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TRAINING AND RETAINING HEALTH
PROFESSIONALS: METROPOLITAN,
RURAL AND REMOTE PERSPECTIVES
Dr Alex Markwell
FACEM
Royal Brisbane and Women’s Hospital and
Greenslopes Private Hospital
Declaration of Interest

I am currently employed at Greenslopes
Private Hospital, a recipient of various
Commonwealth grants
Acknowledgements
Greenslopes Private Hospital and staff
for use of photos
 Queensland Ambulance Service for use of
photos

Overview
Focus on metro and urban setting from
clinical educator perspective
 Evidence, barriers, solutions
 Medical, nursing & paramedic examples

Evidence
Cost of health care worker turnover is
huge
 Estimated in 2004 to be at least 5% of
total annual operating budget 1

¼
of total cost due to nurse turnover
 Medical turnover lower than others but costs
much higher
1. Waldman et al. The Shocking Cost of Turnover in Health Care.
Health Care Manage Rev, 2004, 29(1), 2-7
Evidence- Business
Supports continuing professional
development (CPD) & skills development
opportunities
 Linked with job satisfaction
 Part of suite of retention strategies

Evidence- Health
Training and skills development is
included consistently in retention
strategies across disciplines
 Little research in urban context
 More evidence available in rural and
remote settings

 Long
look programs
 Rural clinical schools
Evidence

Nursing disciplines
 RN,
Midwives
 ENs, AINs

Allied health
 Ministerial
Taskforce in Queensland- Full and
Extended Scope of Practice in Allied Health

Medicine
 Students,
junior, rural & senior docs
Training -what is it?
Includes informal and formal “in-services”
or education sessions
 Didactic, small group, bedside, simulation,
other modalities
 Generally discipline-specific but greater
emphasis now on inter-disciplinary
learning...

Training- Barriers
Cost
 Time
 Supervisor capacity
 Supervisor experience
 Matching learner need with training
opportunities
 Service provision is priority
 Culture

Training- Barriers
Cost, time (resourcing)
 Service provision is priority


IHPA currently undertaking modelling
exercise to estimate cost of education and
training as part of Activity Based Funding
(ABF)
Training- Barriers
Supervisor capacity & experience
 Matching learner need with opportunities
 Culture
 More difficult to quantify
 Increasing focus on “doctor as teacher” but
less so for other disciplines
 Reliant on opportunistic access to training

Supervisor Shortfall
Training and Retaining- Solutions
GPH nursing education
 Simulation Centre Programs
 In-services
 Other sessions e.g. Grand Rounds, GP
Educations sessions etc
Training and Retaining- Solutions
Sim Centre Programs
 ALS certification and recertification
 12

RNs/week
Midwifery training
 Specific

obstetric emergencies
MERT scenario training
 RNs
from different wards in MERT scenarios
Training and Retaining- Solutions
Combination of dedicated paid (and
protected) education and training time –
off the floor and separate to clinical shifts
 Safety and Quality aspects and QI
 Dedicated nurse educators- supported
and resourced

Training and Retaining- Solutions
Medical Students
 Specifically recruited from rural
background into rural clinical schools
 “Long-look” program- 6-12 month clinical
placements in rural facilities (QRME)
 Sim scenarios- ward call, MERT, ALS
Training and Retaining- Solutions
Junior Doctors
 CRuSE (Clinical Rural Skills Enhancement)
workshops
 Intensive
2 day skills & simulation workshop with
supporting lecture sessions
 “Prepare RMOs for positive short-term
placement in rural QLD hospitals”
 Monthly sessions
 Cunningham Centre partnership with GPH
Training and Retaining- Solutions
Junior Doctors
 ALS training, airway, MERT scenarios
 Registrars and residents
 Small group sessions
 Senior medical facilitators
 Dedicated & protected teaching time
 Dedicated and funded medical educators
Solutions- GPH
Solutions- GPH
Solutions- GPH
Solutions- GPH
Training and Retaining- Solutions
Rural Docs
 Heavily reliant on locums/back fill to
access training
 Support programs e.g. QLD Country
Relieving Doctors Program essential
 Prioritised leave cover
 Providers such as Cunningham Centre,
QRME & Health Workforce QLD are
crucial
Training and Retaining- Solutions
Rural Docs
 RDAQ conferences have very strong
family programs which enable whole
families to attend & helps develop
positive teaching and training culture
Training and Retaining- Solutions
Paramedics
 High fidelity in situ training
 Real-time critique and feedback
 High-stakes scenarios but clinically rare
Training and Retaining- Solutions
Warning!!!
References
Waldman et al. The Shocking Cost of
Turnover in Health Care. Health Care Manage
Rev, 2004, 29(1), 2-7
 Cunningham Centre:
www.health.qld.gov.au/cunninghamcentre
 Queensland Rural Medical Education (QRME)
www.qrme.org.au/medical-students/
