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Shepparton May 2015 Minutes

13 + 14 May 2015

Represented at the meeting:

University of Adelaide

Australian National University

Deakin University

Flinders University

Flinders NT

James Cook University

Monash University

University of Melbourne

University of Newcastle

University of New South Wales

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

National Rural Health Student Network Australian Medical Students' Network
Murray to the Mountains Intern Program
 Day 1 – Wednesday, 13 May 2016
Welcome to Country
Mr Neil Morris welcomed participants on behalf of the Yorta Yorta people.
Welcome to Shepparton
Professor Julian Wright welcomed participants to the University of Melbourne’s Rural Clinical School, Shepparton. Uni of Melbourne also has clinical schools at Ballarat, Bendigo and Wangaratta.
Welcome to FRAME
As the current Chair of FRAME, Professor Amanda Barnard welcomed everyone and introduced herself to those who were new to FRAME meetings and outlined the Day 1 agenda.
Update from RCS/RMS
Representatives from clinical schools gave a three minute presentation on the ‘End of the Triennium: Successes and Challenges’.
(Refer to Menu - Shepparton Documents)

Post Budget Update & Update on Consultations re RHMDT -

David Meredyth, Director, Rural Training Pathway section and Katy Roberts from Health Workforce Division, Department of Health
  • RTP section has a broad role these days - managing the Rural Training program, the Specialist Training policy and the Specialist Training Program. Also Junior Doctor, Training policy, involved in the current review of Intern training, Postgraduate continuing professional development programs and Rural procedural grants program as well as the Clinical training funding program.
  • Work in partnership with stakeholders
  • Keen to maintain stakeholder relationship, constant communication and on-going debate around how to continue to get the best outcomes
Health Budget update
  • Doesn’t contain huge packages as in previous years reflecting the current fiscal environment
  • New and reformed areas such as strengthening and modernising Medicare
  • Reshaping of Primary care to address the burden of Chronic Disease
  • Reaffirmed commitment to e-Health but wants to restructure how this will work
  • Focus on shortages of Doctors in Rural Australia
Budget Key measures
  • $485 million to fund operation e-health and re badged as the My-health record. Aim to increase numbers and to be embraced by both patients and the profession
  • Review of the Medicare benefits schedule and review of MBS items
  • Development of the Mental Health plan
  • New primary health care advisory group
  • $1.3 billion over 4 years on new PBS listings
  • Reform of the pharmaceutical benefit scheme
  • $10 million funding for medical research funds in 2015/2016 with a further 400 million scheduled over forward estimates to go into that
  • $26.4 million as an investment in immunisation
  • $20 million to RFBS
Budget Health Workforce Initiatives
  • Changes to scholarships and changes to rural incentives
  • Continuing investment in medical training programs
  • Reviewing specialist training program
  • Consolidating, streamlining and reforming the RHMT program
  • Participating in the review of Intern training
  • Branch is Rolling out the reforms to the Australian General Practice training program
  • Number of GP training places is growing, targets are being maintained
  • Upcoming tender process for the regional training program, new boundaries and a lot of engagement with the profession as to how this is going to work
  • Business as usual environment with reform added
  • Applications for GP training for next year are really high
  • New geographic classification system for doctors and dentists with a focus on smaller rural communities
  • From 1 July GPRIP incentive will not be available to doctors working in large regional towns with a population of more 50,000 which covers places like Albury/Wodonga, Townsville, Cairns and Hobart
  • Doctors will need to stay in rural and regional areas longer – from the current 6 months to 2 years in small rural and regional towns and 1 year in remote areas before they start to get the retention incentives
  • Scholarship programs – quite a large area of reform including fairly significant changes in return of service Scholarship schemes
  • No longer running 2 schemes – from 2016 the Medical Rural Bonded Scholarship program will be consolidated into the Bonded Medical Place Scheme
  • Students with a new bonded place will receive a position in a medical school dependent on working for a reduced return of service period of 1 year in a non-metropolitan district of workforce shortage or small town.   Defined as Categories 4-7 under the modified Monash classification scheme
  • Doctors will be able to complete their return of service in an appropriate modified Monash area as well as locations classified as districts of workplace shortage
  • New scholarship program in 2016 for medical, nursing, midwifery and allied health students
  • Dedicated scholarships available for ATSI people studying to enter into the health workforce
  • For all other scholarship recipients, there will be a requirement to work for a year after graduating in a non-metropolitan area. This is expected to provide over 2000 health professionals in rural and regional Australia this year

