more comprehensively
♦ Collate available evidence and utilise FRAME website more effectively to provide information about the success of RCSs
National Medical Training Advisory Network (NMTAN)- Health Workforce Australia (Judi Walker)
Five key elements of National Medical Training Advisory Network Discussion Paper
1. Training of the medical workforce should be matched to the community’s requirements for health services, including where those services are required geographically and in what specialty
2. Matching supply and demand for medical training should recognise the changing dynamics of the healthcare system over time, including advances in service models and workforce development trends
3. Medical training should be provided in the most cost effective and efficient way that preserves the high quality and safety of Australia’s current training system and the sustainability of the health service delivery system
4. Training requirements should be informed by relevant and up-to-date information about future service needs
5. Training places for Australian trained medical graduates should be prioritised over immigration of overseas trained doctors to fill workforce gaps in responding to short and long-term workforce need
  • Training plans to be informed by analysis of quality data sources / future workforce supply
  • Need to be organised to respond in timely fashion
♦ Chair to advise Chair NMTAN that FRAME Task Group of Sarah Strasser, Joe McGirr, David Campbell, Lucie Walters, Ruth Stewart & Nicky Hudson will provide responses to future requests
Independent Hospitals Pricing Authority Teaching Training & Research Working Group (Judi Walker)
  • Introducing system of activity based funding for teaching, training and research - difficult to quantify in terms of outcome
  • Public hospitals and public health services moving from block grants to activity based funding by 30 June 2018
  • Consultant engaged to draft Discussion Paper
♦ FRAME Task Group of Sarah Strasser, Jennene Greenhill / Rachel Dyer, Craig Zimitat and Lesley Forster to review discussion paper and the FRAME response

DAY 2: Friday, 10 May 2013

FRAME Business Meeting continued

Issues Raised from Day 1
  • Extension of funding contracts to June 2015
-          Parameter 7 - Develop structure for better reporting
-          Parameter 8
-          DoHA might be able to pass on some indexation
-          Don’t need to do end of contract report in June 2014
-          Extension will enable recommendations from Review of Health Workforce Programs to be analysed and impacts of changes reflected in new Funding Agreements
-          Future funding will be via one overarching agreement with each university with all health workforce programs under one funding agreement.
  • Parameter 7 - more comprehensive reporting could incorporate:
-          Activities around cultural competencies for students and staff
-          Integration of RCS programs with other indigenous health programs in faculty or university
-          Relationships with Aboriginal Medical Services
-          Collaborations across Rural Clinical Schools
-          RCS connections with local external organisations
-          Meeting Indigenous curriculum framework, supporting MDANZ work
-          Community engagement at the local level – employment of professional and academic staff, engagement in curriculum design, recruitment of local aboriginal people into courses
-          Students’ attitudes towards aboriginal people – the programs ability to change cultural attitudes over time
-          Outcomes directly attributable to RCS funding and what we collaborate on with wider schools and faculties
Potential tools:
-          Tool to use to evaluate own program; matches across core competencies; address gaps;   overarching frameworks
-          Berendht Report
-          LIME guidelines
  • Parameter 8
-          Reporting evidence base
-          Use AHPRA
-          Rural clinical schools and rural medical schools – setting up working groups to track rural medical graduates; datasets are available; share information and how well it’s working
-          Difficult to persuade rural clinical staff to undertake research; many opportunities not capitalised on eg: MABEL - Medicine in Australia Balancing Employment and Life
-          Encourage RCS staff to look at MSOD and MABEL, pick a topic to write about
-          Publish case studies; report outcomes data on FRAME website

Charles Sturt University Rural Health Conference 24 May 2013 - Canberra
  • There was detailed discussion covering the background to the issue which directly affects University of Sydney, University of NSW, University of Western Sydney, Notre Dame Sydney, Monash University and University of Melbourne
  • FRAME members to contact their local politicians as appropriate and ensure good news medical student recruitment and graduate outcomes stories are publicised
  • ARHEN and FRAME to work collaboratively to respond to this and similar issues
♦ Judi Walker, Nicky Hudson & Lesley Barclay to liaise about FRAME – ARHEN response
If required FRAME members agreed to contribute an agreed level of funding toward engaging the services of a skilled campaigner
  • Fourteen RCS and RMS Directors responded to the Aims of FRAME /Future Structure survey which included a revised draft of the aims of FRAME
The final version of the Aims of FRAME document was endorsed and will be mounted on the FRAME website
Moved: Lucie Waters; seconded Daryl Pedler
Refer Attachment 3          
Future Structure of FRAME
  • Four Options were proposed in the Future Structure survey:
-          Option 1 Do Nothing was preferred by 3 universities
-          Option 2 Fully Incorporate – overwhelming agreement that this was not the way to go due to financial constraints and complexity / diversity of RCS / RMS
-          Option 3 Collaborate with another organisation was preferred by 4 universities – other organisations suggested included ARHEN, MDANZ, NRHA, ACCRM, RACGP
-          Option 4 New Model – there were no suggestions for a new model
FRAME Policy group to negotiate with potential partners and develop proposal around Option 3 including costing for a two year trial period

