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Port Lincoln May 2014 Minutes

Represented at the meeting:

University of Adelaide

Australian National University

Deakin University

Flinders University

James Cook University

Monash University

University of Melbourne

University of Notre Dame

University of Queensland

University of Sydney

University of Tasmania

University of Western Australia

University of Western Sydney

University of Wollongong

Commonwealth Department of Health

University of New South Wales

National Rural Health Student Network

Medical Deans of Australia & NZ







DAY 1: Thursday, 8 May 2014

Traditional Welcome to Country
Emma Richards, Indigenous Project Officer, University of Adelaide and her son Kaden welcomed participants on behalf of the Parnkalla people
Welcome and Introduction to the FRAME Meeting
Assoc Prof David Mills gave an overview of Port Lincoln and the joint program with Flinders University in the Barossa.
Participants including the Dean of Medicine and Head of Medical Education, University of Adelaide were warmly welcomed to the meeting.
Apologies were noted from Prof Nicky Hudson (University of Newcastle), Prof John Wakerman (Flinders NT), Assoc Prof Pascale Dettwiller (Flinders NT) and Assoc Prof Suzanne McKenzie (James Cook).

Update from Commonwealth Department of Health, Health Workforce Division
Refer Appendix 1 in Documents
David Meredyth, Director Regional Training and Education Reform, Health Workforce Division, Commonwealth Department of Health
Mr Meredyth was pleased to see new faces as well as friendly and familiar faces as an encouraging sign of sustainability of leaders.
Overview of restructured Department of Health
  • Mr Meredyth provided an overview of the restructured Department of Health and revised roles and responsibilities.
  • The Regional Training and Education Reform Section (RTERS) works collaboratively to connect different levels of training. It shares responsibility for rural health multidisciplinary training with Grant Services.
  • Administration and grant management is the responsibility of Grant Services, whilst policy is the responsibility of the RTERS.
  • The Department is currently reviewing the Commission of Audit document.
  • There are Recommendations relevant to the health education sphere, but the impact will not be known until Budget has been released. The report recommends centralisation of some functions to look for efficiencies and avoid duplication in this tight fiscal environment.
Key priorities for the RTERS
  • Primary care workforce measures.
  • Doubling PIP payments to $200 per teaching session.
  • Scholarships in Nursing and Allied health.
  • Commonwealth funded intern positions ($40 mill over 4 years)
Future for RCTS Program
  • The impact of current reviews on rural health education programs and policy is not yet clear.
  • RTERS is working closely with Ministers Nash & Dutton.
  • Important for existing programs to promote their outcomes to government – educational value and evidence-based, around workforce distribution and benefits to rural communities.
  • New program funding is unlikely. It is essential to get value out of existing resources and leverage existing infrastructure.
  • Ministers Nash and Dutton are keen to look at opportunities for the medical training pathway and pipeline / vertical integration. A number of good proposals have been received. The government has accepted the policy argument and is now looking for realistic, detailed proposals around funding, coordination and management.
RCTS Reporting
  • The Department is keen to receive short reports, targeted to parameters. It is not necessary to include excessive detail, focus on parameters and targets, what’s working and what’s not.
  • Expend funds in the financial year allocated (use it or lose it) – parameters are broad and allow for a lot of activities – opportunities to be more innovative if operations are efficient and running a surplus.
Rural Placement Information Project (See Appendix 1)
  • Creation of a single, comprehensive Rural Placement Information website is the first step in building a better rural training pathway.
  • Participation by Rural Clinical Schools shows the government and senior Department staff the capacity of RCSs to do more, do it well and at no extra cost.
  • RCSs have the connections at the local level to engage with training providers, identify “hot spots” – well integrated training pathways and Identify gaps.
  • Students are interested in information that will enable them to continue their training without having to return to the city.
  • The functionality exists and can be modified to include more data - Districts of Workforce Shortage, training support and incentives, Enhanced map of medical placements, opportunities and contact information. It is essential to have a real person to talk to regarding positions and identification of the best contact person is key.
  • The next step is for the Department to design a template and circulate to RCSs & UDRIHs for feedback. The process should not be onerous and the Department wishes to move quickly to collect the data, modify the website, test internally then launch.
Questions and Discussion
  • Types of positions to record – accredited, funded, not filled.
  • Keeping the database up to date? The Department will request updated information on annual basis. The website will include a disclaimer around the need to speak with the contact person to confirm information and availability.
  • The website will be restricted to medical training in its initial phases with potential for expansion to include multi-disciplinary training places.
  • There is a role for RCSs in brokering opportunities.
Action: David Meredyth to circulate template to RCSs for feedback.
General Questions
  • Remote Area Classification Review – The government is still interested in the idea, which was a major feature of the Review of Health Workforce programs.
  • Budget & Funding - The Department is aware that Funding Agreements will expire 30 June 2015. The Government’s agenda is around streamlining, reduction of regulations and red tape, and reporting. Timing is difficult with budget uncertainty and contracts expiring. Re-funding processes are not simple.
  • There may be a role for FRAME to review the appropriateness of parameters, and provide collaborative feedback.
  • Refining Reports - diversity in the program is one of its strengths. Outcomes focussed parameters will allow flexibility, as long as the program is meeting its objectives & workforce outcomes.
  • Merging of UDRH and RCTS programs – would the Department be interested in a proposal on how it could be done at the local level? It is important to ensure there are not unintended consequences of the streamlining agenda.