Rural Health Multidisciplinary Training (RHMT) Programme
  • Funding will continue to end of 2018 at existing levels
  • Existing funding agreement schedules have been extended for 6 months to align with academic cycles and allows consultation process around national program parameters and options for future reform
  • DoH is not going to be able to fix the problems of the impact that short term funding extensions have on staffing recruitment. There might be space for discussion with DoH and universities about how critical long term appointments are made so as to avoid this problem. No prospect of 5-10 funding. Department has noted concerns.
  • Consultation process underway – Framework distributed to stimulate debate and department is open to ideas
  • Written submissions received by most everyone about the RHMT framework and follow up consultations have commenced.
  • Feedback sought from other key stakeholders – National Rural Health Students Network, Australian Indigenous Doctors Association, and the Australian Medical Students Association
  • Spoken to the AMA, RACGP and ACCRM about some key aspects of what DoH is doing
  • Face to face consultations will continue until June, then Ministerial approval will be sought for the overall national Framework
  • Feedback on consultations – overall universities are supportive of proposed Framework, there is support for streamlining funding arrangements, reducing the reporting burden and red tape, reducing duplication and universities like idea of greater flexibility in how they manage their budgets and they have been receptive to the protections built in to the Framework to make sure there is still a genuine rural training program delivered by rural academics, administrators and professionals staff.
  • No argument re the 5% infrastructure charge target
  • Some concern around the 30% rural origin targets that are designed to match the department’s target with the rural population share and the government really needs to achieve growth in that area.
  • Also concern about the potential for a competitive environment between universities for a fairly small pool of candidates and the impact that might have on academic standards. Helpful to get a bit more evidence and hard numbers around that rather than just assertions. Department understands that it reflects the demographics of universities.
  • Mixed views on the definition ‘Rural origin’ that has been put forward. Department is open to ideas about a better definition.   Core of the definition is about growth of rural origin students studying medicine because research shows pretty good outcomes linked to that.
  • Enrolment and graduation targets for ATSI students. There is a need to be able to quantify targets not just have spoken aspirational targets. Proposal to do this on a university by university basis which reflects the demography. Students need to be better supported and mentored and not just enrolled so that we get more completing Indigenous doctors.
  • Mixed views on the reduction of the 4 week short term placement target for all medical students. This reduction is not compulsory and Universities will have the flexibility to continue if they feel it fits into the curriculum or is achieving good outcomes. It is resource intensive so universities must balance their resources.
  • Mixed reactions to the idea of ‘rural stream’. Some confusion about the wording and some perception that it will lock Urban students out. DoH is suggesting that there is a good selection system of prioritising who gets those precious rural placements to try and maximise outcomes.   Preferential selection systems should not just be based on academic merit but a combination of factors most likely to generate better workforce outcomes.
  • Rural Health Research plan – Definition of ‘eligible’ research is contentious and maybe too narrow. If research is to be funded then it must be clearly linked to program outcomes. It is important to imbed research into rural training academic programs and have targeted rural health research that provides direct benefits to rural communities in terms of improving their health outcomes.
  • John Flynn Placement program - From consultations held so far feedback indicates that some universities are pretty keen to take on this role in managing holiday placements for their students and linking them to their overall rural training program. More discussion needed, but should look at the JF program for workforce outcomes not just as a student entitlement. If universities do take this on, then there would be funding to support this.
  • Medical Training – Concept of Rural multidisciplinary training targets to be set by each university. Should pick up on existing Rural Health training activity in Allied Health and Nursing. Take steps to strengthen and have more well structured, well supported, longer term multidisciplinary placements.
  • DOH has had feedback that the Framework does not include a focus on inter-disciplinary learning. Not intentional and are happy to look at that. More resourcing is merited in this area but there is no huge infrastructure bucket available and unlikely to get one. Universities who receive funding through multiple streams will need to undertake a careful balancing act to work out how to use those streams to get the best outcomes.
  • DoH has put the onus back on to faculties for resourcing of these arrangements. Have built in protections in the Framework listing the key rural training sites to make sure those are maintained and encouraging universities to make sure that their employment arrangements are based on rural academic and professional staff.
  • Consultations will continue and then there will be very some detailed negotiations around funding agreements for the next 3 years. Department is well aware that these agreements need to be in place before the end of the year.
Rural Generalism – Update from 2nd World Summit
Professor Richard Murray and A/Prof David Campbell gave a brief update from the 2nd World Summit which was held in Montreal, Canada from the 8-9th April 2015. Further information can be obtained from the attached presentation.
(Refer to Menu - Shepparton Documents)

