Outcome Report for 2014 Medical Graduate Recruitment, Prevocational Accreditation, Education and Training.

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Outcome Report for 2014

Medical Graduate

Recruitment, Prevocational

Accreditation, Education and

Training.

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DOC13/19067 2

TABLES

TABLE 1 NSW HEALTH PRIORITY LIST FOR 2014 INTERN RECRUITMENT 7 TABLE 2 2014 PGY 1 POSITION CAPACITY BY PREVOCATIONAL TRAINING NETWORK 8 TABLE 3: APPLICATION STATUS FOR 2013 MEDICAL GRADUATE RECRUITMENT 9 TABLE 4: 1ST PREFERENCE BY UNIVERSITY AND PRIORITY CATEGORY 10

TABLE 5: ABORIGINAL APPLICANTS BY UNIVERSITY 11

TABLE 6: ABORIGINAL APPLICANTS BY NETWORK AND HOME HOSPITAL 11 TABLE 7: NUMBER OF RURAL POSITIONS FILLED BY HOSPITAL 12 TABLE 8: RECRUITMENT VIA REGIONAL PREFERENTIAL ALLOCATION 13 TABLE 9: RECRUITMENT VIA OPTIMISED PREFERENCE ALLOCATION 14

TABLE 10: CORE AND NON CORE STANDARDS 16

TABLE 11: NETWORK EMERGENCY MEDICINE POSITIONS ACCREDITED FOR PGY1 TRAINEES 18 TABLE 12: RPR EMERGENCY MEDICINE POSITIONS ACCREDITED FOR PGY1 TRAINEES 19

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EXECUTIVE SUMMARY

The Medical Board of Australia requires provisional registrants from the Australian Medical Council (AMC) accredited medical schools in Australia and New Zealand to work in approved intern positions. After completing a 12 month approved intern position including satisfactorily completing the necessary terms, registrants are eligible to apply for general registration.

Domestic graduates from NSW Universities are guaranteed intern training positions, and domestic interstate graduates and International full fee paying students are eligible to apply for vacant positions but are not guaranteed an intern position.

The Health Education and Training Institute (HETI) has delegated authority from the NSW Ministry of Health to recruit trainees to prevocational training networks in NSW on behalf of Local Health Districts (LHDs). HETI coordinates the recruitment of medical graduates from accredited Australian and New Zealand universities seeking their initial training position as a doctor.

An increasing number of medical graduates completing training require a prevocational training position. Between 2005 and 2013 NSW total medical school graduate numbers increased from 423 to 1055 (149%). During the same period international full-fee paying medical graduate numbers at NSW Universities increased from 79 to 162 (105%). To accommodate the increased number of medical graduates, between 2008 and 2014 NSW has increased prevocational training positions from 630 to 964 (53%).

Of the 964 position available for the 2014 clinical year HETI recruited 959 positions; the other five positions were recruited by the ACT to fill positions in Bega and Goulburn Hospital which form part of the ACT prevocational training network.

In the 2013 medical graduate recruitment 1470 applications for a prevocational trainee position were accepted by HETI. Ultimately

 816 NSW domestic graduates

 92 Interstate graduates

 50 International full fee paying students

were recruited to prevocational trainee positions in NSW. One position was unfilled, as Network 5 elected to not recruit a medical graduate to a vacancy that arose in January 2014.

The core terms required for general registration are Medicine, Surgery and Emergency Medicine. Ensuring there is sufficient emergency term capacity is often a rate limiting factor in promoting the expansion of the prevocational trainee workforce. The number of accredited emergency departments and the capacity they have for accommodating interns limits the number of trainees that can be rotated through Emergency Medicine terms.

In NSW there are currently 215 accredited emergency medicine full time positions that could be offered to a maximum of 107 additional trainees. Therefore HETI suggests the Networks that currently have this additional capacity be considered the most likely Networks to support any growth opportunities; however this is dependent on funding and supervisory capacity.

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HETI's Prevocational Training Program oversees the training of all graduates in their first and second postgraduate years (PGY). Prevocational training in NSW takes place in 135 training facilities which are grouped together into 15 prevocational training networks. The training sites in the networks are comprised of five term home hospitals, three term home hospitals, rotational hospitals and general practices. Network training sites support each other to train prevocational trainees.

In December 2013 HETI provided the AMC Prevocational Standards Accreditation Committee with an initial report outlining how HETI meets the domains for assessing accreditation authorities. As a result of this HETI has been granted initial accreditation by the Medical Board of Australia as the intern training accreditation authority for New South Wales. Initial accreditation will continue until an AMC team completes a full assessment of HETI intern training accreditation services, in either 2015 or 2016.

The prevocational training program is governed by the Prevocational Training Council, a clinician-led body with representation from all the training networks. The NSW Junior Medical Officer Forum, with trainee representatives from all the networks, is an advisory subcommittee of the Prevocational Training Council.

In 2013, HETI was responsible for overseeing the training of 927 PGY1 and 850 PGY2 trainees across 15 training networks and 135 training sites. The training sites include 58 hospitals accredited for prevocational training, and 77 general practices.

HETI supports the training networks, DPETs, trainees, trainee supervisors and JMO Mangers in many ways including

 supporting the Prevocational Training Council to deliver the training program

 publishing and distributing a series of resources

 hosting the Prevocational Medical Education Forum



over sighting the assessment of prevocational trainees via the prevocational progress review forms.

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INTRODUCTION

In order to ensure an appropriate NSW Health workforce is available and providing services aligned to the needs of the community, it is necessary to ensure health care professionals are adequately trained in careers that are needed, that they are located where service delivery is needed most, and they are supported throughout their career to maintain skills that are relevant to the community needs. It is also important that healthcare facilities, particularly those facing difficulty in retaining a health professional workforce are supported in growing an appropriate workforce relevant to the needs of their patients.1

In recognition of the need to expand the medical workforce, NSW successfully advocated to increase the number of domestic medical places in NSW universities. These graduates are now entering the workforce and will alleviate existing medical workforce shortages with the aim of reducing reliance on international medical graduates.

This report reflects work undertaken by HETI in 2013 to recruit medical graduates to prevocational trainee positions commencing in 2014 and the education and training support provided by HETI in 2013 to support the prevocational medical workforce to deliver excellent patient centred care.

MEDICAL GRADUATE RECRUITMENT OUTCOMES

HETI coordinates the annual recruitment of final year medical graduates from Australian and New Zealand universities to prevocational training networks within NSW.

All applications are completed online via the Prevocational Training Application Program (PTAP). HETI offers the following four recruitment pathways for medical graduates:

1.

