Radiology Training in NSW

Recommendations for the Delivery of Radiology Training in NSW Health Services – Final Report

December 2006

This is the work of NSW IMET and may not necessarily represent the views of the NSW Minister for Health, NSW Health or other groups.

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EXECUTIVE SUMMARY

Radiology has grown considerably over the last 30 years with the advent of cross-sectional imaging; the gains in imaging precision as new ways of capturing and recording images have become available; the development of teleradiology and a ‘filmless” environment in which images can be easily stored and retrieved; and, the evolution of new, less invasive and more effective treatments for patients using interventional radiology techniques.

The growth of radiology is expected to continue as clinicians incorporate more imaging into their daily clinical practice. The contribution of radiology to the diagnosis and, increasingly, the treatment of many illnesses, means that it plays a central role in the provision of modern health care both in the acute hospital setting and in the community.

As the demand for radiology services has increased over the last decade, radiology workforce shortages have emerged around the world and in Australia. The 2001 AMWAC report on the radiology workforce found that there was an undersupply of specialist radiologists which was greater in some states (including NSW) than others. Since the AMWAC report was published NSW training numbers have increased significantly. However the growth in training numbers has not occurred in rural and regional NSW - areas in which there are greater shortages of specialist radiologists available to work in public and private radiology services.

It is against this background that the NSW Minister for Health requested that IMET undertake a review of the delivery of radiology training in NSW.

IMET sought feedback from the Department of Health, the Royal Australian and New Zealand College of Radiology (RANZCR), trainees, clinicians and health service managers to develop the draft recommendations contained within this report.

The review has identified many strengths of radiology training in NSW. Radiology is a popular specialty among medical graduates that offers attractive career opportunities. NSW trainees perform well in College examinations. The apprenticeship model of training, in which consultant radiologists provide on-the-job teaching, supervision and support to registrars, is highly valued by both trainees and trainers. Trainees enjoy being located in “clinical hub” of the hospital from which they interact with all specialty groups as part of the clinical team.

During the course of the review, the groups and individuals we spoke to raised some concerns and issues regarding radiology training in NSW. These include the:

lack of consistency in the delivery of training at different hospitals

difficulty some trainees have in gaining access to available training courses

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need for support for trainers and trainees in recognition of the additional demands associated with training

pressures on the public hospital training system to increase trainee numbers while at the same time continuing to deliver high quality training

lack of standardisation of supervisors’ assessment of trainees

relatively limited collaboration among accredited radiology departments as far as training matters are concerned

implications of implementing the new RANZCR curriculum

process of trainee feedback to radiology training departments

lack of academic research and clinical leadership for radiology in NSW

clarity of the role of the 5th training year

availability of advanced training positions

access to different modalities and equipment and other imaging infrastructure

lack of radiology training in rural and regional areas

workforce shortages and mal-distribution between metropolitan and rural/regional areas

retention of the radiology workforce in the public sector

training experience in the private sector

planning for training positions and the future radiology workforce

ad-hoc nature of recruitment to radiology registrar positions.

The recommendations in this report aim to address these issues and concerns and support the delivery of high quality radiology training and imaging services across NSW into the future. Specifically, the vision for the delivery of radiology training in NSW is a system that is of high quality, fair, and sustainable and which produces a skilled radiology workforce accessible to patients and clinicians across NSW.

The key elements of the proposed training system are:

Networked training programs based on area health service boundaries. Trainees spend the majority of time at one hospital, but spend a minimum of 6 months on rotation to other hospitals in the area.

An education program consisting of courses/lectures/tutorials (based on the RANZCR curriculum), equally available to all trainees in NSW. The formal education program should be accessible to trainees who are unable to attend in person through distance education technologies.

Protected time for learning and teaching especially for trainees and Supervisors of Training.

A focus on education and research through the development of academic radiology in NSW.

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Standardised recruitment times each year.

Trainee numbers that meet current health service requirements and future radiology workforce requirements.

The development of rural and regional training positions that are networked with metropolitan teaching sites.

An appropriate mix of basic and advanced training positions (including fellowship positions) in each area.

State and local management and oversight mechanisms for radiology training in NSW which bring together all the relevant stakeholder groups.

We believe that these recommendations will support public sector radiology services in NSW. Investment in teaching and research will increase the attractiveness of public sector radiology as a career choice for radiology trainees and consultants.

Summary of Recommendations

EDUCATION PROGRAMS

Recommendation 1. State Wide Education Program

Radiology departments, with support and coordination from the proposed NSW Radiology Training Implementation Group (see recommendation 8 below), should develop and deliver a formal state wide education program for radiology registrars. The program should be developed in conjunction with the RANZCR (NSW Branch Education Officer) to ensure that it is consistent with College’s national curriculum (currently in development) and should be accessible from any site in which radiology training occurs. The state wide education program should complement local training programs provided at each hospital and should ensure equity of access for all trainees to a common training program.

Recommendation 2. Academic Radiology

NSW Health should support the development of academic radiology in NSW through clinical appointments and administrative support for university appointed academic radiologists.

If an Academic Chair in radiology is appointed in NSW, the position should be supported by a Radiology Education Support Officer (see Recommendation 14) for the development and delivery of radiology training programs .The Academic Chair in should play a leading role in the development of the state wide radiology education program.

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DELIVERY OF TRAINING

Recommendation 3. Rotational Training Networks

Radiology training in NSW should be developed into area health service based networked training programs to deliver training across a number of hospitals within an area health service. Rotational training networks should be prospectively introduced starting with a first year cohort in 2008. The training networks should be based on the following principles:

All training sites within the network must meet RANZCR accreditation requirements.

Registrars are based at one hospital within an area health service (“home hospital”) but will spend between six and twelve months of their training at (an)other accredited radiology department(s) within the area health service.

The network shall ensure that there is a suitable mix of trainees from different training years at each training site.

Out of area rotations will still need to occur in some circumstances e.g. to access required training that is not available within the network e.g paediatric radiology training.

Area training schemes can potentially incorporate (where appropriate) rural and/or private sector training sites.

New training sites should be approved by the NSW Radiology training Implementation Group (RTIG).

All training networks shall provide equitable access for trainees to a range of clinical experience and training opportunities.

Each rotation within the network will develop specific learning objectives that are relevant to RANZCR requirements for radiology training.

Development of networks for radiology training will require careful planning and staged implementation to resolve rostering and other logistical problems to ensure the smooth running of the network.

Management and oversight of the network will involve the active participation and collaboration of site based Supervisors of Training, Heads of Department, trainees, and managers of the imaging service and representatives of the area executive. (See Recommendation 12 concerning governance of training networks).

Recommendation 4. Coordinator of Paediatric Radiology Training A part-time (0.2 FTE) clinical (radiologist) coordinator of paediatric radiology training should be appointed to lead and support the delivery of paediatric radiology training across NSW. The coordinator will work with radiology departments in relation to the

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delivery of paediatric radiology training in NSW, including linking paediatric radiology training rotations with the area-based rotational training networks. The Coordinator Paediatric Training will report to the State Director of Radiology Training (see Recommendation 11). Recommendation 5. Rural and Regional Radiology Training

NSW Health should develop rural and regional radiology training through investment in rural and regional training positions and the infrastructure required to support radiology training in rural and regional areas. Rural and regional training shall be developed in consultation with the Department of Health, Area Health Services, the College and trainees. In developing rural training positions, consideration must be given to area health service planning priorities, the imaging service structure and College accreditation standards that are appropriate for rural and regional training sites. Any new rural and regional training sites must be linked to existing radiology training departments as part of a rotational training network. Rural and regional radiology training should initially be based on a “rural stream” model. This would involve the quarantining of a small number of radiology training positions (for example, one in each of the metropolitan area health services) for applicants who have an interest in rural training and practice and who would be willing to spend some of their training time (for example, 6 months basic training and six months advanced training) in a funded and accredited rural site within a rotational training network. Rural stream trainees would be eligible for an IMET rural scholarship to assist with educational expenses. Non-rural stream registrars may be asked to relieve trainees in the rural stream for periods of up to 4 weeks and this requirement should be built into the training and employment agreement of registrars commencing training from 2008.

SUPPORT FOR TRAINEES AND TRAINERS

Recommendation 6. Time for Supervisors of Training to perform duties in relation to this role

Area Health Services should, in accordance with guidelines from the Department of Health, provide Supervisors of Training with allocated non-clinical time each to carry out their duties in relation to the local coordination and oversight of radiology training within their institution and to participate in professional development activities related to their role. These include RANZCR Supervisor Training events or other activities recommended by the Radiology Training Implementation Group. This will become increasingly important upon implementation of the RANZCR Curriculum.

Recommendation 7. Protected Time for Trainees

Radiology training departments should provide trainees with protected learning time (within award entitlements) for formal clinical education and exam preparation

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activities. This should be negotiated locally within the individual departments to ensure a reasonable balance between training requirements and service provision.

GOVERNANCE – ORGANISATION & ADMINISTRATION OF RADIOLOGY

TRAINING IN NSW

Recommendation 8. State Group for Radiology Training in NSW – the NSW Radiology Training Implementation Group (RTIG)

A state group (the NSW Radiology Training Implementation Group) should be convened to provide oversight of the delivery of radiology training in NSW and to implement changes that are endorsed from this review. The Radiology Training Implementation Group (RTIG) will report to the Institute of Medical Education and Training and should be reviewed after a period of two years. The role of the state group would include functions in relation to the coordination of education programs, training support, training experience, and workforce issues (see p 40).

Recommendation 9. Radiology Trainees’ Committee

A radiology trainees’ committee should be established (with formal links to the governance structures of the College) to facilitate communication among trainees and to provide a mechanism through which trainees can contribute to the RTIG and the various committees of the College. The trainees’ committee should have representatives from each accredited training site in NSW. Recommendation 10. Forum for Supervisors of Training

A regular forum for Supervisors of Training should be established to discuss issues in relation to radiology training. The forum should be auspiced by the RANZCR and any issues arising from this forum may be progressed through the College (for College matters) or the state group as appropriate. Recommendation 11. State Director of Radiology Training

A part-time (0.2 FTE) clinical (radiologist) state director should be appointed to lead and support the delivery of training across NSW. The state director will work with radiology departments in relation to the delivery of radiology training in NSW including the development of rotational training networks. The State Director will report to the Director of IMET, and will chair the NSW Radiology Training Implementation Group.

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Recommendation 12. Area Health Service Radiology Training Group (ARTG - see p 43)

An Area Radiology Training Group (ARTG) should be established in each of the five metropolitan area health services to manage the delivery of radiology training across the area. The membership of the ARTG will include the supervisors of training and department directors from each of the accredited hospitals in the area, a trainee representative from each accredited department, a senior imaging or health service manager, area health service representatives, and others as required. The ARTG should appoint a chairperson (not necessarily a radiologist) with good facilitation and brokering skills who can bring people together to focus on developing and maintaining high quality radiology training across the area. Recommendation 13. Area Director of Radiology Training An Area Director of Radiology Training (0.1 FTE) should be appointed within each of the five metropolitan area health services to oversee implementation of the recommendations of this review. This position will provide accountability for radiology training within the area-based network and management and support for the Education Support Officer. Recommendation 14. Education Support Officers. A part-time (O.5 FTE) Education Support Officer (ESO) should be appointed within each of the 5 metropolitan area health services to facilitate the work of the Area Radiology Training Group by providing technical and executive support for the development and organisation of common educational resources. The ESO will also assist with collecting and collating trainee feedback and evaluation data, in conjunction with the RANZCR.

WORKFORCE

Recommendation 15. Workforce Planning

The Terms of Reference of the proposed Radiology Training Implementation Group (RTIG) should include:

Liaise with AHS to understand demand and capacity for training positions based on imaging activity and training capacity at different hospitals. This information is important for setting up training rotations and ensuring equitable workforce distribution across NSW.

Ongoing collection of data on registrar numbers and distribution, including advanced training positions.

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Recommendation 16. New Training Positions

The RTIG should oversee and approve the establishment of new training positions or training arrangements (e.g. involving teleradiology) outside the currently accredited teaching hospitals. This would include regional and rural sites and potentially the private sector sites (subject to NSW Health Department approval). Approval of new positions will be dependent on achievement of RANZCR accreditation and the approval and support of the relevant area health service.

Recommendation 17. Advanced Training/Fellowship Positions

The RTIG should review the number of advanced training positions available in NSW in comparison to the number of positions available in other states, and determine a benchmark for the number of positions that should be available within NSW. Area health services should review the number of advanced training/fellowship positions available against the benchmark, and consider increasing the number of such positions in order to provide more opportunities for trainees to complete their fifth year of training within NSW, should this be required. For example, an advanced training position in breast imaging could be established within each radiology training network, under the fellowship program of the Cancer Institute of NSW. The positions should include mammography, MRI and ultrasound and be established at hospitals that can provide:

- A genetic counselling centre

- A high risk breast imaging clinic

- MRI

- Access to an integrated cancer treatment centre.