NRHSN and AMSA update
Student Representative - Ankur Verma, NRHSN Allied Health Officer
  • The NRHSN provides a voice for students interested in improving health outcomes for rural and remote Australians
  • Provides rural health careers to students, with the aim of addressing the workforce shortage in rural Australia
  • There are 28 Rural Health clubs throughout Australia
  • The NRHSN helps to develop Rural Professionals buy offering Rural Health publications and resources, assists with Rural Health conference funding, provides Club Support and Advocacy on key issues
  • NRHSN activities include Club events, Rural High School visits and Indigenous community engagement activities
  • 2015 priorities include:
    • Rural and remote training pathways
    • Positive rural experiences
    • Aboriginal and Torres Strait Islander Health
    • Mental Health training for all health students
    • The Mental Health Guide ‘When the Cowpat hits the Windmill’ has been updated and a copy can be downloaded at The Guide is a resource written by students for students focusing on mental health issues faced by Australia's future rural and remote workforce while on placement or working out bush.  It was developed by the NRHSN in conjunction with beyondblue: the national depression initiative for medical, nursing and allied health students.
AMSA student representatives were Skye Kinder and Sophie Alpen.
  • Common requests to AMSA included:
  •        Increased presence within social media channels
  •        Greater rural focus at AMSA national events
  •        Greater publicity of rural events and opportunities
  •        Connections with RHC’s
  • Misconception about the relationship between Rural and Indigenous Health
  • AMSA’s key priorities are:
    •     Promotion
    •        Resources
    •        National events
    •        Connections
    •       Advocacy
  • On 13th April 2015 AMSA established a Rural Health Committee consisting of 6 students from around Australia. It has a flat organisational structure and will have a project based workload
  • Achievements to date were:
    •        A new Branding and logo
    •        Establishing social media presence
    •        Re-establishing links with national stakeholders
    •        Review of AMSA rural health policy
  • Future plans included:
    •        Further website development
    •        Rural elective resources
    •        Rural elective bursary promotion
    •        Addressing myths and misconceptions around rural health
Discussion was started on the NRHSN and AMSA’s view on whether the continuation of a national JFPP should be managed through ACRRM in partnership with the work of the RCS network or replacing it with 14 separate operations within each RCS.
Due to time constraints, the chair thanked the students from NRHSN and AMSA for briefing the meeting and suggested that for those interested parties, the discussion could continue during the lunch break.

RCS Showcase - RCS staff were invited to give a 15 minute (10 minute brief + 5 minute Q/A) on Innovations and Research in Rural Medical Education.
Session 1 included
  • Bruno Franchi – Clinical Reasoning
  • Danielle Kidd and Deb Wilson – Medical Students as per educators in rural schools
  • David Atkinson – A dispersed model of innovative remote and rural medical education in Australia’s most urbanised state
  • Monash School of Rural Health RCTS Directors – A watershed: Affirmation by the Faculty of Medicine of the contribution of Monash School of Rural Health to medical education
  • Amanda Barnard – ANU’s Indigenous Health stream
  • Mia Peardon – A novel program of Rural medical educator accreditation
  • Scott Kitchener – Agricultural health and medicine teaching and research program
Session 2 included presentations from:
  • Ritta Partanen – Simulated inter-professional learning (SILVERQ)
  • Rebecca Caygill – A community mentoring program for rural students
  • Andrew Dean – Development of simulated learning teaching across three campuses
  • Judi Walker – Partnerships and community engagement: The Hazelwood Mine Fire Health Study
All innovation briefings were extremely interesting and further information on these presentations can be found in Menu - Shepparton Documents.