Building Capacity for Aboriginal Workforce 2. Rural Preferential Recruitment

3. Regional Preferential Recruitment 4. Optimised Allocation

At the beginning of each year Local Health Districts advise HETI the number of prevocational trainee positions they wish to have recruited. HETI then recruits applicants to positions using the recruitment pathways, priority list and applicant preferences.

Domestic graduates from NSW Universities are guaranteed intern training positions. Interstate graduates and international full-fee paying students are eligible to apply for vacant positions but are not guaranteed an intern position. All applicants are recruited depending on the priority category they are assigned to. The allocation priority list is outlined in Table 1.

Prevocational training positions offered by HETI are two-year positions and enable the trainee to complete their first and second postgraduate year (PGY) in a single network. All the facilities and terms are accredited for prevocational training.

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Table 1 NSW Health Priority List for 2014 Intern Recruitment

Note

 Applicants in Categories 1 and 2 are eligible to apply for intern positions via the Rural Preferential Recruitment (RPR) Scheme. The RPR Scheme is a merit based selection process. Successful applicants will be offered and appointed to RPR positions regardless of their priority category.



Rural cadets in Categories 1 and 2 are eligible to apply for intern positions via the RPR Scheme. Successful applicants will be offered and appointed to RPR positions regardless of their priority category.

Priority Category Definition

1 Medical graduates of NSW universities who are Australian/New Zealand citizens or Australian permanent residents (Commonwealth Supported Place and Domestic Full Fee paying. This priority category is guaranteed an intern position in NSW.

2 Medical graduates of interstate or New Zealand universities who completed Year 12 studies in NSW who are Australian/New Zealand citizens or Australian permanent residents (Commonwealth

Supported Place, Domestic Full Fee paying or NZ equivalent).

3 Medical graduates of interstate or New Zealand universities who completed Year 12 studies outside of NSW who are Australian/New Zealand citizens or Australian permanent residents (Commonwealth Supported Place, Domestic Full Fee paying or NZ equivalent).

4 Medical graduates of NSW universities who are not Australian/New Zealand citizens or Australian permanent residents and who hold a visa that allows them to work or are able to obtain a visa to work.

5 Medical graduates of interstate or New Zealand universities who are not Australian/New Zealand citizens or Australian permanent residents and who hold a visa that allows them to work or are able to obtain a visa to work.

6 Medical graduates of Australian Medical Council accredited campuses that are located outside of Australia or New Zealand who are not Australian/New Zealand citizens or Australian permanent residents and who hold a visa that allows them to work or are able to obtain a visa to work.

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In NSW, prevocational trainee positions are located within 15 prevocational training networks which consist of multiple hospital and non-hospital facilities who work cooperatively to provide the training and experiences required to prepare prevocational trainees for a diverse range of medical practice.

The network assigns the trainee to a home hospital. The trainees’ employer is the LHD governing the home hospital. Applicants who accept positions acknowledge they will rotate to any facility in the network as required. Medical graduates are recruited once per year and commence either at the beginning or Term 3 of the clinical year.

An increasing number of medical graduates completing training require a prevocational training position. Between 2005 and 2013 NSW total medical school graduate numbers increased from 423 to 1055 (149%). During the same period international full-fee paying medical graduate numbers at NSW Universities increased from 79 to 162 (105%). To accommodate the increased number of medical graduates, between 2008 and 2014 NSW has increased prevocational training positions from 630 to 964 (53%).

Of the 964 position available for the 2014 clinical year in NSW HETI was responsible for recruiting to the 959 positions where NSW Health is the employer. The other five NSW funded positions are recruited and employed by ACT Health to fill positions in Bega and Goulburn Hospital which form part of the ACT prevocational training network.

NSW employs more prevocational trainees that any other state or territory in Australia and this year’s record 959 training positions is an increase of 32 places from the previous year. The positions by network are provided in Table 2.

Table 2 2014 Postgraduate Year 1 Position Capacity by Prevocational Training Network

Network January Positions June Positions Total Positions

Network 1: Inner West & Western Plains 59 0 59

Network 2: Bankers and Campers 41 0 41

Network 3: Concord & Canterbury & Broken Hill

Hospital 45 0 45

Network 4: South West Sydney, Tweed Heads 69 0 69

Network 5: North Shore & Port Mac 73 0 73

Network 6: Hornsby & Northern Beaches 41 0 41

Network 7: Central Coast Network 61 0 61

Network 8: St George, Sutherland, Albury & Griffith 74 0 74

Network 9: From Coast to Coast 53 0 53

Network 10: Eastern to Greater Southern 51 0 51

Network 11: Oceans 11 64 0 64

Network 12: Hunter New England 93 19 112

Network 13: Westnet 114 0 114

Network 14: Nepean & Blue Mountains 59 0 59

Network 15: Central West 43 0 43

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The demand for prevocational trainee positions in NSW is greater than the number of positions available. In the 2013 medical graduate recruitment 1470 medical students had a receipted or verified application for a NSW prevocational trainee position.

Of the 1470 medical students, 894 were NSW domestic students who are guaranteed a recruitment offer. All these students received an offer, with 816 accepting a position. There were 92 graduates of interstate or New Zealand universities recruited in NSW and 50 NSW graduates with temporary residency recruited.

The acceptance rates on NSW domestic applicants was 92%, in comparison interstate domestic applicants with no connection to NSW was 16% and NSW international applicants was 75%. The low acceptance rate by interstate applicants delays medical graduate recruitment in NSW and creates significant administration work for HETI. Consideration needs to be given to ways that can reduce applications from medical students with an ambivalent desire to work in NSW and enable NSW to fill workforce shortage positions effectively.

HETI recruited a total of 958 prevocational training positions in NSW for the 2014 clinical year. One position was unfilled, as Network 5 elected not to recruit a medical graduate to a vacancy that that became available due to an applicant declining their recruitment offer in early January 2014.

There were 23 NSW international graduates who remain unplaced. Should there be requests from hospitals to fill any new vacancies HETI will work with the unplaced cohort to recruit to additional positions.

A breakdown of the status of each application is provided in Table 3.

Table 3: Status of applications received for 2013 medical graduate recruitment Priority

category Receipted Verified

Position accepted

Position

declined Withdrawn Ineligible Total

1 0 0 816 69 8 1 894 2 0 0 68 62 6 0 136 3 0 0 24 126 71 0 221 4 23 0 50 16 34 0 123 5 68 0 0 0 28 0 96 6 0 0 0 0 0 0 0 Totals 91 0 958 273 147 1 1470 Definitions

Receipted The application is accepted in PTAP but documents have not yet been verified.

Verified Indicates HETI has reviewed the application and determined that the applicant is eligible for a position.