SELECTION AND RECRUITMENT

Recommendation 18. Recruitment Cycles

A regular recruitment cycle for radiology training positions that is consistent across NSW should be introduced, commencing with two recruitment intakes in the year – at the beginning and in the middle of the clinical year. In time, it is expected that radiology recruitment would align with other specialty training recruitment processes in NSW. Recommendation 19. Area Based Recruitment

The Area Radiology Training Group should develop an area based recruitment process that complies with NSW Health policy in recruitment of junior medical staff. This may involve hospital departments conducting joint selection processes for training positions and trainees nominating their preferred “home base” hospital. Area based recruitment should commence at the same time as the development of area networked training.

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Recommendation 20. Recruitment and Selection Procedures

The Radiology Training Implementation Group should monitor recruitment process and outcomes of the training networks. Recommendation 21. Employment Contracts

Trainee employment contracts should be consistent with expected training requirements and the minimum length of training, subject to satisfactory trainee performance. First year trainees commencing in 2008 under the new networked training arrangements should be offered four years contracts to cover the basic radiology training period.

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TABLE OF CONTENTS

Executive Summary .......................................................................................................... 2 Table of contents ............................................................................................................11 1. Background and Guiding Principles ......................................................................13 2. Summary of Review Process .................................................................................15 3. Education Programs...............................................................................................17 The Current Environment .................................................................................................17

Vocational Training in Radiology..............................................................................17 Formal Education Programs ....................................................................................17 Assessment...............................................................................................................18 RANZCR Curriculum and Principles of Training Projects........................................18 The Fifth Year of Training – Advanced Training......................................................19 Academic Radiology .................................................................................................19 Infrastructure to Support Radiology Services and Education................................19

Issues for Consideration ..................................................................................................20 Training Programs.....................................................................................................20 The Fifth Year ............................................................................................................20 Academic Leadership ...............................................................................................20

Recommendations ...........................................................................................................21 4. Delivery of Training ................................................................................................22 The Current Environment .................................................................................................22

Training in a service environment ...........................................................................22 Accredited training sites...........................................................................................22 Radiology training is institution specific..................................................................23 Sub-specialty and interventional radiology .............................................................24 Paediatric Radiology Training ..................................................................................25 Rural Training............................................................................................................25 Private Sector Training..............................................................................................26

Issues for Consideration ..................................................................................................26 Training Networks.....................................................................................................26 Paediatric Radiology.................................................................................................28 Rural Radiology.........................................................................................................28 Private Sector Training .............................................................................................29

Recommendations ...........................................................................................................30 5. Support for Trainees and Trainers ........................................................................33 The Current Environment .................................................................................................33

Supervisors of Training.............................................................................................33 Trainees.....................................................................................................................33

Issues for Consideration ..................................................................................................34 Recommendations ...........................................................................................................34 6. Governance – Organisation & Administration of Radiology Training in NSW......36

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The Current Environment .................................................................................................36 The role of the RANZCR............................................................................................36 The Greater Metropolitan Clinical Taskforce ..........................................................36 Feedback and Appraisal...........................................................................................37

Issues for Consideration ..................................................................................................37 State wide group.......................................................................................................37 Forum for Supervisors of Training ...........................................................................38 Trainee Committee ...................................................................................................38 State Director of Radiology Training........................................................................38 Local Governance and Coordination .......................................................................38 Feedback and Appraisal...........................................................................................38

Recommendations ...........................................................................................................39 7. Workforce ...............................................................................................................45 The Current Environment .................................................................................................45

Workforce Supply......................................................................................................45 Workforce Shortages................................................................................................45 Workforce Distribution .............................................................................................46 Trainee Workforce Supply and Distribution ............................................................47

Issues for Consideration ..................................................................................................47 Future supply of radiologists....................................................................................47 Advanced Training Positions....................................................................................48 Role of Radiographers..............................................................................................49 Interventional Radiology...........................................................................................49

Recommendations ...........................................................................................................50 8. Selection and Recruitment ....................................................................................52 The Current Environment .................................................................................................52 Issues for Consideration ..................................................................................................52

Recruitment Cycles...................................................................................................52 Duration of Employment ..........................................................................................53

Recommendations ...........................................................................................................53 9. Review and Evaluation...........................................................................................55 Appendix 1 Radiology Advisory Group .......................................................................56 Appendix 2 Draft role description of academic chair ................................................57 Appendix 3 Potential Radiology Training Networks...................................................58 Appendix 4 Terms of Reference State and Area Radiology training Committees....60 Appendix 5 Position Descriptions. .............................................................................66 Appendix 6 Proposed governance structure for the coordination and management of radiology training in NSW. ..........................................................................................81

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1. BACKGROUND AND GUIDING PRINCIPLES

The NSW Institute of Medical Education and Training (IMET, the organisation formed by the convergence of the Medical Training and Education Council of NSW, and the Postgraduate Medical Council of NSW) was established to develop a sustainable and high quality medical workforce by enhancing the efficiency and effectiveness of service based medical training. IMET, at the request of the NSW Minister of Health and in consultation with relevant groups and individuals, was asked to review and make recommendations regarding the delivery radiology training in NSW.

The objectives of the review (as outlined in the terms of reference1) are to:

1. Describe how the radiology training program currently works within NSW with respect to:

College training program requirements for trainees: entry standards, curriculum, assessment

College accreditation requirements for hospitals and accreditation status

Education programs: state and local, cost and status (mandatory or voluntary)

Current networking arrangements

Governance and management arrangements for the training program as it operates within NSW

Workforce - recruitment and retention

Recruitment and employment arrangements for trainees

Workforce data (total workforce, distribution, vacancies, future workforce planning needs).

2. Understand stakeholder perspectives (from trainees, clinicians, area health service managers, the RANZCR, the Department of Health) of the strengths and weaknesses of the current training system and how the system could be improved.

3. Make recommendations regarding any changes required to the current system including funding requirements, governance and management.

This review of radiology training in NSW has been guided by core principles which underpin all IMET reviews of postgraduate training. These are:

Patient safety and quality of care is paramount 1 Generic Terms of Reference for a specialist medical training program review. Available at http://www.imet.health.nsw.gov.au/files/generic_terms_of_reference_specialty_training_program_reviews.pdf

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Equity of access to high quality care for patients through a well trained and fairly distributed workforce

Equity of access for trainees to excellent medical training for the medical workforce

Medical training and workforce development is a core business of health services

Teaching and training are integral and rewarding parts of medical practice.

The review builds on the Medical Training and Education Council’s previous work on radiology training which outlined a number of strategies many of which are reflected in the contents of this report.2

2 The Medical Training and Education Council commissioned a consultant’s report Developing a Strategy for Provision of Radiology Training in NSW. P Pogson, the leading partnership. (2004)

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2. SUMMARY OF REVIEW PROCESS

The process followed in undertaking the review of the delivery of radiology training in NSW has included a number of components: • Establishment of a Radiology Advisory Group – an expert advisory group,

established in July 2005 assisted the review through provision of feedback and advice. The group included trainees, trainers, the RANZCR, health service administrators, and a radiographer. A list of advisory group members is in Appendix 1.

• Development of Discussion Paper – developed by IMET and released in February

2006, the Discussion Paper defined the current training system, discussed a number of factors that directly or indirectly impact on the delivery of radiology training in NSW, and made a number of suggestions for changes to enhance this training.

• Consultation with relevant groups and individuals - the draft recommendations

included in this paper have been developed as a result of extensive consultation.

- Initial consultation phase – focus groups, telephone interviews and written submissions were held/received in October and November 2005. The purpose of this was to gain an understanding of the issues affecting radiology training in NSW, from the perspectives of trainees, trainers and hospital administrators.

- Second consultation phase – a 5-week consultation period was held in

February and March 2006, to obtain feedback from all groups on the issues and suggestions for change outlined in the Discussion Paper. The primary method used to obtain feedback was through the completion of a questionnaire. Linked with this, IMET staff visited hospitals to dispense questionnaires and promote the consultation process.

- Meetings with relevant groups/individuals – throughout the review process,

consultation took place with representatives from the NSW Department of Health, the RANZCR, the Australian Medical Association Doctors-in Training, the NSW Resident Medical Officer Association and the Health Services Union. Meetings were held with Supervisors of Training and Heads of Department at most of the accredited radiology training sites. The Area Health Service Chief Executives and Directors of Workforce were kept informed of the review process.

- Third consultation phase - A draft report containing a number of draft

recommendations for the delivery of radiology training in NSW was distributed for consultation for 5 weeks in September/October 2006. All groups were

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invited to comment on the draft recommendations by completing a written submission.

• Development of this Paper - This final report contains a number of

recommendations for optimising the delivery of radiology training in NSW. These recommendations have their origins in the draft proposals contained in the first Discussion Paper then refined following the consultation process outlined above.

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3. EDUCATION PROGRAMS

THE CURRENT ENVIRONMENT

Vocational Training in Radiology

The Royal Australian and New Zealand College of Radiologists (RANZCR) provides the only recognised vocational training program in radiology in Australia. Details of the RANZCR radiology training program are available on the College’s public website which states that

“The Royal Australian and New Zealand College of Radiologists is recognised by the Australian Medical Council (AMC), the New Zealand Medical Council and the various medical boards in Australia as the academic body responsible for setting the standards of the training and examinations required to allow recognition and registration as a specialist in Radiology.”3

Radiology training in Australia is a generalist training program that required trainees to gain experience in all current imaging modalities4.

“The aim of the training for the FRANZCR is to provide broadly-based experience in all current imaging modalities. The standards are set to ensure that, at the end of the five year training program, the trainee is capable of performing as a consultant in radiology and can be recommended to the various Medical Boards and Specialist Recognition Committees in Australia and New Zealand for registration as a Specialist. The FRANZCR Examinations ensure that these standards have been achieved.”5

Formal Education Programs

Currently a number of short courses and lectures are available to trainees. These courses are targeted at preparation for the Part I and Part II Exams and include:

Part I Anatomy Course – a weekly lecture course at the University of New South Wales;

Part I Applied Imaging Technology Distant Education Course - CD-Rom/Web Based learning tutorials;

3 RANZCR website http://www.ranzcr.edu.au/educationandtraining/radiodiagnosis/training/01.cfm Accessed 6 July 2006 4 Imaging modalities are: plain radiograph; computed tomography; magnetic resonance imaging; ultrasound; nuclear medicine and mammography. 5 RANZCR website http://www.ranzcr.edu.au/educationandtraining/radiodiagnosis/training/01.cfm accessed 6 July 2006

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Part I Applied Imaging Technology (including radiation safety6) – a weekly evening course over four months at Westmead Hospital;

Part II Pathology Course - Flinders Medical Centre - February each year;

Part II FRANZCR Preparation Course - Weekly evening lectures mainly at Concord Hospital and Friday morning tutorials at RPAH; and,

Part II RANZCR Review Course - Canberra Hospital - July each year.

Trainees can also participate in the monthly education sessions run by a joint venture between the RANZCR NSW Branch and the Greater Metropolitan Clinical Taskforce’s Radiology Services Group.

Assessment

In order to be awarded the FRANZCR and therefore be eligible for recognition and registration as a Specialist in Radiology, a trainee must:

pass both Part I and Part II FRANZCR examinations in Radiology and

complete a minimum of five years of practical training in training positions accredited by the RANZCR.

The Part I examination consists of assessments in Anatomy and Applied Imaging Technology. The Part I examination may only be undertaken by candidates who occupy accredited training positions and is generally attempted during the first year of training or at the start of the second year. Previously, trainees could complete the Part I examination before entering the training program. Candidates are not permitted to sit the Part I subjects separately.

The Part II examination consists of assessments in Radiology and Pathology. Radiology and Pathology must be taken together at the first attempt no earlier than a candidate's fourth year of training.

RANZCR is reviewing its assessment processes as part of the Curriculum and Principles of Training Projects.

RANZCR Curriculum and Principles of Training Projects

RANZCR currently provides a syllabus to guide trainees in their preparation for the Part I and Part II exams and has commenced a large scale curriculum development project based on the CanMEDS roles framework developed by the Royal College of

6 The RANZCR Syllabus for Applied Imaging Technology includes extensive coverage of radiation safety issues. Training and assessment in radiation safety is an essential component of the RANZCR Fellowship. The commonwealth government accepts the RANZCR fellowship to grant specialist recognition as a radiologist for the purposes of Medicare billing. Commonwealth government recognition (a letter from Medicare) is required by the State Department of Environment and Conservation as part of its licensing procedures for the use ionising radiation apparatus by radiologists. Trainees do not require a separate license as they work under the direct or general supervision of a licensed radiologist.

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Physicians and Surgeons of Canada. The new curriculum will be progressively implemented from late 2007 and will have implications for the structure and delivery of radiology training in the future.

RANZCR has also set up a project in tandem with the Curriculum Development Project known as Principles of Training which seeks to identify gaps in the supporting structures of the training program as well as defining the program in terms of opportunities to develop competencies as they are identified through the Curriculum Development Project. It also envisages revising accreditation criteria to explicitly identify the conditions required to support the training program and link accreditation to the provision of these conditions.

The Fifth Year of Training – Advanced Training

Most candidates pass the Part II examination by the end of the fourth year of training and are eligible to undertake their final year of training in a RANZCR approved placement. The fifth year of training can be completed by doing an additional general year of training or by undertaking approved sub-specialist training posts referred to as fellowships. Fellowships are designed to enable trainees to develop greater experience in a particular modality (CT, ultrasound, MRI, mammography, nuclear medicine) or sub-specialty (e.g. paediatric radiology or in interventional radiology). The RANZCR is reviewing the role of the fifth year as part of its broader curriculum project.