NRHSN Report
Refer Appendix 2 in Documents
Student Representatives – Tara Naige (2014 NRHSN Co-Chair) and David Khoo (2014 NRHSN Medical Portfolio Representative)
  • The NRHSN aims to provide a voice for students who are passionate about rural and remote health.
  • There are 28 rural health clubs throughout Australia with over 9000 members.
  • The NRHSN provides exciting and inspiring opportunities to encourage students to think and act rurally:- short or long term placements, scholarships, conferences in rural regions, rural high school visits, Indigenous festivals, local events – social evenings, camps, trips, clinical skills weekends.
  • The NRSHN develop policy and provides advocacy on key issues from a student perspective.
  • Representatives from the NRHSN attend and present at conferences of national significance, and leadership seminars.
  • NRHSN provides Alumni support through email communication and a bi annual newsletter. The Executive acknowledge that Alumni support is an area that requires more focus. As there are very few opportunities to train in rural and remote areas, graduates are moving back to city and establishing roots.
  • NRSHN hopes to pursue engagement, encourage post graduate training in rural areas, attendance at conferences, meeting rural health professionals and remaining in environment to think about rural health in the future.
  • One of the strengths of the NRHSN is that it is multi-disciplinary and encourages the importance of team work amongst health professionals.
Questions and Discussion
  • There is varied involvement and engagement between RCSs and the rural health clubs at different universities. The NRHSN encourages clubs to go to rural locations. There is often a disconnect between Schools and the student club. The NRHSN has prepared a collection of documents to be delivered to Presidents of student clubs with the intent of encouraging engagement with Schools.
  • It was suggested that Rural Clinical Schools should also approach their student clubs and discuss ways to engage.
  • NRHSN is interested in working collaboratively with FRAME on the development of rural training pathways / training opportunities in rural areas.
  • FRAME can assist the NRHSN by providing positive rural experiences for students. The NRHSN’s “Optimising rural placements” guide – outlines what students think is important to provide.
  • Ausframe provides a mechanism to access stakeholders, opinions and could be a resource for the student group.