Position Accepted Indicates the applicant has accepted a position offer

Position Declined Indicates the applicant has declined a position offered to them. Withdrawn Indicates that the applicant has withdrawn their application Ineligible Application does not fulfill requirements.

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Sixty six percent of NSW domestic students obtained their 1st Network preference, in comparison 24% of NSW international students who accepted a position received their 1st preference. Table 4 explores the percentage of 1st preferences from medical students at different universities.

Table 4: First preference positions by university and priority category

NSW universities NSW domestic students who accepted position Percentage who obtained 1st preference (%) NSW international students who accepted position Percentage who obtained 1st preference (%) University of Sydney 224 67 19 5 University of New England 48 81 0 0

University of New South

Wales 199 76 14 14

Newcastle University 93 75 10 70

Notre Dame University

Sydney 89 61 0 0

Western Sydney

University 102 71 4 25

Wollongong University 61 87 3 33

Total 816 66% 50 24%

Building Capacity for Aboriginal Medical Workforce

In 2011, the Aboriginal people in NSW comprised 2.5% of the total State population and 31.5% of the total Aboriginal population of Australia2. Over 90 per cent of Aboriginal people in NSW live in major cities or inner regional areas3. The difference in life expectancy between Aboriginal people in NSW and the general population is estimated to be approximately 7 – 9 years4

.

Whilst it is a responsibility of all health workers to provide culturally competent services and quality care to the Aboriginal community, it is imperative that the number of Aboriginal people commencing and continuing with a career in health is increased5. This is to enable Aboriginal people access to a culturally competent and culturally safe health workforce.

2_{NSW Aboriginal Health Plan 2013-2023}

http://www.health.nsw.gov.au/publications/Publications/NSW-Aboriginal-Health-Plan-2013-2023.pdf

3_Ibid 4_Ibid

5

National Aboriginal and Torres Strait Islander Health Council (NATSIHC) (2008). A blueprint for action: Pathways into the health workforce for Aboriginal and Torres Strait Islander people. Accessed on 18 November 2009 from www.aida.org.au/pathways.aspx

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The Building Capacity of Aboriginal Medical Workforce program offers Aboriginal medical graduates a recruitment pathway to prevocational training in NSW at a hospital or training network of their first preference. The program has been offered as a recruitment pathway for final year medical students since 2010.

To be eligible applicants are required to provide documentation that demonstrates proof of Aboriginality and address a minimum of one of the six criteria that explains how access to supports will link the applicant to a public health organization or specific geographical location in the NSW prevocational training network of first choice.

Applications are assessed by a panel comprising Aboriginal representation from the Australian Indigenous Doctors’ Association and NSW Health’s Aboriginal Workforce Development Unit and HETI’s Medical Portfolio. In 2013 the panel was chaired by HETI’s Clinical Chair for the Hospital Skills Program.

Ten NSW trained Aboriginal applicants and one interstate Aboriginal applicant applied and were recruited to prevocational training positions in a Network of first preference via the Building Capacity of Aboriginal Medical Workforce pathway. Two Aboriginal applicants were recruited to rural locations in NSW. This is a slight increase on the nine Aboriginal applicants in 2012. A breakdown of building capacity of Aboriginal medical workforce applicants is provided by university and Network in Table 5 and 6 respectively.

Table 5: University of 2013 building capacity of Aboriginal medical workforce applicants

University Applicant Numbers

NSW Universities

University of Western Sydney 4

University of Newcastle 2

University of New South Wales 2

University of Notre Dame – Sydney Campus 2

Sub total 10

Interstate Universities

Flinders University (South Australia) 1

Sub total 1

Total 11

Table 6: Location of building capacity of Aboriginal medical workforce applicants by network and home hospital

Network January 2014 June 2014 Home Hospital

2 1 Campbelltown / Camden Hospital

7 1 Gosford / Wyong Hospital

8 1 St George Hospital

9 1 The Prince of Wales Hospital

10 1 St Vincent’s Hospital

12 2 1 Tamworth Rural Referral Hospital*(1)

John Hunter Hospital(2)

13 3 Coffs Harbour Health Campus*(1)

Westmead Hospital (2)

Total 10 1

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Rural Preferential Recruitment

The Rural Preferential Recruitment (RPR) Program is a merit based recruitment pathway that:

 facilitates access to rural hospitals for rural cadets and other medical graduates who wish to undertake their prevocational training in a rural hospital

 facilitates the priority filling of rural hospital prevocational training positions

 builds a sustainable workforce over the longer term in rural areas.

Applicants wishing to access this pathway apply both to HETI via the Prevocational Training Application Program and to the individual hospitals they are interested in working at via NSW Health’s eRecruit. The rural hospitals undertake the interviews and rank the applicants. HETI’s role is to make the position offers to the eligible applicants.

Prevocational trainees can undertake their entire training at a rural five term home hospital, but they are expected to undertake at least one term a year in another hospital within the same prevocational training network at either a metropolitan or regional facility. HETI strongly supports these rotations as they provide prevocational trainees with exposure to the different health needs of various geographical and demographic communities and it is an opportunity to experience how different facilities provide medical services.

There were 150 eligible applicants who submitted 214 applications for the 131 rural hospital positions in 2013. Eighty two applicants accepted a position; the remaining 49 positions were filled by optimised allocation.

The number of RPR positions offered for the 2014 clinical year increased 19% increase (108 to 131) in comparison to the 2013 clinical year and the number of positions recruited by the RPR pathway decreased from 91 to 82. A breakdown by rural hospital is provided in Table 7. Overall there has been increase in the number of prevocational trainees who will experience working in a rural hospital during their prevocational training.

Table 7: Number of rural positions filled by hospital and recruitment

Network Rural Hospital Number of

rural hospital positions Number of positions recruited via RPR Percentage of positions filled via RPR (%)

1 Dubbo Base Hospital 12 5 42

4 The Tweed Hospital 18 13 72

5 Port Macquarie Base Hospital 12 6 50

8 Albury Wodonga Health 5 4 80

9 Lismore Base Hospital 13 7 54

10 Wagga Wagga Base Hospital 20 18 90

12 Tamworth Rural Referral Hospital 16 7 44

12 Manning Rural Referral Hospital 5 0 0

12 The Maitland Hospital 5 4 80

13 Orange Health Service 15 15 100

13 Coffs Harbour Health Campus 10 3 30

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Regional Preferential Allocation

HETI coordinates a Regional Preferential Allocation recruitment pathway to provide an opportunity for medical graduates of regional and outer metropolitan universities to continue their prevocational training in the geographical area they trained as medical students. This recruitment pathway facilitates the filling of regional and outer metropolitan training positions as a priority, with the aim to build a sustainable workforce over the longer term in outer metropolitan Sydney and regional areas.