Academic Radiology

Academic activity in teaching and research is driven by interested consultants working in hospital departments of radiology. These consultants juggle competing interests of service, administration, teaching and research. At the time of writing this report, there was no academic chair in radiology in NSW.

Infrastructure to Support Radiology Services and Education

NSW Health is moving towards state wide implementation of a Medical Imaging PACS/RIS Program7. This will fundamentally change the way radiology services operate in terms of workflow efficiency. Additionally, the information technology and communications infrastructure required to support a state wide PACS/RIS (Picture Archiving and Communication System/Radiology Information System) will enable remote access to educational resources such as film libraries for trainees, consultant radiologists and other imaging health professionals.

7 NSW Health. Medical Imaging PACS/RIS Program Business Case. November 2006. (Internal document)

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ISSUES FOR CONSIDERATION

Training Programs

Feedback gathered as part of the review indicates that:

The content and delivery of local training programs varies across hospitals and there would be benefit in developing a more comprehensive state wide education program to supplement the local training program. Historically there has been limited collaboration among hospital radiology departments in the delivery of postgraduate training in NSW although this has started to change with the work of the Greater Metropolitan Radiology Services Group and the NSW Branch of the RANZCR. Greater collaboration is viewed as a positive strategy for improving radiology education for trainees in NSW.

The development of a state wide education program should be guided by the new RANZCR curriculum, and would not replace it.

It is difficult for some trainees (e.g. those based at the John Hunter Hospital) to access the Part I and Part II exam preparation courses which are based mainly in Sydney.

The Fifth Year

There are concerns about the value of the fifth (post Part II) year of training. Some radiologists argue that trainees stream too early into sub-specialist training without having the benefit of a year of general senior experience to consolidate consultant level skills. The role of the fifth year is being reviewed as part of the RANZCR’s curriculum project.

Academic Leadership

Feedback obtained during the review indicated that

New South Wales lags behind other states in the area of academic leadership in teaching and research.

The research culture in NSW is said to be “rudimentary” and would benefit from the establishment and appointment of an academic chair to provide leadership in this area.

The academic chair would provide mentoring and academic support to hospital radiologists and trainees.

Research priorities include: cost-effectiveness and outcome studies of imaging procedures and development of research based guidelines on the appropriate use of imaging procedures by referring clinicians.

An academic chair should have a significant role in leading the development of undergraduate and postgraduate training in radiology. In Western Australia, South Australia and Victoria, the academic radiologist plays an important

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leadership and/or mentoring role in the delivery of radiology training in those states.

A senior academic would increase the attractiveness of the public radiology service to which the post holder is appointed for both trainees and consultant radiologists.

There have been recent developments in NSW towards academic radiology, with two university medical schools expressing interest in establishing academic positions in their faculty.

RECOMMENDATIONS

Recommendation 1. State Wide Education Program

Radiology departments, with support and coordination from the proposed NSW Radiology Training Implementation Group (see recommendation 8 below), should develop and deliver a formal state wide education program for radiology registrars. The program should be developed in conjunction with the RANZCR (NSW Branch Education Officer) to ensure that it is consistent with College’s national curriculum (currently in development) and should be accessible from any site in which radiology training occurs. The state wide education program should complement local training programs provided at each hospital and should ensure equity of access for all trainees to a common training program

Recommendation 2. Academic Radiology

NSW Health should support the development of academic radiology in NSW through clinical appointments and administrative support for university appointed academic radiologists.

If an Academic Chair in radiology is appointed in NSW, the position should be supported by a Radiology Education Support Officer (see Recommendation 14) for the development and delivery of radiology training programs .The Academic Chair in should play a leading role in the development of the state wide radiology education program.

A draft role description for an Academic Chair is in Appendix 2.

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4. DELIVERY OF TRAINING

THE CURRENT ENVIRONMENT

Training in a service environment

Training in radiology is service based. That is, most learning takes place “on the job” under the guidance and supervision of a consultant radiologist. Trainees must hold a position (usually a registrar position) within an accredited teaching department. Trainees are expected to complete training in each imaging modality as well as gain experience in paediatrics, angiography and basic interventional techniques.

Accredited training sites

Trainees complete the training program while working as registrars in RANZCR accredited sites. The ten hospital radiology departments which are currently accredited for training in NSW are:

Concord

John Hunter

Liverpool

Nepean

Prince of Wales

Royal North Shore

Royal Prince Alfred

St George

St Vincent’s

Westmead.

The Children’s Hospital at Westmead is also accredited and receives trainees for paediatric radiology rotations.

RANZCR accreditation standards are based on a set of criteria including; number and case mix of examinations and patients, number of consultants (faculty members), spectrum of clinical departments, teaching program, reference book and film libraries and access to all imaging modalities. Initial accreditation includes a site visit by the Chief Accreditation Officer who makes a draft recommendation to the Education Board.

Each trainee must be guaranteed training in each imaging modality and training must be obtained under the direct supervision of Specialists in Radiology recognised by the

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RANZCR. Departments are visited every five years and each year a census survey is requested from each training centre for re-accreditation purposes.

The RANZCR allows certain overseas departments, private hospitals and private radiology practices to apply for accreditation for training provided the guidelines laid down by the Education Board are met.

Training sites need to gain approval from the RANZCR if they wish to increase the number of training positions. This needs to be approved by the Education Board.

RANZCR accreditation standards require that the ratio of the number of staff radiologists (Full Time Equivalent) to the annual number imaging procedures is no more that 1:12,000. In addition to the workload cap, the RANZCR standards also require that the ratio of trainees to consultants is no more than 1.5 to 1. These requirements are designed to ensure consultants’ capacity to provide education, supervision and support to trainees working in the department. As noted by Pitman and Jones,

“The justification for having a maximal allowable workload figure per consultant radiologists in a teaching department is to protect those functions of a teaching hospital department which compete for the same radiologist time as clinical service workload (clinical productivity), namely trainee supervision and instruction.”8

The authors note that the comparative figures for academic radiology in the US indicate an average annual workload of 9400 examinations per FTE consultant and that the workload of UK consultants (18,000-20,000 per annum) is regarded as excessive by the Royal College of Radiologists.

Radiology training is institution specific

Trainees participate in teaching sessions and clinical meetings provided within their hospital and trainees undertake most of their specialist training within one hospital.

The structure of training varies from hospital to hospital but must incorporate the following components in order to fulfil RANZCR requirements including:

Exposure to all imaging modalities throughout the five years of training

At least three months paediatrics training

At least three months full-time MRI training

At least 100 interventional procedures (including angiography)

At least 6 months ultrasound training

One week of radiographic techniques.

8 Pitman AG and Jones DN. Radiologist workloads in teaching hospital departments: Measuring the Workload. Australasian Radiology 2006: 50: 12-20

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Most hospital departments have access to all imaging modalities but are usually not able to provide all training requirements and so must make arrangements with other hospitals to ensure that their trainees have access to the required training (e.g. the tertiary paediatric hospitals for exposure to paediatric imaging). To this extent, radiology registrars rotate to a limited number of sites during their training however unlike other states, there are no formal rotational training networks in NSW. Rotational training programs are in place in Victoria, Western Australia and South Australia. Queensland is currently developing formal training networks9.

Some trainees also spend time at smaller hospitals which are affiliated with and serviced by an accredited radiology department. These “satellite” stations are included in the registrar roster usually on a daily or weekly shift basis. Examples of these arrangements include:

Campbelltown Hospital - part of the Liverpool Hospital service

Canterbury Hospital - part of the Concord Hospital service

Auburn and Blacktown Hospitals - part of the Westmead Hospital service

Sutherland Hospital – part of the St George Hospital service.

Unlike other specialist training programs, there are no agreed rotation lengths or structures and the organisation of the training program over the five years varies considerably from one hospital to another. For instance, some hospitals commence training in interventional radiology from the first year of training while others do not commence this type of training until later in the training program. Some hospitals have trainees working on all modalities during the week while others concentrate on particular modalities for longer periods. Other variations in the local organisation of radiology training include: supervision standards for trainee reporting and arrangements for trainees commencing after-hours duty.

Sub-specialty and interventional radiology

Australian trained radiologists are trained as generalists and there is limited sub-specialist practice compared to Europe and the United States where larger patient and consultant populations have enabled the development of sub-specialist imaging services. Apart from a limited number of advanced training fellowships in NSW, there is no standard or structured program for sub-specialty training or training in interventional radiology for registrars in NSW. The log-book of procedures does not specify how many of which procedures are expected to be completed during training. The role of interventional and sub-specialty training in radiology is being considered as part of the RANZCR curriculum training review.

9 The Western Australian Radiology Training Scheme is a rotational training program that incorporates seven training sites including tertiary referral public hospitals (adult and paediatric), urban private sector sites and a rural site (also private sector). All trainees rotate through the sites during the four years of basic radiology training.

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Paediatric Radiology Training

Registrars undertake their paediatric radiology training during a 3 month rotation to the Children’s Hospital at Westmead or the Sydney Children’s Hospital. Paediatric Radiology is considered an essential element of the training of a general radiologist, as the majority of radiology work involves a component of paediatrics.

Rural Training

Nearly all radiology training is completed in the public hospitals in the Greater Metropolitan area of Sydney and Newcastle. In NSW there is currently no basic radiology training in rural areas10. By comparison, registrars in radiology training programs in other states rotate to rural and regional areas.

The reasons for the lack of rural training positions in NSW are largely historical and include:

The model for the provision of rural radiology services varies:

o Some rural radiology services are partly or wholly out-sourced to the private sector and do not have the required infrastructure to support radiology training within the public hospital.

o Teleradiology provides an alternative service model in which specialists based in metropolitan areas do the reporting for rural areas.

Only one rural site has applied for accreditation for basic radiology training but has been unable to establish a formal training link with another accredited department in metropolitan NSW.11

There has been a general lack of support for rural based training from accredited departments in metropolitan areas.

For a rural site to become involved in training of registrars, a number of factors need to be in place;

Support from the local consultants – namely, enthusiasm and a willingness to teach

Funding for a registrar position from the area health service

Support from a fully accredited metropolitan site as part of a training network

10 There is an accredited musculoskeletal imaging fellowship position with the Border Medical Imaging Group in Albury.

11 A private practice in Wagga Wagga in conjunction with the Greater Southern Area Health Service has obtained partial accreditation from RANZCR but has had no trainees to date.

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The rural site needs to meet RANZCR accreditation standards. Sites can apply for full or partial accreditation. The latter is appropriate if the rural site is a rotation which is linked to a fully accredited site.

Private Sector Training

There is currently minimal involvement of the private sector in radiology training in NSW, although private sector involvement in training does occur in other states.

The type of work and casemix in the public and private sectors is different and there is an argument that on training grounds inclusion of private sector training sites should be considered especially for exposure to procedures that are mainly performed in an outpatient setting e.g. musculoskeletal imaging and obstetric ultrasound.

If rural radiology training is considered, it is likely that private sector support and involvement will be required.

ISSUES FOR CONSIDERATION

Training Networks

Feedback gathered during the review indicates that:

The perceived quality of trainee supervision and teaching varies from hospital to hospital. There is a hierarchy of desirable training locations. Some hospitals have struggled to retain their trainees who tend to move on to more desirable training hospitals when a vacancy arises;

There is variable support from consultants and trainees to broaden the training experience by extending the current system of institution based training with some rotations to training a scheme that incorporates a network of teaching sites within a defined geographic area such as an area health service.

The potential advantages of delivering training across a limited number of teaching hospitals within a networked training scheme include:

Greater exposure for trainees to different clinical environments and radiologists’ work practices. This is seen as an important professional development opportunity for consultant practice which requires communication with a broad range of clinicians;

Greater exposure for teaching departments to trainees from different hospitals within the area;

Development of a culture of professional collegiality among trainees and consultants within a network;

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Enables forward planning of trainee rotations to meet both trainee interest and RANZCR training requirements for particular modalities and sub-specialty areas. Hospitals within a networked training scheme may have complementary strengths in terms of teaching and clinical experience that can be offered to a greater number of trainees;

Provides a vehicle to expand the number of training positions (including advanced training positions and positions in new training sites in regional, rural and private sector settings) in a planned manner as part of a formal network of rotations;

Enables better area health service based planning and delivery of imaging services;

Provides a feedback and support mechanism for radiology departments that struggle to retain trainees.

Some consultants and trainees have concerns about changes to the current institutional training system for the following reasons:

Institution based training enables a strong bond to be built between trainees and consultants over a number of years;

A “cradle to grave” educational approach within one institution is preferred to a rotational system which is viewed by some as diluting rather than enhancing the learning environment for registrars;

Rotations are potentially disruptive to registrars and they might become “lost” in a bigger system;

The introduction of area based rotations would be disruptive to the individually negotiated arrangements that many hospitals have in place to ensure trainees have access to the required modalities and clinical experiences;

It would be logistically difficult to combine different hospitals into a network because each hospital has its own approach to training. An example of some of the feedback received from some SoTs is “It is hard enough to manage the trainees I have within the hospital let alone managing trainees across a network”.