FRAME Structure - Proposal
Refer Appendix 3 in Documents
Professor Judy Searle, CEO Medical Deans of Australia and New Zealand and Professor Judi Walker, Chair FRAME
  • Prof Searle and Walker presented an updated version of the proposal that was discussed in Canberra, October 2013.
  • The document has been refined in line with comments from FRAME members.
  • The document outlines the proposal for a strategic alliance between FRAME and Medical Deans Australia and New Zealand (Medical Deans) that would provide administrative support for FRAME whilst enabling it to maintain its core business.
  • Key issues for FRAME are ongoing advocacy and effectiveness as we move into a different policy and funding environment.
  • Underpinning principles of the alliance with Medical Deans are that Rural Clinical Schools maintain their unique identities, core business and local networks and continue to share best practice, expertise and activities. The alliance would be transparent and flexible and enhance medical schools’ expertise in rural, regional and remote medical education.
  • Engagement with Medical Deans will allow for operationalization of the aims of FRAME and objectives of MDANZ; improved national and international advocacy; Secretariat infrastructure; data collection to assist with providing evidence of workforce outcomes; Shared expertise in indigenous medical education, social accountability and community engagement and the opportunity to look for joint income generation.
Questions and Discussion
  • An alliance between Medical Deans and FRAME provides opportunities for a shared culture, strategies and operations and to utilise academic backbone for rural Australia to its full potential.
  • The alliance would enable FRAME to receive a grant, employ a project officer, make appointments with Ministers.
  • There has been a change within the group of Medical Deans in recent years and they now include both a social accountability and a rural health agenda.
  • It was suggested that any alliance must build in oversight and include a review period.
  • In the past, success for rural meant that rural should stand alone. It was feared than in an arrangement with an organisation where “rural” was not the central focus would result in a risk of FRAME activities being diluted.
  • Some strengths of an alignment include opportunities to expand on the MSOD dataset, and links with Indigenous health education networks in New Zealand.
  • Whilst FRAME has enjoyed the collegiality of being a loose collective, it was agreed that more structure would enable FRAME to employ staff and enter into agreements. It was also acknowledged that it was costly to become an incorporated body.
  • Medical Deans provides a platform to attract funding for initiatives.
  • The governance structure needs to address risk & include explicit processes for conflict management / resolution. It is important for FRAME to maintain its independence.

Port Lincoln Focus - The Ripple Effect
Refer Appendix 4 in Documents
Emma Richards, Indigenous Project Officer, The University of Adelaide
  • Ms Richards became interested in research after undertaking an “Introduction to Research Methods” course and assisting with data collection for the Linkin Health Census in 2010.
  • Ms Richards became a Team leader, encouraging Aboriginal people to be involved. Through respectful methods of data collection, the Aboriginal Community was proud to be involved. They received feedback and had a sense of ownership. This highlighted the benefits of research.
  • The Ripple Effect arose out of the data from the Linkin study that showed Aboriginal youth were struggling with the physical and emotional changes and peer pressure leading to unhappiness and difficulty focussing on education and positive relationships.
  • The focus of the study was a snap shot look at the social and emotional wellbeing of Aboriginal youth and the ways this affected their schooling and transition to employment.
  • Benefits of the study included baseline sample data of Indigenous youth issues and how it can affect their education and information for parents, service providers and the community that can be used to develop or design further programs and projects.
  • Ms Richards created a painting (Wilya Moolga – The cry of the soul) to symbolise the Ripple Effect - The eye is youth or parents crying at a time of distress. The cry creates a ripple effect. The first circle is family, the 2nd circle of spirits represents youth on a journey with options and choices. The blue arcs and ripples are options and choices – good choices turn the issue around positively, if not they go around in a negative circle.
Questions and Discussion
  • Aboriginal culture provides different ways to support youth eg decisions by a mother are backed up by a grandmother.
  • Traditionally, Aboriginal children have not been involved in Port Lincoln’s fishing industry. This is changing by acknowledging different learning styles and providing options eg: Flexible Learning Program (FLOW) keeps youth connected to high school, supports Aboriginal and non Aboriginal children.
  • Aboriginal and non Aboriginal youth have completed one month’s training at the Australian Fishing Academy and are finding employment in the industry. The successful completion of this certificate has come about tough acknowledgement of different learning styles and has given the participants increased confidence.
  • Boredom was identified as a key issue in the study. Youth often require assistance to identify their interests. Parents and the community need to provide positive reinforcement and remind youth they have potential.
  • It is important to be role models for our children, and show them what it is to live and work, and secure their future.
  • Ms Richards has been able to help change the negative image of research within Aboriginal communities through inclusion, consultation and engagement.
Action: Add information on the “Basic Research Methodology” course offered through the Aboriginal Health Council of South Australia to the FRAME website.
The Ripple Effects Workshop
Participants used a “Yarn card” to stimulate discussion on the 10 key factors that arose from the Ripple Effects study and consider opportunities for research in their universities.
  • Boredom.
  • Drug & Substance Abuse.
  • Lack of Support.
  • Income, Finances and Funding.
  • Employment and Training.
  • Access and Equity.
  • Depression, Grief and Loss.
  • Emotional Management.
  • Relationships.
  • Peer pressure.
Discussion Points
  • Need for outcomes based curriculum.
  • 10 key factors are intertwined – in some communities one issue may be more prevalent than another.
  • Youth identified that support from teachers could assist with keeping them engaged in education.
  • Teachers need to encourage to students to catch up after missed days or they lose confidence and are ashamed to go back into the classroom.
  • Boredom refers to needing a sense of purpose or meaning - Focus on education / Learning styles.
  • Lack of support - Interventions are often short lived, then finish, need to make support sustainable.
  • It is difficult to provide positive role modelling when there is so much exposure to the internet and external influences.
  • Ms Richards encouraged FRAME members to think about projects in their own areas, engage with and employ Aboriginal people, develop employment opportunities and ability.
Research Ideas
  • Peer pressure – are Aboriginal youth influenced by their culture, is there a difference between Aboriginal and non-indigenous youth in terms of peer pressure?
  • Retrospective look at successful projects and what happens when funding finishes.
  • How can cultural issues and learning differences be identified in any learning environment and addressed in each environment for each student?