Applicants wishing to work in a regional or outer metropolitan Sydney of NSW use the HETI online Prevocational Trainee Allocation Program (PTAP). To access regional preferential allocation pathway the applicant indicate their first and or second prevocational training network preferences as one of the regional NSW and outer metropolitan Sydney networks. Positions are only offered when positions are available. There is a maximum of two rounds of offers in regional preferential allocation. A second round only occurs when there are more applicants than positions for one or more of the participating networks.

There are seven regional and outer metropolitan networks. Collectively 182 applicants were recruited via the regional preferential allocation recruitment pathway, which equates to a 16% increase on the previous year. The proportion of applicants recruited to each of the networks via this pathway is represented in the Table 8.

It is clear that applicants who studied medicine at a regional university are choosing to work in regional areas. The regional allocation pathway facilitates this by enabling applicants to be directly recruited to their preferred regional or outer metropolitan network. The result being increased prevocational medical workforce in areas of medical health workforce shortage. Network 11 (Illawarra Shoalhaven Local Health District) showed the greatest increase, doubling the number of positions filled via the regional pathway in 2012 and drawing 65% of their regional recruits from University of Wollongong. 48% of University of New England graduates and 47% of University of Newcastle graduates were recruited to Network 7 (Central Coast Local Health District) or Network 12 (Hunter New England Local Health District) via the regional pathway. Table 8: Recruitment to networks via regional preferential allocation

Network Number of regional preferential allocation positions Number of positions recruited by regional allocation Percentage of positions filled via regional allocation pathway (%) 2 40 6 15 4 51 21 41 7 60 32 53 11 64 40 63 12 98 67 68 14 59 14 24 15 43 2 5 Total 415 182 44

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Optimised Preferential Allocation

In the optimised allocation pathway, a series of recruitment rounds are run that match applicant preferences to the positions that are available. Sixteen rounds were run as part of the 2013 medical graduate recruitment with the last round closing on 15 January 2014. The majority of applicants are recruited to a majority of positions via this pathway. Table 9 describes the number of positions filled by the optimized pathway.

Positions in each round are allocated using the optimised preference program. Data including the applicant’s identification number and network preferences, and network vacancies are exported to the optimised preference program. The algorithm allocates the applicants to vacant positions in a way that maximizes more applicants receiving the best preference possible. The algorithm is designed to ensure auditability, the fairest result for all applicants in the same priority group and discourage gaming of the allocation.

Table 9: Recruitment to networks via optimised preference allocation Network Number of optimised

allocation positions

Number of positions recruited by optimised allocation

Percentage of positions filled via optimised allocation pathway (%) 1 54 54 100 2 34 34 100 3 45 45 100 4 35 35 100 5 67 66 99 6 41 41 100 7 28 28 100 8 69 69 100 9 45 45 100 10 32 32 100 11 24 24 100 12 31 31 100 13 93 93 100 14 45 45 100 15 41 41 100 Total 684 683 100

National Medical Intern Data Management

HETI provided data to the National Medical Intern Data Management group. Five audits were undertaken, which enabled nationwide sharing of intern acceptance information for the purposes of identifying the total number of applicants who had accepted more than one position. These applicants were then contacted and requested to confirm which of their multiple positions they intended to accept. This process facilitated the timely release of positions to allow them to be re-offered to other applicants.

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PREVOCATIONAL ACCREDITATION OUTCOMES

HETI has been granted initial accreditation by the Medical Board of Australia as the intern training accreditation authority for New South Wales to ensure high standards of training, education and welfare for all prevocational trainees. This includes all the facilities and positions within them that provide the training opportunities for prevocational medical trainees employed by NSW Health.

The position(s) are located in clinical terms. Each year trainees rotate through five positions located in various terms to enable them to experience a range of clinical situations and service environments. The rotation between terms means each accredited fulltime equivalent position can be used to train five trainees.

In Post Graduate Year (PGY)1 trainees are required to rotate into an emergency medicine, surgery and medicine term. The positions must be accredited in accordance with guidelines developed by HETI and must ensure adequate case-mix, service, teaching, supervision and assessment.

HETI worked consistently to ensure there were sufficient terms accredited to ensure every trainee can gain general medical registration at the end of their first postgraduate year.

Facility Accreditation

During 2013, the ACT established its own Prevocational Accreditation Committee and will be offering accreditation services to facilities within the ACT geographical area. HETI therefore has ceased providing accreditation services to hospitals in this region.

For many years the Albury and Wodonga Hospital have been accredited by HETI and the Postgraduate Medical Council of Victoria (PMCV) respectively. In effect they are a single facility spread over two sites. To recognise this HETI and the PMCV undertook a joint accreditation of the Albury Wodonga Health Campus in 2013 and the accreditation of the entire campus is now the responsibility of the PMCV.

The Australian Medical Council finalised a new quality framework for intern training in the new national registration and accreditation system in 2013. Part of the new framework includes the flexibility to extend the accreditation cycle for facilities training prevocational trainees from three to four years.

HETI reviewed all facilities to ascertain which ones could safely have their accreditation status extended. Facilities granted four year accreditation, had two cycles of three year accreditation and no provisos with respect to the core standards. The core standards for this process were determined by the prevocational accreditation committee. The list of prevocational education and training standards broken into core and non-core are listed in Table 10.

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Table 10: Core and non- core standards

CORE STANDARD NON CORE STANDARDS

NUMBER TITLE NUMBER TITLE

1.3 Supervision 1.1 &1.2 Orientation

2.2 Training and service requirements

2.1 Professional development 2.3 & 2.4 Education and training

opportunities

2.6 Education and information resources

2.5 Assessment & feedback 3.4 & 3.5 Promoting prevocational trainee interests

3.1 & 3.2 Prevocational trainee management

3.6 Physical amenities 3.3 Safe practice

Fifty facilities had their accreditation assessed by the Prevocational Accreditation Committee to establish whether the accreditation could be extended to four years, 24 facilities received an extension of their accreditation.

In 2013 accreditation reviews were undertaken at 60 facilities. This included 20 hospitals, three regional training providers and 37 general practices. The reviews included one focus visit. The reviews involved 66 surveyors. Three team leaders completed two surveys and two trainee team leaders led their first survey. One of the trainee team leaders undertook a second survey during 2013.

New training facilities including general practices are provisionally accredited and are on shortened accreditation periods. At the end of 2013 in NSW there were:

 24 facilities with 4 year accreditation

 87 facilities with 3 year accreditation

 24 facilities with provisional accreditation.

Eight Regional Training Providers have 3 year accreditation from HETI to support NSW prevocational trainees in accredited general practice positions.

A list of accredited facilities for the 2014 clinical year is at Appendix 1.