In weighing the arguments for and against rotational networks, consideration must be given to the potential for each system to provide quality training and meet workforce demands especially in growth areas.

Evidence from interstate indicates that RANZCR accredited rotational training programs have been operating successfully for some time. There is no evidence to suggest that the introduction of training networks (with appropriate resourcing and management) will have a detrimental effect on the delivery of radiology training.

An advantage of a network approach to training is the ability to link in new training sites into the network. The infrastructure that would need to be in place to run a network (e.g. Network Director, Education Support Officer, Area Radiology Training Group) makes it easier to incorporate new sites.

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Paediatric Radiology

Paediatric radiology training currently takes place in the paediatric specialist hospitals in NSW.

Financial and system constraints on the public hospital system limit the ability for the number of positions at these hospitals to simply be increased.

Feedback from specialist radiologists working in the paediatric specialist hospitals indicates that:

Paediatric hospitals are approaching the limit of their capacity to train the current number of trainees.

Many of the administrative and organisational tasks arising from the coordination of these rotations creates additional workload for specialist radiologists at paediatric hospitals.

There are opportunities to develop paediatric training in general hospitals with paediatric inpatient facilities and resident or visiting paediatric radiologists.

A collaborative approach between the paediatric radiology departments in NSW would benefit the development of paediatric radiology training for all radiology trainees.

There is a need to promote paediatric imaging at a time where there appears to be a declining interest among radiology registrars in pursuing paediatric advanced training and fellowship opportunities.

Rural Radiology

There was variable support for the development of rural radiology training in NSW among trainees and trainers consulted as part of this review.

Some argued that rural radiology has much to offer trainees in terms of greater diversity of casemix and clinical problems encountered on a daily basis and that lack of exposure to rural radiology during training does not encourage any trainees to pursue rural work after completion of training.

The NSW Government supports the development of medical training networks that incorporate rural, regional and outer metropolitan areas.12 The Commonwealth Government also provides support for rural training through the provision of funding for specialist training positions in rural areas.13

12 The NSW Government’s Pan for Securing Our Health Workforce 2005 13 Advanced Specialist Training Posts in Rural Areas Program. Department of Health and Ageing www.health.gov.au/internet/wcms/publishing.nsf/Content/workforce-educat-specsup-astpra

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However, many trainees14 and some consultants expressed concern about the prospect of rural rotations for a number of reasons including: lack of supervision; lack of access to education resources; lack of access to full range of imaging equipment; the use of radiology trainees to fill workforce shortages in rural areas; and disruption to study groups and personal lives.

There is more than one model for rural radiology training and there needs to be some flexibility in this respect to take into consideration the needs of trainees, the Area Health Service, the trainers and the RANZCR.

While the traditional training model of a rural rotation (that is, 3-6 month rotation as occurs in most other specialist training programs) may be an option, other models are worth considering including:

The introduction of a “rural stream” for radiology training. This would involve the quarantining of some radiology training positions (for example, one in each of the metropolitan area health services) for applicants who have an interest in rural training and practice and who would be willing to spend some of their training time (for example, 6 months basic training and six months advanced training) in a funded and accredited rural site. Rural stream trainees would be eligible for an IMET rural scholarship to assist with educational expenses.

More frequent but shorter rotations (2-4 weeks) throughout the training period

Fly in fly out arrangements

Remote reporting of films (teleradiology)

Private Sector Training

A federal Medical Specialist Training Committee 15 examining training outside public hospital settings across all medical specialties has recently reported to the Australian Health Ministers’ Conference (AHMC) and the Australian Health Ministers’ Advisory Committee (AHMAC). The Committee recommended that specialist training be undertaken in a broader range of settings, including the private sector, provided that there is no reduction in capacity for health care delivery by the public health system. The recommendation to include the private sector was supported by AHMC and AHMAC but would need the endorsement of NSW Health if private practice training is to be included in the networking arrangements proposed in this review.

14 Petition received from 76 Sydney based registrars. May 2006 15 Medical Specialist Training Steering Committee http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-workforce-new-smoth.htm. The Committee’s report was considered at the AHMC meeting on 17 November 2006.

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RECOMMENDATIONS

Recommendation 3. Rotational Training Networks

Radiology training in NSW should be developed into area health service based networked training programs to deliver training across a number of hospitals within an area health service. Rotational training networks should be prospectively introduced starting with a first year cohort in 2008.

The training networks should be based on the following principles:

All training sites within the network must meet RANZCR accreditation requirements.

Registrars are based at one hospital within an area health service (“home hospital”) but will spend between six and twelve months of their training at (an)other accredited radiology department(s) within the area health service.

The network shall ensure that there is a suitable mix of trainees from different training years at each training site.

Out of area rotations will still need to occur in some circumstances e.g. to access required training that is not available within the network e.g paediatric radiology training.

Area training schemes can potentially incorporate (where appropriate) rural and/or private sector training sites.

New training sites should be approved by the NSW Radiology training Implementation Group (RTIG).

All training networks shall provide equitable access for trainees to a range of clinical experience and training opportunities.

Each rotation within the network will develop specific learning objectives that are relevant to RANZCR requirements for radiology training.

Development of networks for radiology training will require careful planning and staged implementation to resolve rostering and other logistical problems to ensure the smooth running of the network.

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Management and oversight of the network will involve the active participation and collaboration of site based Supervisors of Training, Heads of Department, trainees, and managers of the imaging service and representatives of the area executive. (See Recommendation 12 concerning governance of training networks).

A model showing the potential training networks is in Appendix 3.

Recommendation 4. Coordinator of Paediatric Radiology Training

A part-time (0.2 FTE) clinical (radiologist) coordinator of paediatric radiology training should be appointed to lead and support the delivery of paediatric radiology training across NSW. The coordinator will work with radiology departments in relation to the delivery of paediatric radiology training in NSW, including linking paediatric radiology training rotations with the area-based rotational training networks.

The Coordinator will report to the State Director of Radiology Training (see Recommendation 11).

A role description for the State Coordinator of Paediatric Radiology Training is attached at Appendix 5.

Recommendation 5. Rural Radiology Training

NSW Health should develop rural and regional radiology training through investment in rural and regional training positions and the infrastructure required to support radiology training in rural and regional areas. Rural and regional training shall be developed in consultation with the Department of Health, Area Health Services, the College and trainees. In developing rural training positions, consideration must be given to area health service planning priorities, the imaging service structure and College accreditation standards that are appropriate for rural and regional training sites. Any new rural and regional training sites must be linked to existing radiology training departments as part of a rotational training network.

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Rural and regional radiology training should initially be based on a “rural stream” model. This would involve the quarantining of a small number of radiology training positions (for example, one in each of the metropolitan area health services) for applicants who have an interest in rural training and practice and who would be willing to spend some of their training time (for example, 6 months basic training and six months advanced training) in a funded and accredited rural site within a rotational training network. Rural stream trainees would be eligible for an IMET rural scholarship to assist with educational expenses.

Non-rural stream registrars may be asked to relieve trainees in the rural stream for periods of up to 4 weeks and this requirement should be built into the training and employment agreement of registrars commencing training from 2008.

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5. SUPPORT FOR TRAINEES AND TRAINERS

THE CURRENT ENVIRONMENT

Supervisors of Training

Each Australian training institution has a designated Supervisor of Training (SoT) who is a Fellow (or equivalent) of the RANZCR. The SoT is involved in teaching and supervising trainees as well as providing a path of communication between clinical supervisors, and the Head of Department. In addition, the Supervisor of Training has a key role in counselling trainees who are performing below specified standards. The College does not provide a role or duty statement for SoTs however they have advised that the SoT role is being developed as a specified, recognised role within the College with appropriate support and training. Generally speaking, the current role of the SoT incorporates functions such as:

Ensuring trainees meet all RANZCR training requirements;

Monitoring, supporting and providing information to trainees at their site, both in regards to their professional development and in achievement of learning objectives;

Local leadership and co-ordination of the training program;

Ensuring the quality of the trainees experience through local support of guidelines and policies;

Pastoral care to trainees and mentorship;

Participating in recruitment and rostering of trainees; recruitment of trainees as required;

Preparing candidates for the clinical examinations and reviewing exam results.

Trainees

Trainees have commented that preparation for the Part I examination during their first year can be difficult. They are facing a steep learning curve with their new roles and also trying to learn about medical imaging more generally in addition to the study of anatomy or physics which are required for the examination. Individual hospitals support trainees differently in helping them prepare for exams. The majority of sites have some form of protected learning time for trainees, for example, lunch-time teaching sessions, early morning clinical meetings and tutorials and release time to attend lectures at other training sites. Supervisors and department heads recognise the importance of providing learning and educational opportunities in order to be seen as having a good training program which in turn aids recruitment to registrar positions.

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ISSUES FOR CONSIDERATION

The RANZCR has advised that the curriculum is under development and as part of this, implementation issues are under active consideration. The role of the supervisor is likely to expand to include more in-training assessment and formative evaluation. There will also be greater expectation that SoTs will participate in training and up-skilling in educational issues for their role. The College has advised that they are reviewing accreditation standards and would see protected time for both SoTs and trainees as likely additions to current accreditation standards. Feedback gathered during the review indicates that:

the duties undertaken by SoTs varied depending on the incumbent’s interpretation of what the job should involve

some SoTs also hold the position of Head of Department and there was acknowledgement that it is becoming increasingly difficult for one individual to effectively discharge both these roles, especially with increasing numbers of trainees

Supervisors of Training commented that with increasing clinical service pressures there is a lack of protected time to undertake formal teaching and training duties

protected non-clinical time for Supervisors of Training is a matter for negotiation and performance management between the incumbent and the employer

medical imaging is becoming increasingly complex, and the demands of learning on trainees are high. It is important that for effective training to occur, learning time for trainees should be protected.

RECOMMENDATIONS

Recommendation 6. Time for Supervisors of Training to perform duties in relation to this role

Area Health Services should, in accordance with guidelines from the Department of Health, provide Supervisors of Training with allocated non-clinical time each to carry out their duties in relation to the local coordination and oversight of radiology training within their institution and to participate in professional development activities related to their role. These include RANZCR Supervisor Training events or other activities recommended by the Radiology Training Implementation Group. This will become increasingly important upon implementation of the RANZCR Curriculum.

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Recommendation 7. Protected Time for Trainees

Radiology training departments should provide trainees with protected learning time (within award entitlements) for formal clinical education and exam preparation activities. This should be negotiated locally within the individual departments to ensure a reasonable balance between training requirements and service provision.

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6. GOVERNANCE – ORGANISATION & ADMINISTRATION OF RADIOLOGY TRAINING IN NSW

THE CURRENT ENVIRONMENT

Training delivery is generally managed at hospital level. Each radiology department has a director or head of the department. Some aspects of their role relate to education and training. Each accredited training site also has a Supervisor of Training (SoT). The SoT is involved in teaching and supervising trainees as well as providing a path of communication between clinical supervisors, and the head of department.

There is no area wide governance mechanism for radiology training although area health services are in the process of developing area-wide business units for imaging services.

There is currently no state group with a designated responsibility specifically to provide leadership and oversight of the delivery of radiology training in NSW, although the NSW Branch of the College and the Greater Metropolitan Clinical Taskforce (GMCT) have a role to play (see below).

There is no regular forum for the Supervisors of Training to meet and share good practice or to collaborate on initiatives to enhance training delivery across the state. There is currently no formal trainee committee at a state level.

Planning for new positions is mainly conducted at hospital or at Area Health Service level and there is currently no state oversight or planning of training positions.

The role of the RANZCR

The role of the RANZCR in relation to radiology education and training is to set standards (including accreditation standards), develop the training curriculum and assessment processes and conduct examinations that grant the registration of Medical Practitioners certificates or other equivalent recognition of special knowledge in Radiology16. The College has a Branch Education Officer who supports the delivery of a state wide lecture program. The NSW Branch of the RANZCR has traditionally not had a direct role in the oversight and management of hospital based radiology training programs. The NSW Branch has collaborated with the GMCT Radiology Services Group to provide an educational program for consultants and trainees.

The Greater Metropolitan Clinical Taskforce

The GMCT Radiology Clinicians’ group has been meeting regularly to discuss radiology services in greater metropolitan public hospitals. The group has identified planning

16 RANZCR website, http://www.ranzcr.edu.au/about/index.cfm, accessed on 1 June 2006.

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and capital issues, which affect service delivery. Members of the group include heads of public hospital radiology departments, radiological nurses and radiographers in the greater metropolitan region. They convene a Radiology Executive Committee to represent Radiology Clinicians’ Group as the peak radiology advisory group to NSW Health.17 GMCT draws together all the heads of departments where training is delivered. As such it currently provides the only forum where training issues can be discussed.

GMCT discusses several issues that impact on education and training including:

equitable patient access to radiology services

developing recommendations on future service development

workforce issues and practice.

While the focus of GMCT Radiology Group is more service-oriented, they have a role in relation to radiology education and training. Therefore it is important that any new governance arrangements maintain a strong link with this group.

Feedback and Appraisal

At the end of the calendar year, each accredited department is required to submit to the Chief Censor a report in respect of each trainee, using a standard form that is available on the RANZCR website. Trainees are asked to submit a form providing feedback about the training department in which they have been working.