Rural Medical Training Pipeline (vertical integration) issues - National, State and Territories round up and Panel Discussion
David Meredyth, Richard Murray, Judi Walker, David Garne, David Campbell, Ruth Stewart, Geoff Riley, Georgia Von Guttner
David Meredyth
  • The Federal government is genuinely interested in the concept of vertical integration and the timing is right to progress. The government requires proposals for practical implementation rather than further discussion about the concept.
  • The Department has made significant investment in research on vertical integration. The RACGP has undertaken an extensive consultation process across states, and released a comprehensive report with rural training hubs a key theme. ACRRM has undertaken a similar project.
  • Training for GPs and Specialists have competing needs in the training space.
  • The debate around rural generalism and rural training pathways is similar but not the same.
  • The Department is open to thinking about what might work best in this tight fiscal environment. The Ministers are interested and engaged but the Commonwealth is not in a position to fund new positions in rural areas.
Richard Murray, ACRRM
  • ACRRM has prepared a position paper on the implementation of a national rural generalist pathway.
  • The paper applies a population health approach, focussing on rural doctors providing primary care, secondary care in hospitals and being able to respond to emergencies.
  • The paper includes a literature review and outlines key parts of the pipeline, how training occurs, factors around selection, information for graduates on surviving the junior doctor years, identifying purpose and sense of direction.
  • The paper is currently being circulated for consultation.
Action: Make the ACRRM report available on the FRAME website.
  • It was agreed that the Specialist colleges need to be part of the vertical integration discussion.
  • The Department has not funded Specialist colleges to look at rural training pathways, however the College of Physicians has received funding for some dual training positions.
  • Accreditation systems are starting to broaden. In recent times there have been applications for more accredited training posts than the Department could fund.
  • Surgeons in the Western district of Victoria have reversed the polarity with regionally based positions rotating to metropolitan hospitals. Physicians in Hamilton and Warrnambool are doing the same.
  • The FITCH project report, funded through GPET, has been submitted but has not yet been released.
Geoff Riley, WA
  • Western Australia remains metro centric with training revolving around the Royal Perth Hospital.
  • Between 2007 – 2014 not a lot has happened to further vertical integration.
  • A Committee of representative agencies has been formed and there has been some investment by the state government.
  • New training posts have been established but there is no real rural generalist pathway.
  • Kris Batty, from Rural Health West has been engaged to further the project.
David Garne – NSW
  • A proposal has been driven by graduates wanting to undertake internships & vocational training in rural settings but the places aren’t available.
  • The proposal builds on existing infrastructure in 10 hubs – 1 regional and 9 rural and investment in human capital.
  • The proposal has been submitted to the Federal government for funding for 3 key academics in the hubs – a general surgeon, general physician and general practitioner to facilitate training of graduates from any medical schools wishing to train in a rural setting.
  • The Clinical Academics would also contribute clinical service to the areas and provide supervision to increase capacity.
  • The proposal is contingent on funding..
  • NSW is working in collaboration with other health services, Colleges, Medicare Locals, ICTN, to encourage further training opportunities.
  • The proposal is strengthening medical education linkages, academic links, research links and program evaluation is an important component. It is also tailored to the various hubs’ unique flavour and needs.
Richard Murray & Ruth Stewart, JCU, North Qld (See Appendix 5.1 in Documents)
  • The Northern Clinical Training Network connects regional sites, providing critical mass and linkages in areas of common interest.
  • The network provides integrated medical training towards a specialty career in the tropics.
  • Clinical Deans provide leadership across the links.
  • Students are selected on rural merit and aligned with a rural scholarship.
  • There are close links with undergraduate training, rural generalist training and GP Training.
Georgia Von Guttner, Murray to Mountain program, Victoria
  • Monash & Melbourne universities’ Extended Rural Cohort undertake longitudinal clerkships for 1 year with GP Medical Educators provide training in small regional hospitals.
  • The Murray to Mountains program was established in 2012 and is funded by the State government as part of the Victorian Rural Generalist Program and through PGPPP funding through Bogong Regional Training Network.
  • In 2012 5 interns participated in the M2M program and 4 have stayed in the region.
  • In 2013 10 interns participated in the program and recruitment for 2014 is underway.
  • There has been a great deal of interest in the program from RCS students.
  • Selection is focussed on rurality and commitment to rural practice.
  • The outcomes have been positive with regional hospitals having joint stands at intern recruitment and joint selection panels.
David Campbell, GRIT Gippsland Regional Intern Training Program
  • 10 intern places are funded for a full year in Gippsland.
  • The majority of GRIT places are filled by graduates from Rural Clinical Schools.
Victorian Rural Generalist Programhas been in place for 3 year.
  • 10 rural generalist training places.
  • In Gippsland the model focusses on obstetrics training via the Advanced DRANZCOG with basic anaesthetics, paediatrics and psychiatry.
  • Regional trainees spend time in metropolitan hospitals to top up learning, eg: Northern Hospital for caesarians.
  • Funding has now been received from the Victorian Department of Health to establish a community base intern model. $130,000 per intern. A total of 20 places across Victoria.
  • East Gippsland Community Based Intern Model: 5 intern places for Sale and Bairnsdale to undertake core rotations in medicine, surgery, emergency medicine and 20 week community based placement.
  • The model will be in place for January 2015 subject to accreditation.
Judi Walker, Victorian Regional Medical Training Network (See Appendix 5.2 in Documents)
  • The proposal is unique in that all 3 Victorian medical schools are working together.
  • Promoted as a solution to the maldistribution of medical practitioners.
  • Leverages off investments in RCTS program, PGPPP, GP Training Program and Specialist Training Program.
  • The proposal aims to bring together the different training programs and take advantage of the increasing numbers of rural medical graduates who want to stay rural.
Lucie Walters, South Australia
  • Mt Gambier has a hospital training program for junior doctors - 6 interns are funded for PGY2 and trained in paediatrics, anaesthetics, emergency medicine and obstetrics.
  • The pipeline is producing an oversupply of rural generalists in the region. There are not enough registrar positions so graduates are migrating to western Victorian and the rest of SA.
  • Mt Gambier is unique in that it has a large resident specialist population.
  • A community based internship program in the Riverland was developed 5 years ago, but was unsuccessful in achieving accreditation. There is currently a hybrid rural hospital / community based 20 week GP placement under consideration. 5 interns based for a full year in the Riverland.
  • The 2 universities, 2 rural training programs in SA and Southern GP Training are interest in progressing 2 proposals in SA for accreditation.
  • Region size needs to be determined by community need and critical mass.
  • The challenge is the shift from working only with rural GPs to working with Specialists.
  • Hub and spoke models preserve the uniqueness of regions but gains critical mass.
  • It is important not to cross referral boundaries.
  • As educational models take shape with pathways, there will be an impact on referral patterns.
  • It is a strength that vertically integrated programs rely on the same educators, but there is also potential risk of burn out of clinical teachers across the spectrum (depends on the model of teaching).
  • We need to move away from the assumption that all medical education occurs in office based practice. This is problematic with fee for service.
  • University of Adelaide final year students have an elective option of working in the “medicine learning and teaching unit” at the University of Adelaide. This involves teaching junior students, helping write exams, etc. and produces graduates with an understanding of the program, life long educators, registrars keen to be involved in junior doctor & medical student training.
  • Don’t expect more from existing people, add capacity to the region through academic leadership.
  • Shared educational infrastructure – Clinical Deans provide educational input – positive way to go.
  • Education reinvigorates a site and the community. Studies have proven that rural doctors are refreshed by having medical students and registrars in the town.
  • Rural Clinical Schools have a key role to play in brokering partnerships for training pathways.
Action: Provide David Meredyth with a summary of the discussion around vertical integration.

