The Doctors in Training (DiT) Committee reports to the Advisory Council and has functions including:
- receiving feedback from trainee medical officers about relevant safety and quality matters and to advocate to health services about trainee medical officer training, health and welfare issues,
- develop position statements and policies that support the education, training, health and welfare of student and trainee medical officers and
- provide comment on documents relating to trainee medical officer education, training and welfare.
Unaccredited registrar positions
The following represent the key areas of Doctors in Training (DiT) Committee activity over the past two years.
The SA MET DiT Committee are advocating on behalf of unaccredited registrars, following concerns raised of exploitation and unsafe practices. There are currently hundreds of unaccredited registrars working within SA Health. With no regulatory body this number is unable to be accurately quantified. These positions are created by Hospital departments based on workforce need.
There is no accreditation to ensure adequate support, supervision and education is provided as part of this role. These junior doctors are also not a part of a college, thus have no formal education or training requirements provided by an external body.
There are a number of concerns which have been raised by junior doctors filling these positions within SA Health.
Safety
Unaccredited trainees work significantly more night shifts compared to those on a training program, at a time where there is less supervision and support in the hospital. They often work considerably more hours, with risk of burnout and fatigue, impacting the ability to provide safe patient care.
Education and training
- There is no formal education provided, such as that scheduled for interns, or provided by Colleges for their trainees.
- Training provided is often subject to the needs of the unit rather than the needs of trainees.
- Not having the same education and training as those within a program while undertaking similar scope of practice poses a risk of safety to junior doctors and patients.
Bullying
- Junior doctors undertaking these positions are working towards applying (or reapplying) to their chosen specialty. Often these junior doctors are most vulnerable to bullying as they feel they are unable to speak up without jeopardising their chances of successfully gaining an accredited position.
- With no one accountable and no protection, unaccredited registrars are one of the most vulnerable junior doctor groups in the workforce.
The DiT Committee are working with the SA MET Unit to help identify unaccredited registrar numbers and provide accreditation and oversight of these positions.
Patient Restraint
The SA MET DiT Committee has identified issues regarding the management of agitated patients and the deficiency in relevant legislation for restraint of patients who do not fit the Mental Health Act. Currently, there are still unsafe practices occurring, with trainees and clinicians resorting to legally inappropriate Inpatient Treatment Orders under the Mental Health Act when chemical or physical restraint is necessary, due to a lack of alternative encompassing legislation. This resulted in a Restrictive Practices Amendment Bill to the Consent to Medical Treatment and Palliative Care Act, for which the DiT Committee provided a response to. Due to the change in government, this has been delayed and currently a new Amendment Bill is being drafted.
As trainees perform a large proportion of service delivery within the public health system, especially afterhours when agitated incompetent patients must be managed, this continues to be a significant source of confusion and distress for doctors in training. The DiT Committee continues to advocate and communicate with the Department of Legal and Legislative Policy to ensure appropriate legislative frameworks exist.
National Framework for Prevocational Medical Training
The DiT Committee has been actively involved in the consultation toward the upcoming changes to medical internships. This will be the biggest change to internship training since 2014, so it is important that junior doctors have had a channel to provide feedback on the proposed changes. Throughout 2023, the DiT Committee will continue working with the SA MET Unit to release further details about the transition period and implementation of these changes and will also ensure that any issues identified during this process are rapidly escalated to ensure a smooth transition.
Revised CPD Registration Standards
The DiT Committee has been monitoring the changes to continuing professional development for medical practitioners by the Medical Board of Australia and specifically how this will impact junior doctors. Specifically, the introduction of CPD homes, the requirement for professional development plans and the mandatory types of CPD now required. The new standard will take effect on 1 January 2024 and the DiT Committee will continue monitoring this as further information is released on the impacts to junior doctors.