Day 2 – Thursday, 14 May 2015

Issues Raised from Day 1
No issues were raised
Parameters and Funding
Issues for discussion/consultation with the department
  • What sort of Evidence does the department want?
    • Rural cohort versus other GAMSAT or GPA
    • Confidentiality of data and how we share it
    • How do rural origin students perform in Graduate programs
    • Keep an eye on urban converts
    • Entry scores for non rural/rural students
    • Admissions criteria
* Most RCS staff do not have input with regard to University controlled Admission criteria
* How to strengthen links with Admissions
  • Demographics of particular areas
  • Discussion should be had on definition of ‘rural’ background.
Draft Proposal Paper – Members expressed confusion on the Rural Medical Training core requirements – (term 2d) which states that ‘A number of Australian medical students equivalent to at least 30% of the University’s Commonwealth-supported medical student allocation must come from a rural background, defined as residency for at least 10 years cumulatively in an ASGS-RA 2-5 area, or 5 years consecutively prior to commencing medical school training’
Action: Amanda to contact David Meredyth urgently for clarification on item 2d and will then send the response to all Directors.
  • How does FRAME take this forward?
    • Attendance at Admissions conferences (held every couple of years) – FRAME to perhaps give a presentation on some of the issues about rural entry origin - what are we measuring and why, and what are reasonable outcome measurements.
  • Reward system for those who meet quota of 30% - bonus dollars for increasing numbers
    • What penalties/consequences if quota is not met?
  • Change in short term placements – at least 50% compulsory
    • Bucket of funding will remain the same with perhaps a little CPI increase
    • Up to each RCS how they allocate the bucket
  • Graduate Reporting
Item 2e states that universities must report on the number of its graduates who are working in rural medical practice, with identification of their status with regard to rural origin, type of rural placement (short or long), ATSI background, Bonded Medical Places Scheme and the Medical Rural Bonded Scheme. This is a huge undertaking considering the significant expansion of data required for collection, and will need support through funding.