DAY 2: Friday, 9 May 2014
Feedback from Operational Managers’ Workshop (Amanda Croft)
The meeting provided an opportunity for RCS Managers to discuss issues and share ideas, develop support networks and problem solving.
Issues discussed included:-
  • The 12 month contract variation and how RCSs are struggling to do more with rising costs.
  • The possibility of a consolidated outcomes report from nation-wide RCSs to provide a perspective on the next funding period and parameters / KPIs. (For discussion with DoH).
  • Need funding quarantined (5% rule).
  • Capital infrastructure funding – needs to remain on the agenda for ongoing maintenance costs.
  • to the issue of programs funded by HWA if recurrent funding ceases.
  • Student tracking, graduate outcomes – it is important to report on successes and outcomes so that the DoH continues to invest in RCS.
  • Accommodation – everyone does things differently – some free of charge, some charge rent $100 - $150 / week, some don’t provide accommodation.. Some universities are outsourcing facilities management.
The group decided it is useful to have one meeting per year, prior to the FRAME meeting at a rural clinical site. Next time the administrators will meet for 3 hours and invite the Directors / Academics to join for a 1 hour summary at the end.
The administrators also requested that FRAME meetings be held in the last 2 weeks of the month, not the first.
Process for Elections (Judi Walker)
  • Each University has an academic Head of School or Director RCS program. These leaders are eligible to be Chair of FRAME.
  • Nominations for the Chair must be made prior to the Canberra meeting, with elections to be held in Canberra.
  • It was suggested that the outgoing Chair stay on for one year to assist the new Chair and handover corporate knowledge.
  • Policy Group. The Chair / Returning Officer has a role to review nominations to ensure balance in the Policy group.
  • Prof Walker encouraged FRAME members to discuss FRAME meeting outcomes at their School’s Executive meetings.
Action: Chair to write to Universities, advising Heads of Schools of the process for elections and put the process in place for 2015.

