This presentation given to the 16th Prevocational Medical Education conferenced in Auckland describes the history of postgraduate medical and clinical education and training in NSW, Australia.

1. Reflections on the experience of NSW:
Moving from a PMC to IMET to CETI to HETI.
A 20 year journey
Professor Steven Boyages
Clinical Education and Training Institute
9th November 2011

3. Timeline and Definitions
Postgraduate Medical Council (PMC)
Institute of Medical Education and Training (IMET)
Clinical Education and Training (CETI)
Health Education and Training Institute (HETI)

4. Constants of health
• Clinician patient relationship
• Clash of cultures
Change Drivers
• Patient experience and safety
• Staff experience and safety
• Demography
Resilience
• Individual, self efficacy, social cognitive theory
• Organisational
Adaptability and Agility
• New models of education and learning
• Technology

5. Health is a knowledge based profession
Impart
Knowledge
• Research • Care
• Development • Education • Prevention
• Training
Generate Apply
Knowledge Knowledge

6. Constants of Health
TO RECHON him who taught me this Art equally dear to me as my parents, to share my
substance with him, and relieve his necessities if required; to look up his offspring in the
same footing as my own brothers, and to teach them this art, if they shall wish to learn it,
without fee or stipulation; and that by precept, lecture, and every other mode of
instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers,
and to disciples bound by a stipulation and oath according the law of medicine, but to
none others. (Hippocrates 460-370 BC)

7. The nature of patient care is a constant

8. Health work is a balanced matrix
High
High Touch
Tech
Team and
Technology
Workflow
Platform
Platform

9. Planetary orbits are constant
Managers are from Mars and Clinicians are from Venus

10. These “language” differences may lead
to a clash of cultures

11. A crisis is usually an opportunity for change

12. Institute of Medical Education and
Training (IMET)
Vocational Postgraduate Medical
Networks
Council
Standards & Accreditation Allocation, Supervision
HSP

14. The Perfect Storm
Changing Health
Patterns
Rising cost of Need for new
health care models of care
Increasing
consumer Technology
expectations

15. Patient Safety

16. Staff Experience

17. Intergenerational report 2010

18. Future workforce growth at Feb 2010
Future industry job growth – Australia 5 years from 2009-10 to 2014-15
(‘000) - DEEWR projections

19. Four Pillars
CETI CEC ACI BHI
19

20. Clinical Education and Training Institute (CETI)
Allied Health
Institute of Medical Education and
Nursing
Training (IMET)
Medical
Vocational Postgraduate Medical
Networks
Oral Health
Council
Rural Standards & Accreditation Allocation, Supervision
HSP
Centre for
Learning and
Teaching

21. What are we trying to do?
To improve teamwork, communication and
collaboration for safer patient-centred care, and
better staff experiences
Why are we trying to do this?
Increased staff motivation, well-being and retention
Decrease in staff turnover
Increased patient and carer satisfaction
Increased patient safety
Increase in appropriate use of specialist clinical resources
Reductions in patient mortality and critical incidents
Increase in access to and coordination of health services
21

22. What do we mean by Team Work?
Interprofessional Education (IPE)
Occasions when two or more professions learn from, with and
about each other to improve collaboration and the quality of care
Interprofessional Practice (IPP)
Occurs when two or more professions work together as a team with
a common purpose, commitment and mutual respect (Freeth et al,
2005).
22

23. Team Health
Foundations – Right Start
• Individual
• Roles and Responsibilities
• Risks and Rewards
High Performance Teams
• Roles
• Reflection
• Respect
• Resilience
Advanced Settings of Care
• Advanced Clinical Modules
• Simulation

25. What Is Self-Efficacy?
According to Albert Bandura, self-efficacy is “the
belief in one’s capabilities to organize and execute
the courses of action required to manage
prospective situations” (1995, p. 2).
In other words, self-efficacy is a person’s belief in
his or her ability to succeed in a particular situation.
Bandura described these beliefs as determinants of
how people think, behave, and feel (1994).

26. Sources of self efficacy
1. Mastery Experiences
• "The most effective way of developing a strong sense of efficacy is through mastery experiences," Bandura
explained (1994). Performing a task successfully strengthens our sense of self-efficacy. However, failing to
adequately deal with a task or challenge can undermine and weaken self-efficacy.
2. Social Modeling
• Witnessing other people successfully completing a task is another important source of self-efficacy.
According to Bandura, “Seeing people similar to oneself succeed by sustained effort raises observers'
beliefs that they too possess the capabilities master comparable activities to succeed” (1994).
3. Social Persuasion
• Bandura also asserted that people could be persuaded to belief that they have the skills and capabilities to
succeed. Consider a time when someone said something positive and encouraging that helped you
achieve a goal. Getting verbal encouragement from others helps people overcome self-doubt and instead
focus on giving their best effort to the task at hand.
4. Psychological Responses
• Our own responses and emotional reactions to situations also play an important role in self-efficacy.
Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about
their personal abilities in a particular situation.
• Bandura, A. (1995). Self-Efficacy in Changing Societies. Cambridge University Press.

28. Review Article
American Medical Education 100 Years after the
Flexner Report
Molly Cooke, M.D., David M. Irby, Ph.D., William Sullivan, Ph.D., and Kenneth M.
Ludmerer, M.D.
N Engl J Med
Volume 355(13):1339-1344
September 28, 2006

29. Figure 1
Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5)
Terms and Conditions

30. What is the literature saying?
30

31. Figure 12
31
Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5)
Terms and Conditions

34. We need to embrace social media

36. Health Education and Training Institute
Undergraduate Clinical Education and Training Institute
(CETI)
Vocational
Training Allied Health
Institute of Medical Education
Nursing
and Training (IMET)
Leadership and
Management Medical Postgraduate Medical
Council
Oral Health Vocational Networks HSP
Standards & Allocation,
Accreditation Supervision
Clinical Rural

37. HETI Function Domains
Undergraduate clinical placements
Vocational Education and Training
Post graduate clinical prevocational and
vocational training
Management and Leadership Development

38. Investment and Risk Strategy

39. “Storm Damage”
Staff Shortages
Poor Economic
Competency gaps
Development
Poor staff
Increased Medical
utilisation and
Error
productivity
Poor Staff Morale

40. Bridging the Gap

41. Reflections
Constants of health
• Clinician patient relationship
• Clash of cultures
Change Drivers
• Demography
• Patient experience and safety
• Staff experience and safety
Resilience
• Individual, self efficacy, social cognitive theory
• Organisational
Adaptability and Agility
• New models of education and learning
• Technology