Vertical Integration – FRAME”S need to get involved - Richard Murray
  • Sense that we have failed to take full advantage of the opportunities to link pathways to Rural General practice in partnership with Rural Clinical Schools.
  • More competitive nature with era of GPET contracted rather commercially orientated arrangement of delivery of general practice is now coming to an end.
  • Question is now what is the character of the next piece?
    • There is an opportunity now to do something that is more devolved, more community based, more collaborative, more joined up across the medical student/junior doctor/registrar and fellowship and CPD divide
    • Leverages the opportunity of the thousands of medical students and junior doctors now undertaking their training in rural and remote Australia
    • If we are going to be part of this and have a more joined up community responsive work force orientated system, then now is the time to do it, not later when contracts have been awarded.
  • Opportunities especially for succession planning in the rural academic space, for more linkage into scholarships, Research Higher Degrees, postgraduate coursework.   For that new generation who are interested in having a scholarly, research teaching aspect to their careers.
Collaboration and new RTP Boundaries – Amanda Barnard
Amanda advised that she would be meeting with Minister Ley next week. Minister Ley and Fiona Nash have indicated an emphasis on Rural GP training.   Amanda is happy to push that FRAME is really happy to offer advice and work with them on how you build in the KPIS’s. It would be useful if she could mention any active collaborations.
Research/Outcomes Study/Exit Survey/MSOD – Jennene Greenhill
Outcomes Study
  • Thanked the small group working party which keeps in touch via email and meets a couple of times per year.
  • Frame Survey has been going for 7 years
  • Substantial number of publications have been produced from the data to date
  • Questions will remain unchanged this year due to the uncertainty around the parameters but if parameters change then discussion should be had on possible changes to the questions.
  • Working group might now need to discuss
* Does the Questionnaire need to be revamped?
* What is the life of the current survey?
  • Flag a larger group with reps from all schools, devoting a couple of hours on what FRAME survey 2 will/should look like. Rethink how it might better suit FRAME going forward
  • Paper was not given to the Minister due to the feeling that it was not robust or rigorous enough and the omission of data from some schools
  • DoH want FRAME as a group to have shared variables which have all been agreed upon and collected prospectively.  
  • It was suggested that the Outcomes Data group be reconvened with a ‘coordinator/champion’ to run the group - Nominees were Ruth Stewart, David Atkinson, David Campbell, Joe McGirr, and Deb Wilson volunteered one of her researchers, and Jennene Greenhill.
* Tasks of the group – is to pull out the variables, simplify them and then advise how they are going to be collected across all the schools and then be integrated into the survey or collected by some other means.
* Suggestion of a Non-rural clinical school as a comparison group – really good to have   comparison data
* Data would need to be cleaned up within the schools and then forwarded on to the working group.
  • MSOD data is changing completely. MSOD has 2 years of funding but will now only collect the exit surveys. MABEL might be an option and the working party will discuss this.
  • Data collection for the FRAME Survey will be in August and the on-line and paper versions will be distributed and Schools can choose which one they use.
  • Please make sure the Ethics approvals are up to date.
  • FRAME outcome paper accepted
  • Submitted to AJRH with AMSA
  • One in draft on IPE
  • Volunteers were needed for clinical epistemology paper – Nikki Hudson, Andrew Dean, Daryl Pedlar, David Garne, David Mills, Joe McGirr, David Campbell, and Ruth Stewart all volunteered.
FRAME Deputy Chair position
Amanda advised the meeting that since she was going to be absent from the RCS from early September to the end of October, she was seeking the wider groups’s consensus for the Policy Group to nominate a Deputy Chair when the Chair was not available. General consensus was given from those present at the meeting.

Next Meeting – Canberra
Discussion was held on when the next Canberra meeting should be held. It was agreed that either the 29 & 30 October or 5 & 6 November would suit the majority of members present and that an administration meeting would be arranged to be held on the Wednesday before the FRAME meeting.
ACTION: Amanda will confirm dates and advise everyone.
NOTE: Dates have now been confirmed as the 5th & 6th November with the Administrators meeting to be held on the 4th November 2015.
Venue for 2017
As WONCA would be running their Rural Health conference combined with the National Rural Health conference from 30 April to 2 May 2017 in Cairns, it was suggested that the 2017 FRAME meeting be scheduled prior to this in order to make it easier for people to attend all conferences during a one week absence.
It was confirmed that the 2017 meeting would be hosted by JCU in Cairns on Thursday 27th & Friday 28th April 2017.
Rural and Remote Medicine e-Journal – Amanda Barnard
  • The Australasian region gets 3 times the number of submissions than any other section
  • Growing in its International impact factors
  • Amanda is the Australasian editor, with Nicky Hudson (University of Newcastle) one of the Associate Editor, along with Shaouli Shahid from Uni of WA.
  • An increased number of submissions were being received. These days collective data, novel submissions or those that contained new information were much more likely to be published.
  • Reviewers are always needed to assist with both national and international submissions. Submissions were sent generally sent to 1 international and 2 national reviewers but on occasions due to review time frames they were only sent to 2 reviewers.    
  • Good idea if reviewers please advised their reviewing requirements, such as whether they would be prepared to undertake the review of one or more papers per year.
  • Andrew Dean volunteered to be a reviewer.
ACTION: Amanda to forward on Andrew’s name to Helena and Jenny
Budget Information – Judi Walker
Judi Walker wanted to draw attention to the group that Memos and other information from Medical Deans are important for RCS and she advises that those who don’t receive them should pester Deans to have these memos passed on.
  • Highlights important info for RCS – e.g. That the Rural Multidisciplinary Training funding will continue but at a slightly reduced rate.
  • Clinical training fund money will continue
  • Medical Royal Benefits scholarship scheme will not happen any more but there will be a transfer of those hundred MRBS places to the Bulk Medical Places program.
Leadership Program – Judi Walker
  • Judi advised the meeting that the Developing and Growing Leaders in Rural Healthcare Education leadership program has been run 3 times with the last being a 4 day program run in Broome. FRAME has been identified as being very important for succession planning – growing the next generation of rural education leaders.
  • This year’s program had to be postponed due to only having received 7 registrations. 12 registrations are needed to make it financially sustainable but also educationally viable.
  • Suggested to run in August or piggy back on the Canberra FRAME meeting.
  • Discussion was had on the viability of this program and the consensus was that perhaps the program could be reviewed/modified as follows :-
  • Modularising the program
  • Shortening of the program
  • Need more lead time
  • Only offering it when a FRAME meeting is being held in a capital city as it is too difficult for interested participants to travel to rural towns
  • Program has been targeted for Rural Health Care Education and Succession Planning
  • Involves both Academic and Professional staff