FRAME – MSOD Study (Lucie Walters)
  • 2013 had the most number of schools participating. Medical students completed the survey on exit from RCS, with a 93% return rate.
  • The FRAME survey is working well and the working party has reviewed questions and undertaken statistical analysis to exclude redundant questions and avoid repetition.
  • The next challenge for the working group is to turn the survey into meaningful research.
  • The greatest vulnerability is that there is no control group, no comparison group. It was suggested that city based students could be asked the same questions around clinical skills and cultural competence.
  • There will be very little change in the survey this year (2 additional questions) which should streamline ethics modifications.
  • An updated NEAF application form with tracked changes & comment (date modifications were approved) can be provided to assist with new ethics applications.
  • The University of Melbourne is using RCS evaluation tools to develop medical education unit evaluation for the whole MD program.
  • The consent form 2013 allows return of identified data on cohorts graduation. Can then track at the school level. Approval has also been received to use data from 2011 and 2012 in that way, even though the consent form was not explicit, it was deemed inferred.
  • 2010 data has not been found.
Research Working Group – FRAME SNAPSHOT Survey (Kumara Mendis) (See Appendix 6 in Documents)
  • The SnapShot survey was created prior to the Broome meeting in 2013, as a result of the realisation that there was a lot of literature about the outputs from RCSs, but no details about the staff.
  • The 3 minute survey asks 10 questions and provides an opportunity to give feedback.
  • The survey will remain open for a little longer to encourage more staff to complete it.
  • Results will be published
Action: Chair to email a reminder via FRAMAIL to all staff to complete the survey.
             Dr Kumara Mendis to send a summary of the survey results to each RCS / RMS to discuss with their School Executive and other places.