RCTS End of Year reports
  • The survey included two questions about publication of End of Year Reports
  • The majority of RCS / RMS were not comfortable with sharing financial reports, but happy to provide a summary responses to Parameters for publication on the FRAME website
Research Group through Jennene Greenhill to develop Report summary template for all RCS / RMS to populate prior to publication via the FRAME website
FRAME – MSOD Study (Lucie Walter)
Refer Attachment 4
FRAME Members to email Lucie Walters with ideas / opinions re appropriate tool for measuring Cultural Competency or inter-professional competencies
2012 FRAME Survey results to be put on the FRAME website
eJournal of Rural and Remote Health (Amanda Barnard)
  • RCS, UDRH & ACRRM contribute financially to the eJournal of Rural and Remote Health
  • New Editorial structure - Regional Editor and two Associate Editors (succession planning)
  • Associate Editors will have an interest in following manuscripts from submission through to publication & ideally will have published themselves
  • New Reviewers are required. Current Reviewers are reminded to advise the editorial team straight away if they are unable to review a manuscript.
Expressions of Interest for Associate Editors to be posted via FRAMAIL
FRAME Research Working Group (Jennene Greenhill)
  • FRAME Research Development Workshop to be held at May 2014 meeting with a focus on parameter 8 (evidence)
  • Members of FRAME to showcase research, grants, publications
  • RCS Round Up – survey of achievements 2012, to be repeated in 2013 - findings on the FRAME website
  • AHPRA database tracking from 2014.
  • Parameter 2 – Statistics re RCS staff - results of online Survey (Kumara Mendis)
    • 41 completed
    • Ages 31-65, average age is 50
    • Background 53% urban, 47% rural
    • Professional 38%, academic 59%
    • Average 6 years service
    • 85% RA2, 3
    • RCS staff believe in what they do – are passionate about training rural doctors for the future
    • Longer survey to be developed; Publish results
    • Encourage all RCS staff to join FRAMAIL – respond to survey
    • Ask staff to identify whether Aboriginal or Torres Strait Islander

Academic Partnership with ACRRM (David Campbell)
  • Current trend among junior doctors towards sub specialties is of concern.
  • Reiterating importance of generalism – home of generalism is rural practice.
  • Considering strategies that have workforce outcomes around generalism - GP proceduralists, general surgeons, physicians
  • Current President of College of Physicians is a general physician at Wangaratta – working towards more generalist outcomes
  • ACRRM keen to work with FRAME and RCSs on policy development in this area
  • ACRRM major driver behind rural generalist programs in QLD and other states
  • HWA focus on national program for rural generalist training
  • Opportunities politically to be driving the concept of vertical integrations pathways to rural general practice. What policy changes are required? What should be the governance arrangements?
  • RCSs could become fund holders for GP Proceduralist training program and specialist training program
FRAME members are encouraged to attend the ACRRM conference in Cairns, October 30
Rural Medical Generalist Program – HWA (Judi Walker)
  • Richard Murray & Judi Walker on Project Advisory Group
  • Discussion paper to be released soon for comment
FRAME Task Group consisting of Ruth Stewart, Lucie Walters, Geoff Nicholson & Patricia Stuart to prepare response to discussion paper

New Business
  • Looking to progress the work of the Prevocational Training Policy Advisory Committee (PTPAC) and review of PGPPP (Provider) Guidelines
  • Request for FRAME representation
  • FRAME previously represented by Professor Lesley Skinner and Rosemary Ingham
Prof Amanda Barnard to represent FRAME on the PTPAC
Amanda to nominate an Alternate
Regional Clusters
  • Victorian RCS Collaborative Forum has been formed since the last FRAME meeting – Monash, Melbourne & Deakin universities
    • Useful, informal meeting
    • Collaborative project – measuring graduate outcomes as group of Victorian rural medical schools
    • Difficulties recruiting a Professors of Rural Health Research - considering collaborative approach for visiting professorial fellow
FRAME Research Working Group to consider short term visiting fellow positions rotating through RCS to undertake research projects
  • Top End – Regional consortium - JCU & Flinders NT
    • Greater Northern Australian Regional Training Network – covers top half of Australia, north of the tropic of Capricorn up and whole of NT and funded through HWA
    • Looking at particular issues across jurisdictional borders; transient population
    • Aboriginal health practitioner career pathways mentorship, vocational training, centre of excellence based in NT
    • Consolidate recruitment of junior doctors, not duplicate effort, be cost effective
    • Map accommodation that is available for students from all health professions across Top End
Regional clusters encouraged to post communiques on FRAME website
UDRH – Rural Pharmacy Liaison Officer program
  • Contracts have been extended until June 2014
Announcement of new regional university for Victoria – Gippsland
  • Agreed to by Councils of Monash & University of Ballarat
  • New regional university to be formed from 1st Jan 2014
  • School of Rural Health remains with Monash University and will continue to offer the graduate-entry MBBS program from Churchill campus
2014 FRAME Meetings
May 2014 – Port Lincoln, jointly hosted by University of Adelaide and Flinders University
October 2014 – Uluru, in conjunction with the NOSM/Flinders Muster
  • Structure and content for Port Lincoln conference.
Suggestions included:
  • Focus on rural medical curriculum and Parameter 8 – evidence
  • Research Pre-workshop – anybody at any level welcome to enrol – send brief research CV, consider how to pitch, Pre-reading tasks
  • Structure the meeting like a conference, with a widely varied program that engages everybody, both professional and academic staff
  • Ask student groups to come up with a topic
  • Focus on the benefits of Partnership – panel situation –hospitals, medicare locals, etc
  • Consider half day session for Managers on Friday afternoon – professional development
  • Include new media to promote success stories and things that are working –Digital story telling – short 2 or 3 minutes – put on-line - Samia Goudie ANU to facilitate
Website and Social Media
Make the FRAME website more active and interactive – Twitter, Facebook
All members to ensure they are registered for FRAMAIL