Outcomes from Survey of Student Accommodation, fees and charges policy – Judi Walker
  • At the of end of 2014 Monash sent out a survey to each RCS to identify a picture and pattern of student accommodation charges and policies
  • 19 responses were received from the 17 Rural Clinical Schools
  • Judi advised that the feedback paper was now available and would be emailed out to all
National Rural Health Alliance – Judi Walker
  • Judi advised that she represents FRAME on the NRHA council. There are now 37 member bodies on this council and it is a very important peak body.
  • NRHA will advocate on causes that are brought to the table and one of the 5 priorities that the NRHA came up with last year included the deregulation of university fees. This was tabled by FRAME as there was concern regarding the possible impact and adverse effect the deregulation would have on students in health professions as well as all rural and regional students in terms of access to higher education. The Alliance develops policies around its priorities and other priorities for this year are:
  • Primary Health Networks
  • Broadband for the Bush
  • National Health plan for ATSI people
  • Dental health
    • The Alliance puts out media releases on a regular basis and anything considered pertinent to what RCS do, will be distributed via the FRAME mail list.
    • Collaborative projects - proposal to access to medicines in northern remote areas which could be very helpful, useful and informative to RCS.
    • NRHA Conference is held every other year and the 13th National conference will take place in Darwin in a couple of weeks’ time, followed by the 14th conference in Cairns in 2017.
    • There is a cost to be part of the NRHA which presents a problem for FRAME as it is not an incorporated body but it has been agreed with all the Directors of the Rural Clinical School network to be shared around the RCS. Both Monash and ANU have borne the costs to date.
    • Judi will be stepping down as the FRAME representative on the NRHA in September so FRAME will be looking for another person to be their representative.
ARHEN Report – Nicky Hudson
Nicky Hudson is the FRAME rep on AHREN and she is also the Deputy Chair of the ARHEN Board.
  • For the benefit of those new to FRAME meetings, Nicky explained that ARHEN is the Australian Rural Health Educators Network which is an incorporated company and it is the peak body for the 11 University Departments of Rural Health (UDRH) which are located in every state and the NT.   Meetings are held twice a year with the next meeting in Canberra in September.
  • Secretariat is funded by contributions and current secretariat is a very capable group with a National Director who is very well connected in Canberra.   ARHEN received funding from the previous government which will run out next year and which has helped fund and maintain the Secretariat.
  • AHREN provides updates and summaries on things such as the budget and has networks of special interest groups which include the Simulation Network, Executive Officers network, Interprofessional Learning network, Indigenous network, Mental Health network, Academics network and Rural Pharmacy Network who have published together. It would be good if FRAME members could belong to these networks.
  • Suggested that perhaps FRAME could consider holding a joint meeting with AHREN in the future.
Other Business
No other business was raised.
The chair then thanked Prof Julian Wright and his team for hosting a very interesting and enjoyable two days, and looked forward to seeing everyone in Canberra for the next FRAME meeting.
Meeting closed.