The Australian College of Rural and Remote Medicine called for more consideration of rural settings. As did the AMA.
Model training standards and procedures are “poorly suited” to general practice and rural hospitals, says the Australian College of Rural and Remote Medicine.
The Australian Medical Council, on behalf of the Medical Boards of Australia, assesses and accredits specialist medical training programs.
Earlier this year, the AMC released draft model accreditation standards and procedures – a recommendation of the National Health Practitioner Ombudsman report – to help standardise training accreditation across specialties.
In its response to the consultation on the draft, ACRRM raised concerns that the standards were not as applicable to general practice and rural hospitals.
“It is noted that the initial motivation for the series of reforms associated with this framework was to address issues in urban tertiary hospitals and we see risk with that the final framework may be poorly suited to achieving quality-assured training site accreditation in small rural and remote hospitals and general practices,” reads the submission.
ACRRM added that some of the procedures outlined in the draft wouldn’t be economically viable when applied to rural settings.
“For example, procedures which require administratively complex, clinician-led expert committees to review every accreditation site are simply not financially practicable for our sector,” reads the submission.
“Furthermore, the more prescriptive the requirements and the wording of the standards the less likely it is that they will be suitable across the diversity of our training sites, and the less resilient the systems will be to adjust to changes across the sector.”
The college made six recommendations.
This included a call for an acknowledgement that small general practices, community health centres and rural hospitals provide the majority of healthcare, so the framework should enable, and not have unintended costs for, quality training in these contexts.
The college said that while it supported having a “model” for standards, any requirement for verbatim language across all standards across colleges or sites was concerning.
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“Flexibility at every level is critical to enabling our training programs and the development of future rural generalist workforce,” said ACRRM.
“Achieving national agreement on these standards is a major undertaking of time and resources.
“A high-level, outcomes-focused approach is thus important, as we would expect going forward that the standards will be slow to respond and adjust to technological, structural and other system shifts in the healthcare sector.”
ACRRM also took aim at the six-week timeframe for consultation.
“We would particularly highlight that the ACRRM Aboriginal and Torres Strait Islander Members Group has advised that they would need further opportunity to review across their membership and also to consult with key partner organisations in order to provide meaningful feedback on the standards from their perspective.”
The college called for “continuation of the community-based primary care accreditation model as is currently in operation which is necessary for economic and practical feasibility in this sector”.
ACRRM suggested that the admin burden of accreditation would be too high if minute records of accreditation discussions were required.
Finally, it called for streamlined processes for provisional accreditation for training sites that have applied repeatedly, especially in areas of workforce shortage.
“The college has some concerns that the 12-month maximum period on Provisional Accreditation status would see many accredited training sites lapsing their status and having to repeat the entire process regularly without having received a trainee,” said the college.
In its submission, the AMA was “broadly supportive” of the draft model accreditation standards and procedures.
The association did suggest changes on supervision feedback, specifically a mechanism for feedback about inadequate supervision that wouldn’t require escalation through the supervisor in question.
“This is a common challenge encountered by trainees, where the standard process to escalate concerns about inadequate supervision involves the supervisor,” said the AMA.
“This is an unacceptable arrangement and can create significant stress for trainees.”
The association raised a lack of consideration for rural and remote trainees in multiple sections of the draft, including flexibility in safe supervisor ratios.
It also called for the independence of training accreditation to be maintained.
“The AMA agrees specialist medical colleges must have independence and the appropriate freedom to assess, accredit and monitor training settings,” reads the submission.
“In doing so, communication must be clear, and the transfer of information must be transparent between parties.
“The proposal must not give health ministers any directions to act or impose their decisions on what must be an independent process.”
Ample support must be provided for trainees at sites with revocated accreditation, added the AMA.
“Trainees should not be punished if their training site has its accreditation revoked, nor should their education and training be severely impacted.”
