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Dr Alex Markwell
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
Greenslopes Private Hospital and staff
for use of photos
 Queensland Ambulance Service for use of
Focus on metro and urban setting from
clinical educator perspective
 Evidence, barriers, solutions
 Medical, nursing & paramedic examples
Cost of health care worker turnover is
 Estimated in 2004 to be at least 5% of
total annual operating budget 1
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
 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
Nursing disciplines
 RN,
 ENs, AINs
Allied health
 Ministerial
Taskforce in Queensland- Full and
Extended Scope of Practice in Allied Health
 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
Training- Barriers
 Time
 Supervisor capacity
 Supervisor experience
 Matching learner need with training
 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
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
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)
 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
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
 High fidelity in situ training
 Real-time critique and feedback
 High-stakes scenarios but clinically rare
Training and Retaining- Solutions
Waldman et al. The Shocking Cost of
Turnover in Health Care. Health Care Manage
Rev, 2004, 29(1), 2-7
 Cunningham Centre:
 Queensland Rural Medical Education (QRME)

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