ISSUES FOR CONSIDERATION

State wide group

Feedback from the review indicates general support for the concept of a state-based group for radiology training. A state-based group could promote greater consistency of quality of teaching across the area health services and could support the development of new sites for training.

The state group could also have a role in supporting the delivery of exam preparation courses and the development of a broader state education program that includes areas that are not currently covered on the exam such as research methods, teaching skills, communication, patient safety and quality methods and medical ethics.

The training and workforce implications of service developments such as 24 hour service provision and teleradiology could also be discussed and progressed in such a forum when and as necessary.

17 Greater Metropolitan Clinical Taskforce – Radiology Executive Committee: Terms of Reference.

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Forum for Supervisors of Training

Supervisors of Training are finding it increasingly difficult to manage the growing number of trainees. The major benefit of a state-based group would be to allow sharing of information and strategies on methods of training delivery and to discuss aspects of rostering, subspecialty training and managing difficulties with trainee performance.

Trainee Committee

Trainee participation at all levels of governance of training is important. The NSW Physician Trainees Committee is an example of a model of trainee involvement in governance. This Committee is supported by the RACP and reports to the State Committee of the College and the NSW Basic Physician Training Network Oversight Committee.

State Director of Radiology Training

Feedback gathered during the reviews indicated support for the establishment of a state radiology training director or coordinator. Further consultation indicates that this role should be undertaken by a senior clinician (radiologist), as the state director will need to have a leadership role in implementing changes arising from this review.

Local Governance and Coordination

The implementation of training networks will require the investment of dedicated resources for the planning, coordination, monitoring and review that is essential for the successful operation of training networks. IMET’s experience with the implementation of other training networks has demonstrated that local governance and support is the most important factor.18 Successful implementation of networks requires the support and participation of trainees; supervisors of training, department directors and other consultants who supervise trainees; imaging business managers and the area health service executive.

Feedback and Appraisal

At the area health service level there needs to be a mechanism for ensuring the quality and outcomes of radiology training programs within the area. Supervisors of Training and Department Directors have commented that they do not receive any formal feedback from trainees although there is an annual trainees’ departmental assessment provided to the RANZCR. This information could be useful to review the training programs. In particular as a proportion of trainees move to different training hospitals during their training their experiences of different training departments can serve to bring improvements and consistency across the board.

18 Formal training networks have been introduced for basic physician training, basic surgical training and basic psychiatry training in NSW.

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During the review process, there were some questions raised about the standardisation of the supervisors’ assessment of trainees. The College has advised that the processes around trainee evaluation of departments is currently being reviewed and re-developed.

RECOMMENDATIONS

Recommendation 8. State Group for Radiology Training in NSW – the NSW Radiology Training Implementation Group (RTIG)

A state group (the NSW Radiology Training Implementation Group) will be convened to provide oversight of the delivery of radiology training in NSW and to implement changes that are endorsed from this review.

The state group will report to the Institute of Medical Education and Training and be reviewed after a period of two years.

Role and functions of the State Group

Education Programs:

Monitor the impact and implications of the introduction of the RANZCR curriculum in NSW, and to identify solutions to any problems that may be encountered in relation to this.

Support, through coordination, the development of formal state-wide education programs and resources in NSW.

Identify gaps and facilitate solutions in relation to distance learning.

Utilise the training program feedback and appraisal system to monitor the availability and effectiveness of education programs state wide.

Training Support:

Act as a forum for representatives across training sites and facilitate communication, cooperation and information sharing between those sites.

Encourage systems that allow local management and resolution of issues.

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Training Experience:

Monitor the availability of modalities, training experiences and equipment at all accredited training sites, and ensure that there is equity of access for trainees to these experiences.

Liaise with GMCT regarding GMCT’s work in development of imaging infrastructure including PACS and MRI, to ensure implications for training are taken into account.

Oversee the development of area based training networks following the principles outlined in Recommendation 3 to ensure that trainees are obtaining an appropriately broad training experience.

Ensure that local training programs are collecting trainee feedback on their training experience in accordance with agreed guidelines for the collection of such data.

Monitor the quality and outcomes of training programs using agreed training indicators.

Review sub-specialty training arrangements in NSW, for example interventional, neuro-radiology, mammography and MRI, and develop specific sub- specialty training programs at appropriate sites.

Workforce and Training:

Monitor the development of new training sites in order to determine how training should be integrated with the provision of such services and assist them in developing capacity for training.

The RTIG will be responsible for supporting the AHS once they have identified potential training positions and ensuring that all training positions are appropriately linked within a training network..

Convene working groups to progress specific issues in relation to any of the above, as required.

Membership of the State Radiology Training Council

- RANZCR representative/s - Chair of the Radiology Trainee Committee (to be established see below) plus two additional trainee members nominated from the proposed Trainee Committee (see draft recommendation 8 below). - A Head of Radiology Department

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- A Supervisor of Training - GMCT representative/s - An Imaging Service Manager - NSW Health representative/s - An Area Health Service representative - Academic Chair of Radiology - State Coordinator of Radiology Training (if appointed) - A rural representative - A private sector representative - IMET representatives Other members to be co-opted as required. The combined membership should have reasonable representation from the five metropolitan area health services.

The proposed Terms of Reference for the RTIG are attached at Appendix 4.

Recommendation 9. Radiology Trainees’ Committee

A radiology trainees’ committee should be established (with formal links to the governance structures of the College) to facilitate communication among trainees and to provide a mechanism through which trainees can contribute to the RTIG and the various committees of the College. The trainees’ committee should have representatives from each accredited training site in NSW.

Recom

upervisors of Training will be established to

mendation 10. Forum for Supervisors of Training

A regular forum for Sdiscuss issues in relation to radiology training. The forum will be auspiced by the RANZCR and any issues arising from this forum may be progressed through the College (for College matters) or the state group as appropriate.

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Recommendation 11. State Director of Radiology Training

A part-time (0.2 FTE) clinical (radiologist) state director will be appointed to lead and support the delivery of training across NSW. The state director will work with radiology departments in relation to the delivery of radiology training in NSW including the development of rotational training networks.

The State Director will report to the Director of IMET, and will chair the NSW Radiology Training Implementation Group.

A role description for the State Director is attached at Appendix 5.

Recommendation 12. Area Radiology Training Group (ARTG)

An Area Radiology Training Group (ARTG) should be established in each of the five metropolitan area health services to manage the delivery of radiology training across the area. The membership of the ARTG will include the supervisors of training and department directors from each of the accredited hospitals in the area, a trainee representative from each accredited department, a senior imaging or health service manager, area health service representatives, and others as required.

The ARTG will appoint a chairperson (not necessarily a radiologist) with good facilitation and brokering skills who can bring people together to focus on developing and maintaining high quality radiology training across the area.

The main functions of this group would be:

- To regularly review the delivery of radiology training across the area to assess strengths, weaknesses and opportunities for further development and to develop well structured comprehensive radiology training programs that meet RANZCR training requirements and contribute to the area’s imaging service provision;

- To maintain a local register of training experiences and equipment that can be used to plan of a comprehensive radiology training program at all hospitals in the area;

- To review trainee feedback on the quality of the training experience at each training site and use this information to improve the local delivery of training;

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- To provide regular reports through the area health service to IMET and the RTIG on workforce, education programs, examination results, trainee feedback on their training experience and any emerging issues.

- To develop common educational resources that can be shared across the area;

- To develop systems for managing inter-hospital rotations to ensure high quality training and supervision of registrars at all training sites and minimal disruption to hospital departments;

- To provide a local forum to support individual hospital departments develop their local training programs.

- To liaise with area health services to ensure integration with area planning processes (particularly workforce distribution and capital planning).

The area radiology training group should appoint a chairperson (not necessarily a radiologist) with good facilitation and brokering skills who can bring people together to focus on developing and maintaining high quality radiology training across the area.

The Terms of Reference of the ART are attached at Appendix 4.

Recommendation 13. Area Director of Radiology Training

An Area Director of Radiology Training (0.1 FTE) should be appointed within each of the five metropolitan area health services to oversee implementation of the recommendations of this review. This position will provide accountability for radiology training within the area-based network and management and support for the Education Support Officer.

A role description for the Area Director of Radiology Training is attached at Appendix 5.

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Recommendation 14. Education Support Officers.

A part-time (O.5 FTE) education support officer (ESO) will be appointed within each of the 5 metropolitan area health services, to facilitate the work of the area radiology group by providing executive support and assistance with the development and organisation of common educational resources. The ESO will also assist with collecting and collating trainee feedback and evaluation data, in conjunction with the RANZCR.

A role description for the Area Radiology Support Officer is attached at Appendix 5.

The proposed governance structure for radiology training is attached at Appendix 6.

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7. WORKFORCE

THE CURRENT ENVIRONMENT

Workforce Supply

The Australian Medical Workforce Advisory Committee reviewed the Specialist Radiology Workforce in 200119 and concluded that the workforce was inadequate with particular problems in the supply of specialist radiologists in New South Wales and Queensland. AMWAC recommended that the number of training positions in NSW be increased to 84 positions by 2004. This target was achieved in 2005 (see Figure below) and currently there are 88 trainees in NSW.

Radiology Trainee Numbers NSW 1998-2006Source: Medical Training Review Panel Reports

50 5054 55 53

6670

82

88

66

76

84 84 84

0

10

20

30

40

50

60

70

80

90

100

1998 1999 2000 2001 2002 2003 2004 2005 2006Year

NSW Radiology Trainees AMWAC Recommendations

Workforce Shortages

Despite the recent increase in training positions, RANZCR estimates a likely national short-fall of over 200 Full Time Equivalent radiologists over the next 3-4 years due to a combination of retirement and changing work practices20.

19 Australian Medical Workforce Advisory Committee (2001), The Specialist Radiology Workforce in Australia, AMWAC Report 2001.4, Sydney. 20 Personal Communication, J Burns,RANZCR based on preliminary analysis of the 2006 RANZCR Workforce Survey

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Furthermore, the demand for services is likely to increase as a result of: the aging population; the availability of new imaging modalities; the development of more accurate and less invasive imaging techniques for diagnosis and treatment; and, changes in physician practice due to medico-legal concerns.

Workforce Distribution

There is a maldistribution of the radiology workforce with greater shortages in rural and regional areas; this is reflected in the distribution of Area of Need positions for specialist radiologists in NSW (see table below).

Area of Need positions for specialist radiologists in NSW, July 200621

Location of employer* Number of AoN positions filled

Number of AoN positions unfilled Total

Hunter / New England 2 2 4 Northern Sydney / Central Coast 0 3 3

South Eastern / Illawarra 5 3 8

Sydney South West 1 1 2

Sydney West 0 0 0

Greater Southern 7 3 10

Great Western 1 1 2

North Coast 3 4 7

TOTAL 19 17 36 * Includes private practices and public hospital radiology departments.

21 Source: NSW Department of Health Area of Need website www.health.nsw.gov.au/othp accessed on 1 June 2006, and the NSW Medical Board

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Trainee Workforce Supply and Distribution

The distribution of trainees by hospital department is included in the table below.

HOSPITAL NUMBER OF TRAINEES 2006*

Concord Hospital 8

Liverpool Hospital 11

Nepean Hospital 8

Prince of Wales Hospital 6

Royal North Shore Hospital 9

Royal Prince Alfred Hospital 11

St George Hospital 5

St Vincent's Hospital 7

Westmead Hospital 13

John Hunter Hospital 10

TOTAL 88

*Source: RANZCR and Radiology Departments

While the number of training positions available in NSW has increased significantly over the last five years, it is likely that registrar numbers will continue to grow as a result of:

The increasing demand for out of hours imaging services (registrars play a key role in providing these services)

The addition of new training positions in regional and rural areas.

ISSUES FOR CONSIDERATION

Future supply of radiologists

Demand for radiology services has developed rapidly over the last decade with the increased availability of modern imaging modalities and changes in clinical practice driving demand for more imaging services. This trend is expected to continue. The

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increasing demand has implications for the supply of specialist radiologists and potentially an expansion of the roles of other members of the imaging team.

Public and private sectors struggle to recruit sufficient numbers of specialist radiologists. The shortages are reflected in the significant number of Area of Need radiology positions which are mostly located in rural and regional NSW.

While there has been a recent expansion of training positions in NSW in line with the recommendations of the 2001 AMWAC review of the specialist radiologist workforce, the general view is that the demand for radiology services will continue to increase.

There are currently no agreed workforce supply benchmarks and there is no state based planning of radiology training positions to ensure equitable distribution of registrar positions and sufficient numbers of registrar positions to meet projected demand for extended hours cover and the development of new training sites.

Advanced Training Positions

NSW has a relatively small number of sub-specialist or modality specific fellowship positions for the number of trainees in comparison to other states (see Table below).

NSW VIC WA ACT SA QLD TAS

Advanced Training (fellowship) Positions22

9 25 15 2 10 11 1

Total number of trainees 200523 82 81 24 4 29 40 3

Fellowship positions as a percentage of total trainee numbers

11% 31% 63% 50% 34% 28% 33%

The reasons for this are not clear but appear to be related to funding and local decisions regarding the composition of the department’s training workforce. For example, some radiology directors believe that the fifth year of training should remain a generalist year. Whatever the reasons for the apparent lack of fellowship positions, many trainees in NSW complete RANZCR accredited advanced training fellowships overseas.

