Education renewal:
Next generation learning
physicians
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for
Education: our ongoing journey
Physician education has changed significantly since the College was first established in 1938
and will continue to change to keep pace with modern medicine and increasingly rigorous
design standards for specialist education programs. Figure 1 illustrates key changes that
have occurred in recent years and future innovations.
Past: Historically, physician training has placed a lot of trust in requiring trainees to spend a
defined amount of time in the apprenticeship model of training, and focused on the exam as
a barrier to enter Advanced Training.
Recent past: Since 2008, the College has developed a syllabus and program handbook for
each training program, introduced formative work-based assessment practices and partial
online submission and tracking of training information. However, a prevalent perception
among trainees and supervisors is that work-based assessment is more bureaucracy that
needs to be ‘ticked off’ in order to meet College requirements.
While trainees continue to have largely positive things to say about their clinical exposure
and their learning from peers and supervisors, feedback from both trainees and supervisors
over the past few years tells us that there is some room for improvement to the training
program, particularly around making the curricula more relevant and useful in the workplace
environment, and ensuring that supervisors are supported and have the capacity to provide
quality training in the workplace.
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The Future of Physician Training
Plan for increases in trainee
numbers. “We will need triple the
number of [supervisors] in future due
to the amount of trainees and the
amount of work required.”
Maintain relevance to practice. “The planned
emphasis on assessing competency… during
every day clinical practice should be maintained,
and needs to be supported and encouraged.”
Accommodate workplace practices. “The lack of alignment between the PREP program
requirements and the workplace setting caused frustration among Fellows and trainees…
Many stated that the PREP program requirements are unworkable in practice, because they
ignore the reality of workplace settings.”
More useful and aligned curriculum
“I wasn’t aware of the training curriculum.”
“The examination does not reflect the
curriculum.”
Need for better support
“RACP cannot impose requirements and
expect supervisors to work more, if no
support is provided.”
Future: We are looking to move away from curricula that describe a series of requirements
that a trainee needs to “ticked off” during training and towards curricula that are usable
training guides that are embedded in the realities of daily practice and enable trainees and
supervisors to track progress against set standards across the continuum of physician
training.
The College has a long and proud history of producing high quality graduates from our
training programs. In order to continue to maintain the same quality for our next generation of
learners, we need to undertake significant work on the framework and structure of physician
training in Australia and New Zealand.
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Education renewal
The College is working, in collaboration with a number
of working groups, to develop new curricula for all of
our training programs and new models for supporting
supervising Fellows. What will emerge from this work is
a modern curriculum that will produce world-class
physicians and paediatricians equipped to deal with the
demands of a rapidly changing environment.
Competency-based
training is an outcomesbased approach to the
design,
implementation,
assessment, and evaluation
of a medical education
program using competencies
as the organising framework.
Royal College of Physicians and
Surgeons
of
Canada
and
the
International CBME Collaborators, 2009
Why change?
It is important to ensure that our graduating Fellows continue to be of the highest standard to
serve the health of patients, carers and communities. In the same way that clinical practice
needs to evolve in response to developments in knowledge and understanding of health and
illness, College training programs also need to evolve to suit the changing environment for
physician practice. This means keeping up to date in terms of educational content but also in
the way teaching, learning and assessment are designed and delivered – which is primarily
in the workplace.
We need to update our curricula and training requirements and move from a traditional timebased training approach towards competency-based training and progression that is practical
in the workplace.
The move towards competency-based training reflects the accreditation requirements of both
the Australian Medical Council and the Medical Council of New Zealand. It is already best
practice internationally, including in Canada, the United States, Europe and the United
Kingdom.
What will be different?
1. New selection
process
More rigorous entry
requirements
aligned to College
standards.
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2. New curricula
A new, more user-friendly
curriculum for each training
program designed to make
competency-based training
and progression practical in
the workplace.
3. New services and support
A plan to address capacity to
train issues, a review of
accreditation systems,
introduction of new
technology, and more support
for supervisors and trainees.
What will these changes mean in practice?





Select those best suited to physician training to meet future health and community needs.
New, practical curricula to guide learning in the workplace.
Providing feedback will be easier under a more defined framework that reflects the reality
of the workplace.
Increased infrastructure and support to make space for training, keep trainees on track,
and provide more professional development and resources to assist at points of
transition.
The changes will take effect from 2018 at the earliest.
What work is being undertaken?
1. New selection process
More rigorous entry requirements aligned to College standards
Trainees who are best suited to physician training and practice will be selected according to
the College’s new Selection into Training Policy.
A new selection model, aligned with this policy and College curricula standards, is currently
in development to support selection processes in training networks throughout Australia and
New Zealand. The methods which are proposed are fairer and research shows that they
predict well for trainee progression and successful independent practice in medicine.
The proposed new selection model and processes will be out for consultation in mid-2016.
2. New curricula
A new, more user-friendly curriculum for each training program designed to
make competency-based training and progression practical in the workplace.
Starting with Basic Training, we are reviewing 40 curricula (which cover 61 training
pathways) to make sure they meet the complex demands of a rapidly changing health
environment and reflect the skills, knowledge and attributes of the next generation of
physicians.
Competency-based training and progression means that the curricula will have a greater
emphasis on tracking trainees’ achievement of skills and demonstrated performance, rather
than primarily tracking time spent in training.