eJournal (Amanda Barnard)
  • Associate Editors – Nicky Hudson & Charlize Shaheed were recruited last year.
  • The eJournal encourages early career researchers.
  • Submissions to the eJournal have increased and there is a considerable backlog of articles to be reviewed.
  • The eJournal management committee is working hard to manage the increased interest and looking at how to fund the eJournal’s expansion. There is a core group of editors who are very committed to the eJournal.
  • Creation of an International / South American section adds more to the workload.
  • There is one international, two local reviewers for each article. Prof Barnard encouraged more FRAME members to nominate to be a Reviewer.
  • If looking for publication in an international journal - what are the implications / if reporting on local work, what are the lessons learned, refer to international literature.
IHPA Teaching, Training and Research Working Group (TTRWG) (Judi Walker)
  • Minutes circulated with the Agenda for information.
  • Prof Judi Walker represents FRAME on the working group and FRAME has been part of the consultation process.
  • Bruce Chater is on the Board of IHPA and Sandy Thompson from ARHEN is also on the working group. It is important for rural and regional public hospitals to have a voice.
  • The Working Group is very large, and the IHPA is targeted in the Commission of Audit.
  • It has taken 18 months – 2 years to get to agreed definitions of Teaching, Training & Research.
  • There is useful Information, including the workplan available on the IHPA website.

Leadership Program (Jennene Greenhill & Judi Walker)
  • The 4 day intensive program run in Broome last year was very successful.
  • The Snapshot survey indicates that Leadership training is worthwhile and Medical Deans feel it is an area that can be developed to generate income for FRAME.
  • It is an enormous amount of work to organise and run the Leadership Program. This may be easier with the assistance of a secretariat.
  • It was suggested that a mentoring program be developed from the Leadership program.
Action: Prof Jennene Greenhill, Prof Judi Walker & Ms Georgia Von Guttner to draft a discussion paper, outlining opportunities for the Leadership Program. The paper is to include financial modelling.
National Rural Health Alliance (Judi Walker)
  • The Chair is representing FRAME on the NRHA Council until the end of 2014.
  • A new representative will be required for 2015.
  • There are a large number of issues that aren’t strategic business for FRAME, but it is important to have membership. Education is only one aspect of business of NRHA.
  • There are 35 organisations belonging to the NRHA so it is often hard to get consensus from such a diverse group.
  • For key issues such as medical student numbers, FRAME has been able to make a positive contribution to discussion papers.
  • Prof Walker circulates relevant information via the Ausframe mailing list.
 Medicare Locals/Co-payment issues
  • The Commission of Audit has made recommendations regarding Medicare Locals.
  • FRAME members have varying degrees of relationships with Medicare Locals that enhance training.
  • The Australian Association of Academic Primary Care has released an evidence based statement about the impact of a $15 co-payment.
    The group discussed if there was a role for FRAME to respond to the issue of co-payments, as it will impact on the patient mix that students are exposed to.