There is potential for development of advanced training positions in breast imaging, which would encompass training in mammography, MRI and ultrasound. To be successful, advanced training positions in breast imaging would need to be attached to a principal referral hospital that has the following attributes: 22 RANZCR website http://www.ranzcr.edu.au/educationandtraining/radiodiagnosis/training/11.cfmAccessed on 28 June 2006 23 Medical Training Review Panel 9th Report, available at http://www.health.gov.au/internet/wcms/publishing.nsf/Content/CBF4606E24A21251CA2570D8007E2BA7/$File/mtrp9thr.pdf. Accessed on 28 June 2006.

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• A genetic counselling centre • A high risk breast imaging clinic • MRI • Access to an integrated cancer treatment centre.

Role of Radiographers

There are a number of work areas where radiographers could support the work of radiologists to enhance patient care. These include; radiographer alert systems in the emergency setting, clinical history documentation, gastro-intestinal barium examinations, venepuncture and cannulation, and assistance in breast biopsy. There is potential for these initiatives to increase the efficiency of radiology service provision and reduce the workload of radiology trainees and improve the balance of service and training. The RANZCR has drafted an interim position statement on task delegation and role evolution in medical imaging.24 The College does not support role substitution.

Interventional Radiology

RANZCR trainees are not expected to be fully trained in all areas of interventional radiology by the time that they obtain their specialist radiologist qualification. Those with an interest in interventional radiology will undertake further training in Australia or overseas. At present there is no formal post-fellowship qualification in interventional radiology. RANZCR is reviewing the training requirements for interventional radiology as part of its curriculum project.

Demand for therapeutic imaging services (interventional radiology) is increasing as more minimally invasive image guided procedures are becoming accepted practice. This has significant implications for service provision, workforce planning and training and credentialing appropriately qualified health professionals. While there are mechanisms in place to review the appropriateness of new technologies and procedures25 there is a need for national training and accreditation standards for specialists who undertake interventional radiology. Many non-radiologists (mainly physicians and surgeons) perform image guided endovascular procedures. Cross disciplinary training and accreditation for “interventionists” would promote consistency of standards and would also assist area health services in their credentialing processes.

24 Available at http://www.ranzcr.edu.au/news/article.cfm?intArticle=212. 25 For example, the Medicare Services Advisory Committee, the Australian and New Zealand Horizon Scanning Network and the Nationally Funded Centre Program.

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RECOMMENDATIONS

Recommendation 15. Workforce Planning

The Terms of Reference of the state group will include:

- Liaison with the AHS to understand demand and capacity for training positions based on imaging activity and training capacity at different hospitals. This information is important for setting up training rotations and ensuring equitable workforce distribution across NSW.

- Ongoing collection of data on registrar numbers and distribution, including advanced training positions.

Recommendation 16. New Training Positions

The state group will oversee and approve the establishment of new training positions or training arrangements (e.g. involving teleradiology) outside the currently accredited teaching hospitals. This would include regional and rural sites and potentially the private sector sites (subject to NSW Health Department approval). Approval of new positions will be dependent on achievement of RANZCR accreditation and the approval and support of the relevant area health service.

Recommendation 17. Advanced Training/Fellowship Positions

The state group should review the number of advanced training positions available in NSW in comparison to the number of positions available in other states, and determine a benchmark for the number of positions that should be available within NSW.

Area health services should review the number of advanced training/fellowship positions available against the benchmark, and consider increasing the number of such positions in order to provide more opportunities for trainees to complete their fifth year of training within NSW, should this be required.

For example, an advanced training position in breast imaging could be established within each radiology training network, under the fellowship program of the Cancer Institute of NSW. The positions should include mammography, MRI and ultrasound and be established at hospitals that can provide:

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- A genetic counselling centre

- A high risk breast imaging clinic

- MRI

- Access to an integrated cancer treatment centre.

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8. SELECTION AND RECRUITMENT

THE CURRENT ENVIRONMENT

To be eligible to join the radiology training program, trainees must have full medical registration and have completed 2 years of postgraduate training.26

Area health services are the employing bodies that create and maintain radiology registrar positions but the management of recruitment and selection of trainees is devolved to radiology departments.

Radiology training positions are advertised and recruited to at any point in the year. There is no common starting or finishing date for radiology training. Radiology registrars are currently employed on 12 month contracts.

RANZCR does not play a direct role in recruitment of radiology trainees although the NZ branch of the College has recently implemented a centralised recruitment and selection process. The College advises that they would like to consider these models for radiology trainee selection in Australia.

ISSUES FOR CONSIDERATION

Recruitment Cycles

The ad-hoc nature of recruitment to positions may be a detractor to radiology training for those considering their specialist training options during the annual recruitment cycle i.e. posts advertised in July commencing in January. Feedback from trainees indicates that in order to find out about vacant positions, they have to maintain a constant watch on advertising for them, or rely on word of mouth. A standardised recruitment cycle may be beneficial for trainees as they would know when positions were being advertised.

Having the staggered start creates an administrative burden for radiology departments and can disrupt clinical services as trainees vacate their previous clinical positions to take up a radiology appointment at odd times throughout the year. The staggered arrangement also complicates organising key educational or professional opportunities across a training year e.g. an orientation course for trainees. A standardised recruitment cycle may serve to alleviate some of these difficulties as it would bring the start and finish dates of employment contracts into alignment.

26 RANZCR website, http://www.ranzcr.edu.au/educationandtraining/radiodiagnosis/training/03.cfm. Accessed on 12 July 2006.

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However, whilst there are potential benefits associated with a standardised annual recruitment cycle, some argue that having all new registrars starting at the same time each year would be burdensome from an administrative perspective. There is also the question of managing vacancies which can occur at any time during the year. Positions need to be filled as soon as vacancies arise and this might not fit with a rigid recruitment cycle – some flexibility is required.

Some trainees take fellowship positions overseas which begin in July each year, resulting in a higher level of vacancies being available at that time of year. Hence, whilst feedback from the review indicates that while a standardised annual recruitment cycle may be advantageous, it would be preferable to have two annual recruitment cycles so that positions vacated mid-year can be filled.

Duration of Employment

Although registrars are employed on one-year contracts, there is an expectation of re-appointment once a trainee has joined a radiology department’s training program.

The one-year contract does not align with the length of the training program. Longer contracts (with appropriate performance appraisal and management provisions) would provide an element of certainty for trainees with regard to completing their training.

RECOMMENDATIONS

Recommendation 18. Recruitment Cycles

A regular recruitment cycle for radiology training positions that is consistent across NSW should be introduced, commencing with two recruitment intakes in the year – at the beginning and in the middle of the clinical year. In time, it is expected that radiology recruitment would align with other specialty training recruitment processes in NSW.

Recommendation 19. Area based recruitment

The Area Radiology Training Group should develop an area based recruitment process that complies with NSW Health policy in recruitment of junior medical staff. This may involve hospital departments conducting joint selection processes for training positions and trainees nominating their preferred “home base” hospital. Area based recruitment should commence at the same time as the development of area networked training.

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Recommendation 20. Recruitment and Selection Procedures

The Radiology Training Implementation Group should monitor recruitment process and outcomes of the training networks.

Recommendation 21. Employment Contracts

Trainee employment contracts should be consistent with expected training requirements and the minimum length of training, subject to satisfactory trainee performance. First year trainees commencing in 2008 under the new networked training arrangements should be offered four years contracts to cover the basic radiology training period.

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9. REVIEW AND EVALUATION

Any changes implemented as a result of this review will need to be formally and independently evaluated after a suitable time to ensure that objectives are being met. The format of the review will require further discussion with key stakeholders. The review may include a facilitated forum with representatives from the RANZCR, Area Health Services, the Department of Health, medical administration, trainees and clinicians.

The Radiology Training Implementation Group will be reviewed after two years, which would be an appropriate time to conduct an evaluation any changes implemented as a result of the review.

The Education and Training Program will be reviewed independently to ensure that it is meeting its objectives.

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APPENDIX 1 RADIOLOGY ADVISORY GROUP

Chair

Marie-Louise Stokes

IMET Project Team

Alix Brown

Jennifer Chapman

Louise Rigby

Natalia Vukolova

RANZCR Representation

Joan Burns

Rob Loneragan

Julia Snedic

Don Swinbourne, CEO

Radiologists (including Heads of Departments and Supervisors of Training)

Stephen Blome

Derek Glen

Han Loh

Anne Miller

Lloyd Ridley

Richard Waugh

Noel Young

Rural Representatives

Roger Davies

Bill Turnbull

Trainee Representation

Marina-Portia Anthony

Kate Archer

Virgil Chan

Kevin Ng

Consumer Representation

Ling Yoong

Radiographer

Ingrid Egan

Medical Imaging Business Unit

Michael Symonds

Greater Metropolitan Clinical Taskforce – Radiology Group

Pon Anura

Health Services

Linda McPherson

The role of the advisory group is to inform the work of the specialist training program review through provision of feedback and advice. The recommendations in this report are those of the Institute of Medical Education and Training and do not necessarily represent the views of individual advisory group members.

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APPENDIX 2 DRAFT ROLE DESCRIPTION OF ACADEMIC CHAIR

The Academic Chair would have three areas of equal focus: research, teaching and clinical practice. Research Activity

To provide academic leadership for radiology research in NSW and improve the profile of imaging research in NSW.

To seek new imaging projects and funding opportunities for research.

To collaborate with other medical disciplines regarding clinical research projects and grant applications that require medical imaging methods.

To establish research networks in NSW.

To encourage new researchers and oversee PhD students and research projects.

Teaching Activity

To contribute to undergraduate medical imaging teaching activities at the university.

To contribute to postgraduate medical imaging teaching activities in NSW.

To liaise with training centres, supervisors of training, NSW Health and the RANZCR, in order to link future radiology training in NSW in a coherent fashion.

To be an expert in radiology pedagogy i.e. the strategies, techniques, and approaches that teachers can use to facilitate learning in medical imaging.

Clinical Activity

To undertake clinical activity, in order to maintain clinically relevant focus for research and teaching.

To assess the clinical role of medical imaging.

To assess the use of technology to restructure imaging workflow and radiologist work practices.

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APPENDIX 3 POTENTIAL RADIOLOGY TRAINING NETWORKS

South East Sydney Illawarra AHS Sydney South West AHS Sydney West AHS

Primary accredited sites

Affiliated Departments

Paediatric Training

Prince of Wales

St George

Royal Hospital for Women

Sydney Children’s Hospital

Sutherland

St Vincent’s

Wollongong

Primary accredited sites

Affiliated Departments

Paediatric Training

Concord

Liverpool

Canterbury The Children’s Hospital at Westmead Campbelltown

Royal Prince Alfred

Primary accredited sites

Affiliated Departments

Paediatric Training

Nepean

Westmead

Blacktown/Mt Druitt

The Children’s Hospital at Westmead

Auburn

Potential New sites

Potential New sites

Bankstown

Potential New sites

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Northern Sydney Central Coast AHS *The radiology service at the planned Frenchs Forest Hospital may become a RNSH affiliated department.

** If Gosford Hospital has not achieved accreditation by 2008, alternative arrangements may need to be considered for RNSH such an as out of area rotation to another accredited department.

Hunter New England AHS**

Primary accredited sites

Affiliated Departments*

Paediatric Training

Royal North Shore

The Children’s Hospital at Westmead

Gosford

Primary accredited sites

Affiliated Departments

Paediatric Training

Potential New sites

Hunter New England Imaging Service

The Children’s Hospital at Westmead Tamworth

Maitland

Potential New sites**

** As there are no other accredited departments within the Hunter New England Area Health Service, a potential link to a Sydney based training program could be considered to enable Hunter trainees to spend some time in another department.

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APPENDIX 4 TERMS OF REFERENCE STATE AND AREA RADIOLOGY TRAINING COMMITTEES

Terms of Reference

NSW Radiology Training Implementation Group

Purpose of Commit tee : To provide oversight of radiology training in NSW Health services in accordance with the NSW Health endorsed recommendations for the delivery of radiology training in NSW. The purpose and functions of the RTIG will be reviewed after a period of two years.

Ro le and respons ib i l i t ies :

Training Experience:

Ensure the effective functioning of the Area Radiology Training Networks. Monitor the availability of modalities, training experiences and equipment at all accredited training sites, and ensure that there is equity of access for trainees to these experiences.

Monitor the composition of the Radiology Training Networks in NSW, and approve changes to the Networks as required (in consultation with NSW Health and the hospitals involved). Liaise with NSW Health and the GMCT Radiology Services Group regarding development of imaging infrastructure including PACS and MRI, to ensure implications for training are taken into account.

Ensure that local training programs are collecting trainee feedback on their training experience in accordance with agreed guidelines for the collection of such data.

Monitor the quality and outcomes of training programs using agreed training indicators.

Review sub-specialty training arrangements in NSW, for example interventional, neuro-radiology, mammography and MRI, and develop specific sub- specialty training programs at appropriate sites.

Workforce and Training:

The RTIG will be responsible for supporting the AHS once they have identified potential training positions and ensuring that all training positions are appropriately linked within a training network..