Broken Hill Base and Kempsey District Hospitals changed from PGY2 only accredited facilities to PGY1 accredited facilities. Broken Hill Base Hospital commenced PGY1 trainees in Term 3 of 2013 and Kempsey District Hospital will commence PGY1 trainees from Term 1 2014.

The accreditation process allows for the assignment of provisos when a facility has deviated from the standards. The provisos need to be addressed by the facility within a defined time. The Prevocational Accreditation Committee issued 23 provisos and reviewed the evidence provided for a further 46 provisos. The provisos issued related to:

 Promoting prevocational trainee interests (6)

 Supervision (6)

 Education and training opportunities (3)

 Training and service requirements (3)

 Prevocational trainee management (2)

 Assessment and feedback (1)

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General Practice Accreditation

Regional training providers are accredited by HETI. The total number of general practices has dropped by one to 77 in 2013 and the number of accredited positions has dropped to 86.5. Twenty two of the general practice training positions are accredited for PGY1 trainees, an increase of four over 2012.

Position Accreditation

Each position that is filled by a PGY1 or PGY2 trainee requires accreditation to ensure the clinical supervision and training is suitable. HETI reviewed 95 new and revised terms in 2013 for and 24 new terms were accredited.

By the end of 2013 the total number of accredited terms was 1011 and they contained 2,371 accredited positions.

Postgraduate Year 1 Term Capacity

PGY1 trainees are provisionally registered by the Medical Board of Australia to practice medicine during their PGY1 year. To obtain general medical registration they are required to successfully complete five terms of training including a term in emergency medicine, medicine and surgery.

In NSW there are 1223.5 positions accredited for PGY1 trainees. Within the hospitals accredited in NSW there are 215 emergency medicine, 458.5 medicine and 320 surgery terms. These numbers represent the theoretical capacity of the NSW Health system for each term type. The actual number of positions may be smaller; hospitals seek additional accreditation to prepare for growth, to provide flexibility to deliver clinical services or to provide trainees with experiences that fit their career pathways. Some of the positions while accredited are not funded.

It is essential that each prevocational training network and rural preferential hospital has sufficient positions accredited to enable PGY1 trainees to meet their general registration requirements. Each year HETI reviews the networks and rural preferential (RPR) hospitals number of accredited positions in their emergency medicine, medicine and surgery terms, where the number of positions is below what is required for the PGY1 trainees recruited, HETI works with the networks and RPR hospitals to accredit further positions.

Of the three terms required for general registration, emergency medicine has the smallest number of accredited positions and as such this term type constrains the number of PGY1 trainees who can be employed in NSW. RPR hospitals and networks need to consider their ability to provide an emergency medicine experience when expanding the PGY1 medical workforce.

Based on each fulltime equivalent position having the capacity to train five trainees NSW, in theory, can use the 215 accredited emergency medicine positions to train 1,075 trainees. NSW has 959 prevocational training positions for medical graduates which means NSW has an additional 23.2 fulltime equivalent accredited emergency medicine positions which would allow the training of a further 116 PGY1 trainees. Table 10 and 11 provide a breakdown of

At the end of 2013, Network 2, Lismore, Dubbo and Port Macquarie Hospital had a shortfall in the number of accredited emergency terms required for their PGY1 trainee positions. Network 2

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requested an additional PGY1 position in December 2013, which created an emergency term shortfall. HETI is currently working with Network 2 to provide an updated emergency term description for accreditation.

Dubbo Base, Lismore and Port Macquarie Hospital did not fill all their RPR positions for the 2014 clinical year and therefore do not require the additional emergency positions to be accredited. The Networks these hospitals belong to have sufficient emergency positions to provide an emergency term to PGY1 trainees recruited to the network.

Table 11: Network Emergency medicine positions accredited for PGY1 trainees

Network Number of emergency medicine positions (FTE) Number of PGY1 trainees that can be trained in emergency medicine Number of PGY1 trainee positions in 2014 Additional PGY1 trainees that can be trained in emergency medicine Number of emergency positions unfilled (FTE) 1 14 70 59 11 2.2 2 8 40 41 -1 -0.2 3 10 50 45 1 0.2 4 18 90 69 21 4.2 5 17 85 73 12 2.4 6 10 50 41 9 1.8 7 13 65 61 4 0.8 8 16 80 74 6 1.2 9 12 60 53 7 1.4 10 12 60 51 9 1.8 11 15 75 64 11 2.2 12 23 115 112 3 0.6 13 26 125 114 11 2.2 14 12 60 59 1 0.2 15 9 45 43 2 0.4 STATE TOTAL 215 1075 959 107 21.4

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Table 12: RPR emergency medicine positions accredited for PGY1 trainees Hospital Number of emergency medicine positions (FTE) Number of PGY1 trainees that can be trained in emergency medicine Number of PGY1 trainee positions in 2014 Additional PGY1 trainees that can be trained in emergency medicine Number of emergency medicine positions unfilled (FTE) Coffs Harbour Health

Campus 3 15 10 5 1

Dubbo Base Hospital 2 10 12 -2 -0.4

Lismore Base Hospital 2 10 13 -3 -0.6

Manning Rural Referral

Hospital 1 5 5 0 0

Orange Health Service 3 15 15 0 0

Port Macquarie Base

Hospital 2 10 12 -2 -0.4

Tamworth Rural

Referral Hospital 4 20 16 4 0.8

The Maitland Hospital 2 10 5 5 1

The Tweed Hospital 6 30 18 12 2.2

Wagga Wagga Base

Hospital 5 25 20 5 1

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PREVOCATIONAL EDUCATION AND TRAINING

In NSW, HETI's Prevocational Training Program oversees the training of all graduates in their first two years of postgraduate training (PGY1 and PGY2). The program is guided by the Australian Curriculum Framework for Junior Doctors.

The prevocational training program is governed by the Prevocational Training Council (PvTC), a clinician-led body with representation from all the training networks. The NSW JMO Forum, with trainee representatives from all the networks, is an advisory subcommittee of the Prevocational Training Council.

In 2013, HETI was responsible for overseeing the training of 927 PGY1 and 850 PGY2 trainees across 15 training networks and 135 training sites. The training sites include 58 hospitals accredited for prevocational training, and 77 general practices.

HETI supported:

 Orientation by revising the online NSW Health Medical eOrientation.

 Assessment of prevocational trainees via the progress review form

 Prevocational training stakeholders by developing and distributing a series of resources, hosting the prevocational forum, supporting the JMO Forum and funding DPETs

 Prevocational Network Structure by monitoring the prevocational education and training provided and resolving issues raised about the Networks.