In developing new curricula, we are returning to the question of what it is to be a physician,
informed by our new Standards Framework, and replacing the tick box approach to learning
and assessment with a focus on the essential real-life work tasks trainees need to do as part
of their everyday practice and clinical decision making (Entrustable Professional Activities).
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The new Basic Training curricula will be out for consultation from mid-2016. The College’s
Curriculum Advisory Group is planning the review of Advanced Training curricula, which will
start in 2017.
Teaching and learning
The curricula will include a teaching and learning program that recognises that
predominantly occurs in the workplace and from others. Supplementary formal
resources will be identified or developed, including new eLearning courses and an
lecture series for both Adult Medicine and Paediatrics & Child Health Basic
programs.
learning
learning
updated
Training
Assessment
A program of assessment will be developed that aligns closely with curriculum outcomes.
This will include an emphasis on evidence-based progression decisions in the workplace.
The College’s examinations strategy includes a review of the Divisional Clinical Examination
assessment processes, including simplification of the marking scale and improvement of
examiner calibration and feedback processes. We are also planning the introduction of
computer-based testing for the Written Examinations, and investigating potential for holding
the exam more than once per year. Consultation on potential date change for the Adult
Medicine Division Clinical Examination is currently underway; if approved the change will
take effect from 2018.
3. New services and support
A plan to address capacity to train issues, a review of accreditation systems,
introduction of new technology, and more support for supervisors and trainees.
We want to get implementation right. This means working with our partners in medical
education to make space for quality training through our capacity to train initiatives, focusing
on more support for our trainees and supervisors, developing more rigorous accreditation
systems, and using technology more effectively to support the new selection processes and
curricula. We will also introduce comprehensive evaluation systems to gain continuous
feedback for ongoing improvement.
Partners and governance
We recognise that there are many stakeholders in physician training. We will be working to
develop partnerships with consumers, local networks, health jurisdictions and others. We will
also be looking at refining our governance structures to help with optimal implementation of
education renewal changes.
Capacity to train
An unprecedented rise in the number of trainees over the last decade, together with other
changes in the healthcare environment and medical education are challenging our
supervisors’ capacity to provide physician training in Australia and New Zealand.
The College is working on solutions to capacity to train issues. This includes work on setting
evidence-based numbers of trainees that can be sustainably trained at both individual
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training setting levels and the broader College level. We will also be advocating at federal
and local levels to help create space for quality training.
Trainee support
The College is committed to supporting the wellness and wellbeing of our trainees. We
have a new Trainee in Difficulty policy and support pathway, and a dedicated Trainee
Support Unit who work closely with trainees, supervisors and College committees to
coordinate support for trainees experiencing difficulties. Our support services will be
enhanced to include a focus on induction into the training programs, and a new helpline for
trainees or supervisors to discuss confidential issues.
Supervisor support
We are committed to ensuring that the vital contribution and commitment of each and every
one of our supervisors is rewarded, recognised and supported.
Our supervisor support strategy outlines seven distinct pieces of work to better support
supervisors. This includes work on role clarity, standards, rewards and recognition,
selection, training, evaluation, and engagement.
The College’s Supervisor Professional Development Program offers workshops and online
courses to help both new and experienced supervisors to brush up on skills and share ideas
for good supervision.
Accreditation of training settings
We are reviewing our accreditation process and a new accreditation system has been
proposed. Standards to support the delivery of the new curricula are being developed for
training settings and networks. The proposed system will be out for consultation in May 2016
and the generic standards will follow in the second half of 2016.
The review includes the development of accreditation processes, trainee and supervisor
feedback tools, online accreditation tools, assessor and training provider training.
Technology
The new selection into training process and the new curricula will need to be supported by
technology to be useful for trainees and supervisors. We are investigating options for a new
ePortfolio to help track progress through the training program and on into continuing
professional development.
Evaluation
We will be developing strategies to evaluate the impact of competency-based training on the
trainee performance and impacts on patient experience and health outcomes.
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Next steps
The next step for College education renewal includes a lot of consultation opportunities. We
want feedback to help us design the best possible, practical and fit-for-purpose changes to
College training programs. Changes will be implemented from 2018 at the earliest.
We consulted on the proposed changes to the selection of
applicants for entry into RACP Basic Training in Adult Internal
Medicine and Paediatrics & Child Health between May - June
2016. These insights are now being integrated into the model for
the selection process.
New selection process
A new selection process will be developed over 2017.
Contact [email protected] for further information.
The proposed new Standards Framework and associated
Fellowship Standards were open for consultation between March
-May 2016.
New curricula
Parts of the new draft Basic Training curricula will be presented
online for broad consultation from mid-2016, supported by a
number of consultation workshops around Australia and New
Zealand. Design of the teaching and assessment components of
the curricula will continue.
Renewal of the 38 Advanced Training curricula will start from
2017.
Contact [email protected] for further information.
We are currently consulting on our Supervisor Support Strategy,
aspects of the Capacity to Train strategy, and the proposed new
standards for the accreditation of training settings.
New services and
support
Work to improve resources and support for trainees and
supervisors will continue into the future.
Visit our website to find out more:
www.racp.edu.au/trainees/education-renewal
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