Monitor data on registrar numbers and distribution, including

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advanced training positions.

Liaise with NSW Health and Area Health Services regarding Area clinical service plans to ensure that workforce requirements are being met in terms of radiology registrar numbers and future workforce requirements. Liaise with the AHS to understand demand and capacity for training positions based on imaging activity and training capacity at different hospitals. This information is important for setting up training rotations and ensuring equitable workforce distribution across NSW. . Monitor and evaluate trainee numbers and distribution across the Radiology Training Networks, and make decisions on the distribution of trainees as required and where relevant. Advisory functions: Provide advice to the IMET Management Committee regarding radiology training funding allocations, as required. Provide a written report to the IMET Management Committee twice per year and provide advice and expertise to the IMET Management Committee when required. Act as a forum for the discussion of issues at the service delivery/training interface. Advocate for radiology trainees, and seek solutions to important issues raised by radiology trainees. Review matters referred by the Area Radiology Training Groups, trainees, and other bodies as appropriate. Operational Functions: Evaluate the management of radiology training network funding, and approve changes to allocations proposed by the networks and supported by the relevant Area Health Service, in accordance with funding policies determined by NSW Health and/or IMET as appropriate. Recognise that ultimate responsibility of care and special purpose funding resides with the IMET Management Committee. Convene working groups to progress specific issues in relation to any of the above, as required.

Authority is delegated to the RTIG by the Director, IMET. De legated Author i t y :

Membersh ip

A l l members are appo inted by the D i rector, IMET

State Director of Radiology Training (Chair), for the duration of their tenure in this role, or until the RTIG is reviewed after a period of two years. All other members are appointed for a period of 2 years, at which time the RTIG will be reviewed.

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RANZCR representative

RANZCR NSW Branch Education Officer (ex-officio)

Radiology Trainee Committee representatives x 3

A Radiology Department Head

A Supervisor of Training

A GMCT Representative

An Imaging Service Manager

A NSW Health Representative

An Area Health Service Representative

An academic radiologist

The State Coordinator of Paediatric Radiology Training

A rural representative

A private sector representative

An IMET representative

Other members to be co-opted as required

Respons ib i l i t ies • Actively participate in the work of the RTIG.

• Represent the interest of the RTIG.

• Participate in other working parties/committees as required.

• Disclose interests that may impinge on the exercise of duties as an RTIG member.

• To be provided by IMET Commit tee Secretar ia t

Conduct o f Meet ings

Quorum

• The quorum is to constitute 50% of members.

• There needs to be a minimum of 50% of the RTIG members present (quorum) in order to conduct a meeting

• Any executive decisions made outside the RTIG meeting can only be made by the Chair or the pre-approved delegate of the RTIG, and need to be approved by the quorum during the next RTIG meeting

• As necessary Vot ing

• Quarterly Frequency• To be advised T ime/Location• Via email or post to members of the RTIG. Distr ibut ion of

minutes

Record Keeping • Minutes will be approved and endorsed at the following RTIG meeting.

• Minutes will be held by IMET for 7 years

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Radiology Trainees Committee Sub-Commit tees/Forums

IMET Management Committee Formal repor t ing to

The RTIG will be reviewed after a period of two years in relation to its effectiveness to date, any ongoing state wide functions that will be required, and the best methods of fulfilling ongoing functions.

Eva luat ion o f Commit tee and Terms of Reference

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Terms of Reference <AREA HEALTH SERVICE LOGO>

Area Radiology Training Group

Purpose of Commit tee : To manage the delivery of radiology training across the relevant area health service and oversee the development of a networked training program in accordance with NSW Health’s recommendations for the delivery of radiology training in NSW.

Ro le and respons ib i l i t ies :

To regularly review the delivery of radiology training across the area to assess strengths, weaknesses and opportunities for further development and to develop well structured comprehensive radiology training programs that meet RANZCR training requirements and contribute to the area’s imaging service provision; To maintain a local register of training experiences and equipment that can be used to plan of a comprehensive radiology training program at all hospitals in the area; To review trainee feedback on the quality of the training experience at each training site and use this information to improve the local delivery of training; To develop common educational resources that can be shared across the area; To develop systems for managing inter-hospital rotations to ensure high quality training and supervision of registrars at all training sites and minimal disruption to hospital departments; To provide a local forum to support individual hospital departments develop their local training programs. To liaise with area health services to ensure integration with area planning processes (particularly workforce distribution and capital planning). To provide regular reports through the area health service to IMET and the RTIG on workforce, education programs, examination results, trainee feedback on their training experience and any emerging issues. To act as a forum for the discussion of issues at the service delivery/training interface. To review matters referred by the relevant area health service, trainees, and other bodies as appropriate. The area radiology training group should appoint a chairperson (not necessarily a radiologist) with good facilitation and brokering skills who can bring people together to focus on developing and maintaining high quality radiology training across the area.

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Authority is delegated to the ARTG by the Area Health Service Chief Executive. De legated Author i t y :

Membersh ip Chair, appointed by election of ARTG members for a period of two years.

Head of Department (or delegate) from each accredited department in the network (ex-officio)

Supervisor of Training of each accredited department within the network (ex-officio)

A trainee representative from each accredited department within the network (nominated by trainees) appointed for two years

The Area Imaging Service Manager/Director (ex-officio)

An Area Health Service Representative (nominee) appointed for two years

The Radiology Education Support Officer (ex officio)

The Area Director of Radiology Training (ex-officio)

Academic Chair (where applicable – ex-officio)

Other members to be coopted as required appointed for two years..

Respons ib i l i t ies • Actively participate in the work of the ARTG.

• Represent the interest of the ARTG.

• Participate in other working parties/committees as required.

• Assist in the development of relationships with partners.

• Disclose interests that may impinge on the exercise of duties as a ARTG member.

Quorum • The quorum is to constitute 50% of members.

• There needs to be a minimum of 50% of the ARTG members present (quorum) in order to conduct a meeting

• Any executive decisions made outside the ARTG meeting can only be made by the Chair or the pre-approved delegate of the ARTG, and need to be approved by the quorum during the next ARTG meeting

At least quarterly Frequency of meet ings

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APPENDIX 5 POSITION DESCRIPTIONS

Position Description: The State Director of Radiology Training

Role Expectations and Specification Position Title Part time (0.2FTE) State Director of Radiology Training Reports To Employment: Area Health Service Professional: Director of IMET, and College (where appropriate) Liaise With State Radiology Training Implementation Group Performance Review Director of IMET, in line with individual Performance

Agreement

Primary Objectives The State Director of Radiology Training provides clinical leadership to the State Radiology Training Implementation Group (RTIG) as Chair and expert advice to the NSW Institute of Medical Education and Training (IMET). The incumbent is responsible for ensuring the efficient and effective delivery of training through the Radiology Training Networks. Liaison with many key groups and individuals is a critical part of this role.

Major Accountabilities

1. Oversee the implementation of recommendations arising from the review of the delivery of radiology training in NSW hospitals including:

a. Preparing a 5 year plan to advise IMET on where rural and regional metropolitan posts should be established in NSW

b. Developing a statewide education program following the RANZCR curriculum

c. Overseeing and ensuring the effective functioning of the area Radiology Training Networks

2. Negotiate and liaise with Area Radiology Training Groups in each Area Health Service to implement Area-based networked rotational training programs for radiology training in NSW.

3. Work with radiology departments, the College and the academic chair/s (if appointed) to develop and coordinate a formal state-wide education program and resources in NSW which is based on the RANZCR curriculum, building on local training programs that are already in place and ensuring equity of access for all trainees to a common training program.

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4. Work with Area Health Services and radiology departments to investigate potential new sites and training positions for radiology training in NSW. This would include assisting regional locations to achieve accreditation and join rotational training programs, investigating options for rural training, and developing advanced training positions.

5. Provide leadership in the resolution of issues arising from the delivery of training programs within the purview of the NSW RTIG, including where those issues may require support or intervention at a local level

6. Lead and facilitate of discussion at NSW Radiology Training Implementation

Group (RTIG) meetings a. Be present at meetings of the NSW Radiology Training Implementation

Group b. Facilitate discussion of the items on the agenda in such a manner as to

ensure that the views of all stakeholders are heard and respected c. Ensure that decisions made about items discussed are clear, and

recorded transparently d. Ensure that perceived or real conflicts of interest are managed

appropriately

7. Prepare for meetings of the NSW Radiology Training Implementation Group (RTIG) in conjunction with IMET staff. This includes:

a. approval of agenda content and review of all items b. responding to documents or requests for feedback in a timely fashion c. reading of the agenda and other relevant materials d. notifying IMET executive of emerging risks e. providing a point of clinical liaison for the referral of issues to the

Director, IMET

8. Undertake follow-up duties following a NSW RTIG meeting in conjunction with IMET staff. This includes:

a. Review and approve minutes b. Review and sign correspondence as appropriate c. Read relevant incoming and outgoing correspondence and written

documents as required d. Taking a leadership role in the resolution of issues

9. Support IMET developing relationships with key groups and individuals relevant to the delivery of training programs within the purview of the NSW Radiology Training Implementation Group

a. Attend College or other meetings as necessary as a representative of IMET or the NSW RTIG.

b. Represent IMET or the NSW RTIG on ad-hoc committees or working groups as appropriate

c. Liaise with the GMCT Radiology Group and the RANZCR on education and training issues

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10. Provide strategic direction and advice to IMET’s Directors, Executive and program staff, as well as its Management Committee, in relation to emerging issues and risks within the purview of the NSW RTIG.

11. Develop and maintain sound relationships with IMET Directors, Executive and

program staff, which may involve formal meetings with IMET Directors.

12. Comply with the NSW Health Code of Conduct (http://www.health.nsw.gov.au/pol ic ies/pd/2005/pdf/pd2005_626.pdf)

Key Relationships

1. IMET Directors, Executive, program staff and Management Committee

2. Trainees : through the Radiology Trainees Committee

3. Clinician teachers – Heads of Radiology Departments, Area Directors of Radiology Training, Hospital Supervisors of Radiology Training

4. Clinicians holding posts within structures of the RANZCR

5. Staff and officials of the relevant college(s) or other educational institutions

6. Officials of the NSW Department of Health

7. Managers of Health Services

8. GMCT Radiology Services Group

ORGANISATIONAL CHART

Academic Chair

NSW Radiology Training

Implementation Group (RTIG)

Director of IMET

Paediatric Radiology Training Coordinator State Director of

Radiology Training Chairs RTIG

Reports to the Director of IMET

IMET

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Position Description: The State Coordinator of Paediatric Radiology Training

Role Expectations and Specification Position Title Part time (0.2 FTE) State Coordinator of Paediatric

Radiology Training Reports To Employment: Area Health Service delegate Professional: State Director of Radiology Training Liaise With NSW Radiology Training Implementation Group Performance Review Area Health Service delegate and State Director of

Radiology Training, in line with individual Performance Agreement

Primary Objectives • To coordinate the delivery of the paediatric radiology component of the

RANZCR training program in NSW including the coordination of trainee access to accredited paediatric training terms in NSW Health services.

• To work with paediatric radiology departments, the College and the academic chair (if appointed) to contribute to the development of the formal state-wide education program NSW.

• To provide advice and reports to the State Radiology Training Implementation Group, IMET, and Area Health Services as required, in relation to paediatric radiology training.

Major Accountabilities

• To work with the State Director of Radiology training, radiology departments, the College and the academic chair (if appointed) to contribute to development and coordination of a formal state-wide education program and resources in NSW which is based on the RANZCR curriculum, building on local training programs that are already in place and ensuring equity of access for all trainees to a common training program.

• To negotiate and liaise with Area Radiology Training Groups in each Area Health Service to coordinate the requirements for paediatric radiology training in NSW.

• To oversee the roll-out of the paediatric radiology component of the new RANZCR Curriculum across NSW.

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• To work with Area Health Services and radiology departments to investigate potential new sites and training positions for paediatric radiology training in NSW.

• To promote paediatric radiology as a rewarding career pathway for registrars.

• To provide regular reports to the Director of IMET and the State Radiology Training Implementation Group.

• To liaise with Area Directors of Radiology Training and Radiology Education Support Officers (ESOs) in relation to paediatric rotations.

• Remain aware of RANZCR policies that will affect paediatric radiology training.

Key Relationships

1. State Director of Radiology Training

2. Area Directors of Radiology Training and heads of departments at paediatric specialist hospitals - to coordinate access to paediatric radiology training.

3. The Academic Chair – liaise with the Academic Chair/s in Radiology regarding the development of the paediatric radiology component of the state wide education program and the roll out of the RANZCR curriculum within NSW.

4. The RANZCR - liaise with the RANZCR to ensure that trainees achieve the objectives of the training program in line with College policies and standards

5. Area Radiology Education Support Officers (ESOs) - liaise with the ESO to ensure the smooth running and organisation of the education program across NSW.

6. The State Radiology Training Implementation Group – liaise with the state group in relation to paediatric radiology training.

7. IMET - report through the State Director Radiology Training to the Director of IMET to report on progress of training objectives and to deal with any issues.