 Formal education through provision of unified lectures series topics

NSW Health Medical eOrientation

Medical eOrientation provides medical staff with information about relevant policies and processes so they can effectively transition in to employment with NSW Health. The information in the program is standardised across NSW and ensures that Health Services fulfil their legislative requirements in respect of work health and safety and employees have an awareness of the Code of Conduct.

In 2013 HETI revised the NSW Health Medical eOrientation, a set of online learning modules available to facilitate the orientation and on-boarding process for prevocational trainees. The modules revised included Documentation and Activity Based Funding for Clinicians, and Clinical Documentation – Getting it Right.

HETI undertook consultation with the system to develop the program and determine which modules should be considered as a mandatory part of orientation week, and which modules can be completed within the first four weeks of internship.

The revised NSW Health Medical eOrientation was published in December 2013 and all LHDs and prevocational networks were made aware of the changes.

Prevocational Progress Review Forms

HETI supports the assessment of all prevocational trainees in NSW through the oversight of prevocational progress review forms. Around 18,000 Prevocational Progress Review Forms are completed in NSW each year by both trainees and term supervisors. HETI has undertaken a number of activities in 2013 to make the forms more informative and to create efficiencies in the assessment process. To create a more informative and valuable assessment process HETI

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trialled two improvements to the forms in 2013. The forms assess the competencies described in the Australian Curriculum Framework for Junior Doctors.

1st Trial of Criterion Based Forms

In 2013, HETI reported on the initial trial of criterion based forms, developed to address weaknesses identified in prevocational progress review forms used in NSW since 2009.

A key problem with the 2009 forms appeared to be the rating scale, which lacked a standard. Different people interpret the “expected level” of performance differently, and the “expected level” probably varied from the beginning of training to the end. The chief innovation in the new forms was replacing the “below expected level … borderline … at expected level … above expected level” rating scale with a four-point scale that used specific competency descriptions (assessment criteria) for each assessable item. The rationale for this approach is that the explicit criteria make it easier for trainees and supervisors to judge what is being assessed and how the trainee’s performance should be rated.

The new forms appear to trigger some degree of more focused qualitative comments for each item assessed. The frequency with which clinical procedures, improving time management and efficiency, and improving communication skills are raised as specific areas in the comments section would suggest that the criteria may have triggered reflection on these skills by trainees in particular.

Analysis of the qualitative comments on the forms confirmed that on the whole prevocational trainees are a capable and high performing cohort. The vast majority of trainees were assessed at either rating 3 or rating 4 (confirming that they were performing at a high or very high level.) Given that to separate analyses of different forms identified that the vast majority of assessments are in the upper two categories, a form that allowed for three out of four positive criteria was developed and trailed.

It had been acknowledged that a change in assessment form, in isolation, is unlikely to improve assessment processes for prevocational assessment. Contact between senior medical staff and each trainee, and the term supervisor spends with the trainee at the assessment meetings matter more than does completion of a form.

2nd Trial of Criterion Based Forms

Following the initial trial of criterion based forms, HETI developed a form with the aim of providing greater discrimination and information on positive assessments. The objective of the trial was to evaluate if increasing the number of ratings describing different levels of satisfactory performance will help discriminate performance amongst a group of prevocational trainees. The new criterion based assessment forms were developed describing behaviours consistent with unsatisfactory (1) and three increasing levels of satisfactory performance (2 – 4) and replaced the two different assessment forms used in each prevocational network from term 2, 2013. The new term assessment forms provided greater scope for differentiating junior doctor performance.

Our findings demonstrated that implementing changes to the rating descriptions of the assessment forms improved the spread of performance levels amongst interns.

HETI has begun a trial of the use of online assessment software, saving significant resources and time, as well as enabling a greater use of assessment data to improve prevocational

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education. The evaluation of the assessment forms may assist the Australian Medical Council in their development of work-based, patient centred outcome statements to be used as criteria when assessing interns. The system has significant functionality, including term allocations, rostering, trainee assessments, term evaluations, reporting on activities on numerous levels and trainee log books.

Publications

HETI publishes the following resources:

 The Doctors Compass

 The Doctors GPS

 The Superguide: A handbook for supervising doctors

 The DPET Guide

 The JMO Managers’ Guide to Managing and Supporting Prevocational Trainees.

 Network Principles for Prevocational Medical Training

 Trainee in Difficulty: a management guide for DPETs

In 2013 HETI developed or reviewed the following publications.

The Super guide: A Handbook for Supervising Doctor

The Superguide is focused on providing practical advice to improve the effectiveness and educational value of clinical supervision for prevocational trainees and undergraduate students and peers in a range of settings, including general practice.

The DPET Guide

This practical guide provides information for DPETs about many aspects of prevocational education and training including: leadership in medical education, working with prevocational trainees, clinical based education and training working with term supervisors, assessment and feedback, formal education program, HETI accreditation, and DPET support structures.

The JMO Managers’ Guide to Managing and Supporting Prevocational Trainees.

The JMO Managers’ Guide was developed and funded as part of the Health Workforce Australia’s Integrated Clinical Training Networks (IRCTN) Program. The JMO Manager’s Guide is a practical resource that provides information about many aspects of prevocational education and training including medical training pathways and how prevocational trainees learn, recruitment and selection process, term allocations and HETI accreditation.

In 2013 HETI printed:

 950 copies of the Doctors Compass given to each PGY1 trainee at orientation.

 500 copies of the DPET Guide. Two copies were sent to each accredited prevocational training site.

 500 copies of The JMO Manager’s Guide. Two copies were sent to each accredited prevocational training site.

NSW Prevocational Medical Education Forum

HETI annually hosts the NSW Prevocational Medical Education Forum (PMEF) to promote excellence in prevocational medical education and training. This is an opportunity for all of those involved in prevocational training to come together and share their achievements, innovations and experiences, to workshop critical issues and hear practical advice from leaders in the field.

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The 2013 PMEF included 38 separate presentations and a forum dinner which recognises the contributions of those involved in prevocational education and training during the year. Participants also received a copy of The Superguide and either a copy of The DPET Guide or The JMO Managers Guide.

Directors of Prevocational Education and Training (DPETs) and JMO Managers are supported by HETI to attend the PMEF.

JMO Forum

The JMO Forum has 45 members, composed of one elected PGY1 and PGY2 representative from each of the 16 prevocational training networks and representative from each rural home hospital. Three hospitals have opted to sponsor an additional JMO onto the Forum. The forum allows prevocational trainees to meet and discuss issues relevant to prevocational recruitment, accreditation, supervision, training, and welfare.