Specific Issues from Day 1
FRAME Structure
  • It was agreed that the proposal will be refined in light of comments received and sent to designated University Heads / Directors to seek a response.
  • It was suggested that Heads talk with colleagues and put on the agenda at internal meetings.
  • Following approval by RCS Directors, FRAME will go back to Medical Deans to finalise details.
  • A 12 months trial period will be included.
  • FRAME will have a dedicated staff member (FRAME Project Manager) situated at Medical Deans Sydney Office utilising Medical Deans IT, HR, pay roll, office space.
  • Expert advice will be sought to ensure checks and balances are in place.
  • There were some concerns about dilution of FRAME’s effectiveness and mission.
  • FRAME’s presence within Medical Deans is a risk mitigation strategy, as it keeps rural on the agenda for the Medical Deans.
Action: Refine the proposal and distribute to Heads of Rural Clinical Schools, for ratification.
  • The student presentation raised opportunities for RCSs.
  • Students are interested in rural training pathways.
  • It is Important for students to understand FRAME’s priorities and its worthwhile for them to attend meetings and express opinions.
FRAME can:-
  • review the “providing positive rural training experience” document on the NRHSN website.
  • make contact with rural health clubs and build relationships were necessary.
  • work with the NRHSN to ensure the handover from one committee to the next is smooth and there is a good transfer of corporate knowledge.
  • encourage local rural student clubs to write handover manuals.
  • ensure there are local students at the FRAME meetings at rural clinical sites.
  • provide an opportunity for representatives from the NRHSN Executive to provide a brief report at the Canberra meeting.
  • Encourage DoH to include students in the trial of the Rural Placement Information website.
 Process for Negotiating RCTS Funding Parameters and other Issues
  • In the past DoH has been good at listening and making adjustments, however the processes have often been left to the last minute.
  • It was suggested that either the Policy Group or a working group, meet with the Department around the time of the Canberra meeting, to commence discussions about funding.
  • It is unlikely that the Department will start thinking about RCTS funding until the end of the year. RCTS will continue, but won’t continue as is. There will be no more money but RCSs will need to explore ways and means of leveraging off other activities, opportunity to be innovative and generate income
  • Funding parameters will be a priority discussion at the Canberra meeting.
  • The Administrators’ comment about the 5% rule was noted and it was suggested that it should be somewhere between 0-5%. (Policy group to discuss).
  • Alumni tracking work legitimises investment in RCSs and could become part of the parameters.
  • It is anticipated that the parameter around compulsory 4 week rural placements will change and it may be up to Individual universities to make the decision about short term placements.
  • Parameters might not be nearly so precise in an attempt to reduce red tape, and allow for simplification of reporting.
  • RCSs understand sub specialties and the need for specialist training and specialist registrar posts. FRAME could discuss parameters around specialist training. The RCTS program could absorb funding for specialist training currently going to Colleges and jurisdictions.
  • It was suggested that FRAME approach the Department for access to Medicare provider number data to support outcomes data
 Action: Funding parameters to be a feature item for the Canberra meeting.
             Each RCS to provide a summary of their thoughts around parameters and synergies.
DoH Rural Placement Information Project and mapping out training needs
  • There was some discussion as to the details of the project and concerns that data may quickly become out of date.
  • It is often difficult to get information about available jobs from medical superintendents, however FRAME members are well placed to ask the question.
  • It was agreed that it is essential to have a key contact person to provide accurate information about the post.
  • If the website is only to be updated twice a year, it was suggested this be done at an appropriate time, such as one month before students make choices.
  • Students should be involved in the planning process and provide input on where they would like to work if funded positions were available.
 Action: Continue discussions about the Rural Placement Information project via Ausframe.

Canberra Meeting, 18-19 Sept
  • The 2 day meeting will be held at ANU as DoH was unable to provide a venue.
  • Representatives from the DoH will attend.
  • Information and registration forms will go out closer to date.
  • It was suggested that FRAME host a breakfast for Ministers and senior Advisors.
 Flinders / NOSM Muster (Jennene Greenhill)
  • The NOSM / Flinders Muster will be held in Uluru from 27th – 31st October.
  • The call for Abstracts has now closed.
  • Key note speakers include Dr Agnes Soucat from South Africa, Ms Donna Ah Chee from the Cnetral Australian Aboriginal Congress, Dr Fortunato Cristobel from the Phillipines and Dr Patricia miller from the Central Australian Aboriginal Legal Aid Service, Dr Rachel Ellaway from NOSM and Prof Stephen Billet from UQ.
  • The event is very collegial and will allow participants to be immersed in Uluru with an excellent social program.
  • An icon in the program will flag relevant rural presentations but there will not a specific afternoon set aside for rural.
  • Profs Judi Walker, Geoff Riley and Amanda Barnard and Assoc Prof Ruth Stewart volunteered to Chair sessions.
Venue for May 2015
University of Melbourne, Shepparton, Wednesday 13th & Thursday 14th of May.
  • Time and room could be made available for a Leadership course or research intensive on Monday and Tuesday.
  • The Operations Managers will meet on Tuesday afternoon.
  • The meeting will be held at the Clinical School.
  • Shepparton is a 2 hour drive from Melbourne airport and has nice restaurants, walks, an art gallery and the Labyrinth.
Suggestions for May 2016
  • University of Wollongong
  • University of Qld, Fraser Coast Rural Clinical School, Hervey Bay
  • It was suggested that both universities prepare a presentation for the Canberra meeting where FRAME members will make a decision.

Other Business


  • It was suggested that a parameter be chosen to be the focus of each meeting.

 Research intensive

  • Positive feedback was received. It was a lot of work for participants and others who gave their time to be part of it.


  • FRAME is still collecting research publications and there is a link on the FRAME website.
  • 200 publications are listed so far.
  • Clinical Schools are encouraged to forward details of publications to Helen Peacocke (University of Sydney)
  • The Chair expressed her thanks to Helen Peacocke for continuously updating the FRAME website.