8. Area Radiology Training Groups

9. Trainees

ORGANISATIONAL CHART

Paediatric Radiology Training Coordinator

State Director of Radiology Training

Chairs RTIG Reports to the Director

of IMET

IMET

NSW Radiology Training

Implementation Group (RTIG)

Director of IMET

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Position Description: The Area Director of Radiology Training

Role Expectations and Specification Position Title: Area Director of Radiology Training Award Classification: Senior Staff Specialist Level 1 Hours: 0.1 FTE Reports To Employment: Area Health Service delegate Professional: Head of Radiology Department and State

Director of Radiology Training Liaise With Area Radiology Training Group Performance Review Area Health Service delegate, in line with individual

Performance Agreement

Primary Objectives • To develop area health service radiology training networks in accordance with

the NSW Health principles for the delivery of radiology training in NSW. • To coordinate and oversee the delivery of the radiology training program

across all training sites within the network. • To provide advice and reports to the Area Radiology Training Group, the State

Director of Radiology Training and the NSW Radiology Training Implementation Group on data and issues relating to the operation of the network.

• To provide advice and reports to the Area Health Service (AHS) on the performance of the network and organisation of training.

• To manage the Radiology Education Support Officer (ESO) in the organisation of training and to liaise with Supervisors of Training to ensure quality of training and supervision at each site in the network.

Major Accountabilities

• Responsible for the development of trainees within the network and to assess and provide feedback on their performance and progression within the training program.

• Develop and communicate network policies and procedures, in conjunction with the NSW Radiology Training Implementation Group.

• Ensure that all sites within the network have quality training and supervision.

• Assist with recruitment to fill vacancies, during the two annual recruitment cycles for radiology training.

• Manage and report on funds within the network training cost centre.

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• Liaise with relevant medical / hospital administrators to manage issues and ensure access to training resources.

• Remain aware of RANZCR policies that will affect network.

• Manage the Radiology Education Support Officer (ESO).

Key Relationships

1. Trainees The Area Director of Radiology Training will meet with all trainees on a regular basis to discuss training issues related to the development, implementation and ongoing operations of the training network.

2. Supervisors of Training

The Area Director of Training will work with Site Supervisors of Training collectively to raise standards of training and learning, and to recruit and retain trainees.

3. The Education Support Officer (ESO)

The Area Director of Training will work closely with the ESO to ensure the smooth running and organisation of the networked training program across their network. The ESO will provide full administration and organisational support in organising meetings, collating budgets and reports to the Area Radiology Training Group, organising training, collating evaluation of trainee terms and training sessions.

4. Heads of Radiology Departments

The Area Director of Radiology will consult regularly with heads of Radiology Departments within the area regarding the development, implementation and ongoing operations of the radiology training network.

5. The Director of Medical Services or Equivalent

The Area Director of Radiology Training will liaise with the hospital DMS and other clinicians in the specialty to ensure quality training in their network.

6. The Area Radiology Training Group

The Area Director of Radiology Training will report to the Area Radiology Training Group regarding all network training issues.

7. The Area Health Service The Area Director of Radiology Training will liaise with the Area Health Service (AHS) that is part of the network, to report on progress of training objectives and to deal with any AHS issues.

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8. The State Director of Radiology Training and the State Radiology Training

Implementation Group (RTIG) The Area Director of Radiology Training will be accountable to the State Director and RTIG for the implementation of the network training program in accordance with the NSW Health principles for the delivery of radiology training in NSW and RANZCR training requirements.

9. The Institute of Medical Education and Training.

The Area Director of Radiology Training will liaise with IMET staff regarding the delivery if radiology training within the network.

10. The RANZCR The Area Director of Training will liaise with the RANZCR to ensure that trainees achieve the objectives of the training program in line with College policies and standards.

ORGANISATION CHART

Education Support Officer

Trainees Supervisors of Training

Directors of Departments

Area Radiology Training Group

Area Director of Radiology

Academic Radiologist

Area Health Service Level

Hospital Level

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Position Description: The Area Radiology Training Support Officer Position Title: Part time (0.5 FTE) Education Support Officer Reports to (Employment): Area Director of Radiology Training

(Professional): Area Director of Radiology Training

Performance Review (Employment): Area Director of Radiology Training (Professional): Area Director of Radiology Training (or delegate)

MAIN PURPOSE OF POSITION To develop, coordinate and evaluate education training program(s) and/or educational activities, liaising with the Area Director of Training, Supervisors of Radiology Training and where applicable, senior academic radiologists as required.

Provide support to the area health service radiology training group. KEY ROLES AND RESPONSIBILITIES

1. Manage the coordination and facilitation of a network training program across multiple sites, by liaising with the Area Director of Radiology Training, Supervisors of Training and other relevant hospital and Area Health Service staff.

2. Undertake background research into adult education principles; models of best-practice in training; trainee terms and placements; workforce; education and training program development, as required in order to support and improve delivery of the training program.

3. Ensure awareness of Royal Australian and New Zealand College of Radiologists (RANZCR or the College) training policies and procedures, and relevant NSW Health/Area Health Service policy directives. Develop local policies for training networks in accordance with College, NSW Health/Area Health Service policy directives and adhering to any NSW Radiology Training Implementation Group guidelines.

4. In areas where a senior academic radiologist (Professor of Imaging or Radiology) has been appointed, provide support for the academic radiologist for activities related to education and training of resident medical staff, specialist radiology registrars and staff specialist radiologists.

5. In conjunction with the RANZCR, collect and collate trainee feedback and evaluation information about the quality of training within the network, and in

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individual training sites within the network; ensure appropriate distribution of this information for the purposes of improvement of the training program.

6. Participate in working parties and contribute to the sharing of knowledge and good practice as required.

7. Draft reports, including the quarterly non-financial reports and other reports required from time-to-time by IMET or the NSW Radiology Training Implementation Group.

8. Provide high-level executive support to the area health service radiology training group, including guiding the work of the committee, preparation and distribution of papers and other secretariat functions.

9. Respond to internal and external requests for information relevant to the radiology training program.

10. Maintain and use databases, including data entry, monitoring and following up data returns, reviewing the quality of data provided, producing tables and assisting with data interpretation and preparation of reports.

11. Effectively liaise with IMET project staff.

12. Maintain and report on financial expenditure, as requested by the Area Director of Radiology Training.

13. Support the Area Director of Radiology Training in the recruitment of Medical Officers to vacancies.

14. Provide assistance to doctors-in-training in regards to Human Resources and recruitment matters. The Education Support Officer may be required to provide pastoral care to doctors-in-training and refer their issues to relevant individuals.

15. Support the implementation of the Department’s policies on Equal Employment Opportunities, Occupational Health and Safety and Principles for Culturally Diverse Society.

16. The scope of the role may evolve and develop with time. For example, the role may also incorporate education and training support for other imaging health professionals who are training within radiology departments such as radiographers and radiology nursing staff. Any major role amendments will be negotiated with the post holder.

LOCAL BACKGROUND AND ENVIRONMENT

The radiology training networks were developed as part of the NSW Health initiative to improve support for education and training. This is co-ordinated by the NSW Institute of Medical Education and Training (IMET), in association with the relevant groups and individuals including College, NSW Department of Health, NSW Area Health Services, clinician trainers and doctors-in-training.

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The aim of the program is to ensure that the delivery of training in NSW is:

• of the highest quality;

• sustainable;

• transparent; and

• in accordance with College training requirements and clinical service need.

Each training network is governed by an area health service radiology training group and contains accredited radiology departments within the area. In the future training networks may expand to incorporate accredited training sites in rural areas and potentially private sector training sites (subject to approval by the NSW Health Department).

The effectiveness of the training delivery program(s) in terms of the provision of high quality training and equitable distribution of the relevant doctor-in-training workforce across NSW is monitored by the NSW Radiology Training Implementation Group.

The focus of the education training program is on the doctor-in-training’s acquisition of the applicable core competencies. The training program needs to provide all relevant doctors-in-training with:

o a broad range of clinical and non clinical experience relevant to achieving core competencies

o facilitation of high quality exam preparation activities, where applicable

o general education program that is clinically relevant (this may include: case presentations, skills acquisition/assessment, scenario management, use of skill labs where available)

o a non-clinical professional development program

o other training requirements as appropriate (eg. critical care)

ROLES OF POSITIONS SUPERVISED Not currently applicable. KEY INTERNAL AND EXTERNAL RELATIONSHIPS

The position holder will be required to establish and maintain relationships across a range of colleagues and stakeholders.

• The Area Director of Radiology Training. Work closely with this post holder to ensure the smooth running and organisation of the training program across the network.

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• Supervisors of Training. Liaison with post holders on matters in relation to the governance, policies & procedures, workforce data, doctor-in-training issues and so forth, where relevant.

• Academic radiologists who have a clinical appointment within the area health service.

• The DMS or Department Heads should relief and staffing resources require negotiation.

• The College and other medical education providers to ensure up to date information regarding policies for accreditation and training standards.

• Members of the area health service radiology training group, including the chair.

• Staff throughout the Area Health Service, particularly in Finance, Information Services Division, Human Resources regarding the administrative functions/activities of the organisation.

• Department of Health and Area Health Service staff, medical staff, members of other government agencies and non-government organisations regarding policies and procedures that impact on training, the functions of the network, meeting and conference arrangements.

• Doctors-in-training and prospective doctors-in-training.

• Suppliers of goods and services including travel, accommodation, catering, venue hire, equipment and office supplies.

• The NSW Institute of Medical Education and Training (IMET).

• Other Education Support Officers in the same or in different specialty areas.

CHALLENGES/PROBLEM SOLVING • Meeting deadlines and undertaking and/or supporting a number of projects in a

pressured, large-volume work environment.

• Balancing workload and priorities if involved across multiple training programs.

• Maintaining a high level of organisation and professional service, particularly when providing secretariat support to committees and when working with clinician trainers and doctors-in-training.

• Maintaining familiarity with the extensive range of current research, policy and initiatives impacting on the relevant training program(s), so that work on projects and policy reflects current knowledge and best practice.

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DECISION MAKING

Decisions which can be made by the position holder include:

• decisions relating to the day-to-day operations of the training network in order to achieve program objectives.

• implementation of processes and issue of correspondence relating to Committee secretariat functions.

• implementation of project plans, if relevant.

• day to day decisions relating to work priorities and workload management.

• determining whether data provided for incorporation into databases is adequate or needs to be followed up for clarification or amendment.

• analysing and interpreting information gathered.

• content of draft correspondence/reports/papers.

• content of information and advice provided in response to enquiries.

Decisions which are referred to the Area Director of Radiology Training or a supervisor include:

• finalising content of network training program.

• approval of changes to trainee term allocation and rosters.

• sign off of reports and correspondence which is other than routine.

• expenditure.

SKILLS, KNOWLEDGE AND EXPERIENCE USED

• Experience in and broad knowledge of the healthcare system.

• Good oral and written communication skills, including capacity to prepare high quality reports, briefings, submissions, business cases and correspondence.

• Demonstrated analytical skills, both verbal and quantitative.

• Strong organisational skills and proven experience in the management of complex projects and multiple tasks in a timely manner and to meet assigned deadlines.

• Relevant qualifications or equivalent experience in adult education.

• Previous experience in the coordination and development of education programs.

• Ability to coordinate, monitor and evaluate training programs.

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• Experience in organising meetings and supporting committees, including preparation and distribution of papers.

• Demonstrated experience of financial procedures.

• Evidence of capacity to work with minimal direction, to undertake a diverse range of tasks, work under pressure and meet tight deadlines.

• Ability to work as an effective member of a team in a high pressure, high volume work environment.

• Effective skills in office systems, including word processing and spreadsheet packages.

• Understanding of EEO and OH&S principles.

• Current drivers licence and ability to undertake some rural travel.

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ORGANISATION CHART GANISATION CHART VERIFICATION VERIFICATION This section verifies that the position holder and supervisor have read the above position description and are satisfied that it accurately describes the position. This section verifies that the position holder and supervisor have read the above position description and are satisfied that it accurately describes the position. POSITION HOLDER POSITION HOLDER Signature..................................................................... Date....................................... Signature..................................................................... Date....................................... SUPERVISOR SUPERVISOR Signature............................................... Signature...............................................

Hospital Level

Area Health Service Level

Education Support Officer

Trainees Supervisors of Training

Directors of Departments

Area Radiology Training Group

Area Director of Radiology Training

Academic Radiologist

APPENDIX 6 PROPOSED GOVERNANCE STRUCTURE FOR THE COORDINATION AND MANAGEMENT OF RADIOLOGY TRAINING IN NSW

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Area Health Service (employment and accountability)

Area Director of Radiology Training

5 x 0.1

IMET

State Implementation Group Includes representatives from Directors Supervisors Trainees RANZCR GMCT IMET NSW Health

State Level

Education Support Officers

5 x 0.5 FTE

Area Health Service

Supervisors of Training

5 x Area Radiology Training Group, with Chair

Includes Supervisors of Training Directors, Trainees Directors of Imaging Area Health Service representative

Directors of Departments Trainees Hospital Level

Area Health Service Level

Paediatric Radiology Training

Coordinator 1 x 0.2 FTE

Director of IMET

State Director of Radiology Training

1 x 0.2 FTE Chairs the State Group

Reports to the Director of IMET