In 2013 trainees received presentations including ones from the HETI LEAD and LEAP programs, Agency of Clinical Innovation, Clinical Excellence Commission, HETI Medical Directorate, HETI People Management Skills Program

The JMO Forum formed seven working groups for 2013 that undertook the following activities:

 Advocacy: Created a JMO Forum position statement on the value of a two year generalist prevocational medical training program.

 Education: focused on the implementation of the “Clinical Transition Week” Presented results and recommendations at the NSW Prevocational Medical Education Forum, and the 18th National Prevocational Medical Education Program. Many recommendations were added to orientation programs by training networks

 JMO Census: Analysed data from a survey of 80 JMOs. Presented results and recommendations at the NSW Prevocational Medical Education Forum, and the 18th National Prevocational Medical Education Program. Obtained ethical approval to conduct the JMO Census of all NSW in 2014.

 IT: Investigated the role of IT in health provision as related to JMOs in the future. Presented results and recommendations at the NSW Prevocational Medical Education Forum, and the 18th National Prevocational Medical Education Program.

 Communication: Promoted effective communication lines between JMO Forum and the JMOs of NSW and ACT. Published a newsletter and poster after each JMO Forum to keep NSW JMOs abreast of what's happening and to raise the profile of the JMO Forum.

 Supervision (Four Hour Rule): Provided an assessment of the National Emergency Access Target (NEAT) impact on JMOs supervision and education. Presented results and recommendations at the NSW Prevocational Medical Education Forum, and the 18th National Prevocational Medical Education Program.

 Workforce: Analysed where new interns positions were made, where additional positions weren't made and why not. Researched the fair distribution of workload amongst the prevocational training networks. Presented results and recommendations at the NSW Prevocational Medical Education Forum.

DPET Funding

Under the NSW Health Policy Directive Clinical Training Grants for Postgraduate Year One and Two Medical Officers (PD2005_259), funding is provided annually to each accredited hospital to support Directors of Prevocational Education and Training (DPETs) the education and training

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of prevocational trainees. NSW Health delivers all funding for HETI programs to LHDs in an allocation called the Medical Specialty Training Networks Funding Allocation (DOHRS no. MB345).

HETI provides annually advice to the LHDs about the amount that should be available to each DPET. However HETI bases this advice on annual incremental increases applied to a historical funding base. There is a significant risk that this information is inaccurate.

While some DPETs report that the advice from HETI is useful in securing the DPET funding, HETI still received regular feedback in 2013 from DPETs stating that they either have great difficulty accessing the funding, or are unable to access any funding at all.

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OPPORTUNITES FOR IMPROVEMENT

Workforce Distribution Funding

The supply of expected medical graduates each year is greater than the preferred number of prevocational trainee positions required by the Local Health Districts in NSW.

This has necessitated the use of a formula to determine the number of graduates each LHD must take to ensure the NSW Government guarantee is met, to place all domestic medical graduates. Each year LHDs are asked to nominate the number of positions they will fund and the request is to match or increase the number on the previous year. The current workforce distribution formula was established in 2008 and HETI has commissioned a review of the formula. A result of this work will be a revised formula that better accounts for the current medical service activity and a strategy to better align the number of intern positions across the State to the formula.

Alignment with the Australian Medical Council accreditation

standards

The Medical Board, in conjunction with the Australian Medical Council, has implemented a National Intern Training Accreditation Framework. Under this framework, the AMC will review the state and territory intern term accrediting bodies. As NSW is likely to be accredited in 2015, this is an opportunity for HETI and LHDs to make the necessary changes to ensure there is alignment with the national framework, this will require changing many of the current work practices. HETI will take the lead on this process as follows.

1. HETI has identified gaps in current accreditation standards and will draft new

standards

2. Implement a new accreditation model to move towards an outcome based

accreditation process

3. Develop a plan to assist training facilities regarding their responsibilities against

the new framework and the AMC Standards.

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APPENDICES

Appendix 1: Prevocational Training Networks

Network Accredited Facility LHD/RTP Status

Network 1 Inner West and Western Plains

Balmain Hospital SLHD R

Dubbo Base Hospital WNSWLHD T5

Royal Prince Alfred Hospital SLHD T5

Dubbo Medical and Allied Health Centre (PGY2 only) BME GP Hyde Park Medical Centre (PGY2 only) (Sydney CBD) GP Synergy GP

Network 2 Bankers and Campers

Bankstown-Lidcombe Hospital SWSLHD T5

Bowral & District Hospital (PGY2 only) SWSLHD R

Campbelltown/Camden Hospital SWSLHD T5

Moss Vale Medical Centre (PGY2 only) CCCT GP

Bowral Street Medical Centre (PGY2 only) (Bowral) CCCT GP Allcare Medical Centre Hammondville (PGY2 only) GP Synergy GP General Practice for Children and Young Families

(Campbelltown) GP Synergy GP

Allcare Medicals Wattle Grove (PGY2 only) GP Synergy GP Allcare Carnes Hill Medical Centre (PGY2 only) GP Synergy GP Network 3 Concord, Canterbury & Broken Hill Base Hospitals

Broken Hill Base Hospital FWLHD R

Canterbury Hospital SLHD T3

Concord Repatriation General Hospital SLHD T5

Excel Medical Centre (PGY2 only) (Chester Hill) GP Synergy GP

Network 4 South West Sydney, Tweed Heads Fairfield Hospital SWSLHD T3 Liverpool Hospital SWSLHD T5

The Tweed Hospital NNSWLHD T5

Cecil Hills Medical Centre (PGY2 only) GP Synergy GP Musgrave Street Medical Centre (PGY2 only)

(Coolangatta, QLD) NCGPT GP

Yagoona Medical Centre (PGY2 only) GP Synergy GP

Powell Street Medical Centre (PGY2 only) (Yagoona) GP Synergy GP Tweed Health for Everyone Superclinic (Tweed Heads) NCGPT GP

Network 5 North Shore & Port Mac

Greenwich Hospital NSLHD R

Kempsey District Hospital MNCLHD R

Port Macquarie Base Hospital MNCLHD T5

Royal North Shore Hospital NSLHD T5

Ryde District Hospital NSLHD T3

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Complete Primary Care Medical Centre (Port Macquarie) NCGPT GP Cremorne Medical Practice (PGY2 only) GP Synergy GP

Greenmeadows Medical (Port Macquarie) NCGPT GP

Network 6 Hornsby & Northern Beaches

Hornsby Ku-ring-gai Health Service NSLHD T5

Manly Hospital NSLHD T3

Mona Vale Hospital NSLHD T3

Sydney Adventist Hospital Private R

Hornsby GP Unit /Brooklyn Community Health Centre GP Synergy GP Network 7

Central Coast Network

Gosford District Hospital CCLHD T5

Wyong Hospital CCLHD T3

Reliance Medical Centre (PGY2 only) Wyoming/Gosford VTCGPT GP

Network 8 St George, Sutherland, Albury & Griffith Hospitals

Albury Campus, Albury Wodonga Health Service AWH/

MLHD T3

Griffith Base Hospital MLHD R

St George Hospital and Community Health Service SESLHD T5

Sutherland Hospital SESLHD T3

Calvary Health Care Sydney SESLHD R

Cremorne Medical Practice (PGY2 only) GP Synergy GP Gardens Medical Group (PGY2 only) (Albury) BGPT GP

Your Health Griffith CCCT GP

Allcare Carnes Hill Medical Centre (PGY2 only) GP Synergy GP Picton Family Medical Centre (PGY2 only) GP Synergy GP Family Health Care Roselands (PGY2 only) GP Synergy GP

Network 9 From Coast to Coast

The Prince of Wales Hospital SESLHD T5

Lismore Base Hospital NNSWLHD T5

The Langton Centre, Surry Hills SESLHD R

Grant Street Clinic (Ballina) NCGPT GP

Allcare Carnes Hill Medical Centre (PGY2 only) GP Synergy GP

UNSW Health Service (PGY2 only) GP Synergy GP

Cecil Hills Medical Centre (PGY2 only) GP Synergy GP Union Street Family Medical Practice (PGY2 only)

(Maclean) NCGPT GP

Network 10 Eastern to Greater

Wagga Wagga Base Hospital & Community H.S MLHD T5

St Vincent’s Hospital SVHN T5

War Memorial Hospital, Waverley SESLHD R

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Southern Gundagai General Practice Service (PGY2 only) CCCT GP Peter Street Medical Centre (Wagga Wagga) CCCT GP

Glenrock Country Practice (Wagga Wagga) CCCT GP

Kings Cross Clinic (PGY2 only) (Sydney) GP Synergy GP Campsie Family Medical Centre (PGY2 only) GP Synergy GP Evans St Surgery (PGY2 only) (Inverell) GP Synergy GP Coolamon Shire Medical and Dental clinic (PGY2 only) CCCT GP

Network 11 Oceans 11

Shellharbour Hospital ISLHD T3

Shoalhaven District Memorial Hospital ISLHD R

Bulli Hospital ISLHD R

Wollongong Hospital ISLHD T5

Coledale Hospital (PGY2 only) ISLHD R

Port Kembla Hospital ISLHD R

Milton-Ulladulla General Practice (Milton) CCCT GP

Dapto Healthcare Pty Ltd (PGY2 only) CCCT GP

Meroo Street General Practice (PGY2 only) (Bomaderry) CCCT GP

Shell Cove Super Clinic (Shellharbour) CCCT GP

Network 12 Hunter New England

Armidale Rural Referral Hospital HNELHD R

Belmont District Hospital HNELHD T3

Calvary Mater Newcastle HNELHD T3

Hunter New England Mental Health HNELHD R

John Hunter Hospital HNELHD T5

The Maitland Hospital HNELHD T5

Manning Rural Referral Hospital HNELHD T3

Tamworth Rural Referral Hospital HNELHD T5

Royal Newcastle Centre HNELHD R

Charlestown Surgery (PGY2 only) (Charlestown) VTCGPT GP Northwest Health, Homespace (PGY2 only) (Tamworth) GP Synergy GP Newcastle Mental Health Service (Newcastle West) VTCGPT GP Blackbutt Doctors Surgery (PGY2 only)(New Lambton) VTCGPT GP Evans St Surgery (PGY2 only) (Inverell) GP Synergy GP

Network 13 Westnet

Auburn Hospital WSLHD R

The Children’s Hospital at Westmead (PGY2 only) SCHN R

Coffs Harbour Health Campus MNCLHD T5

Westmead Hospital WSLHD T5

Orange Health Service WNSWLHD T5

Kendal St General Practice, Cowra (PGY2 only) (Cowra) BME GP

The Wellness House (PGY2 only) (Orange) BME GP

Kelso Christian Medical Centre (PGY2 only) (Kelso) BME GP George Street Medical Practice (PGY2 only) (Bathurst) BME GP Kable Street General Practice (PGY2 only) (Windsor) Wentwest GP

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Toormina General Practice (Toormina) NCGPT GP Richmond Road Family Practice (PGY2 only)

(Glendenning) WentWest GP

Richmond Marketplace Medical Centre (PGY2 only) WentWest GP Union Street Family Medical Centre (PGY2 only)

(Maclean) NCGPT GP

Evans Street Surgery (PGY2 only) (Inverell) GP Synergy GP

Bridgeview Medical (Toongabbie) WentWest GP

Grafton GP Super Clinic (Grafton) NCGPT GP

Twinkle Medical Centre (PGY2 only) Northmead) WentWest GP

Network 14 Nepean & Blue Mts

Blue Mountains District ANZAC Memorial Hospital NBMLHD R

Hawkesbury District Health Service NBMLHD R

Nepean Hospital NBMLHD T5

Lithgow General Medical Practice (PGY2 only) BME GP Hazelbrook General Practice (PGY2 only) WentWest GP Dr Dinh’s Surgery (PGY2 only) (Blaxland) WentWest GP Erskine Park Family Clinic (PGY2 only) WentWest GP

Kingswood Mediclinic (PGY2 only) WentWest GP

Network 15 Central West

Bathurst Base Hospital WNSWLHD R

Blacktown Hospital/Mt Druitt Hospital WSLHD T5

Erskine Park Family Clinic (PGY2 only) WentWest GP

Other* PGY2 only

Alice Springs District Medical Officer (DMO) Service

(PGY2 only) (Central Australian region, NT) NTGPE GP DHF Remote Health – Top End (PGY2 only) (Western

zone of Top End region, NT) NTGPE GP

Wurli Wurlinjang Health Service, Katherine NT(PGY2

only) NTGPE GP

Jabiru Health Centre, Kakadu Health Service NT (PGY2

only) NTGPE GP

Alyangula/Angurugu Health Service (PGY2 only)

(Groote Eylandt, Gulf of Carpentaria NT) NTGPE GP Wadeye Community Health Centre, NT (PGY2 only) NTGPE GP Ngalkanbuy Health Centre, Elcho Island NT (PGY2 only) NTGPE GP Miwatj Health Aboriginal Corporation, East Arnhem Land

NT (PGY2 only) NTGPE GP

Gove District Hospital, East Arnhem Land NT (PGY2

only) NTGPE GP

Batchelor, Adelaide River and Pine Creek Community

Health Centres, NT (PGY2 only) NTGPE GP

Outcome Report for 2014 Medical Graduate Recruitment, Prevocational Accreditation, Education and Training.