Medicopolitical

Flexible Advanced Training for rheumatologists to expand


A Flexible Advanced Training program to help rheumatology trainees manage conflicting work-life demands will be expanded to include basic trainee physicians and a second Sydney hospital.

The go-ahead follows a successful pilot at Concord Repatriation Hospital in Sydney’s inner west, which allowed two rheumatology advanced trainees returning from maternity leave to work 2.5 days per week each as of February 2020.

Dr Bethan Richards, Director of Wellness at Sydney Local Health District and Head of Rheumatology at Royal Prince Alfred Hospital, told the limbic that the outcome was a “win-win situation” for trainees and the health system.

“The two additional rheumatology advanced training positions at Concord will be continued as two separate jobs, and we are preparing to adopt the model for basic physician trainees at RPA,” Dr Richards said.

“We also discussing with surgeons how this kind of approach can be operationalised for them.”

The program co-ordinators, led by Dr Richards and Associate Professor Ananda Ana, Head of Rheumatology at Concord Hospital, say in their report that the model could be applied to “any trainee with a need to work less than full-time”.

Despite the disruption of COVID-19, which affected trainees’ ability to sit exams and examine patients, the two additional rheumatology roles at Concord helped the hospital expand its clinical delivery and teaching functions.

Flexibility and independence

Their report published in Internal Medicine Journal says the pilot’s success hinged on the creation of two independent part-time positions tied to department education, clinical and trainee needs, rather than a job-share arrangement.

The Concord Hospital program did not require a trainee to be present during all business hours. Rather, overlapping rosters allowed them to attend weekly departmental meetings and education, which helped improve the model through the year.

“In our case the flexible training positions were additional to existing staff, yielding more flexibility with the hours required to be onsite,” the report says.

The two added positions enabled registrars to take part in two subspecialty clinics (osteoarthritis and psoriatic arthritis) in which the respective advanced trainees undertook specific patient-centric research.

The advanced trainees also provided extra cover for sick leave and RDOs, enabled a basic physician trainee placement during restructuring related to COVID-19, and contributed to teaching of medical students, basic trainees and simulation-based teaching of management of confirmed or suspected COVID cases.

The program recognised that while hospital-based training has focused traditionally on inpatients, rheumatology advanced trainees would work primarily to provide ambulatory care in the community.

“Shifting the primary focus of this training position to outpatients better matched the workforce demands currently required in rheumatology,” the report says.

And despite minimising face-to-face consults as part of its COVID-19 response from April 2020, the department saw increased patient numbers and recorded no unrostered overtime claims in the clinical year. Increased rebatable outpatient services made the new positions cost neutral.

Key outcome

In what the report calls the key outcome, the two advanced trainees in the pilot scheme reported high satisfaction with their work arrangements.

They met sub-specialty training requirement milestones while raising very young children, the regular hours of outpatient clinics let them collect children from childcare on time, and, notably, they “didn’t have to choose” between work and parental responsibilities.

“While young mothers might seem the best fit for this model, any trainee with a need to spend less than full-time at work can benefit,” the report says.

Candidates could include medical trainees with elder-care responsibilities, major interests in sports or the arts, or family illness; and elements of the model could be adapted by specialties with a major outpatient or procedural focus, particularly those with predictable timetabling.

The report authors said flexible training appointments need to be determined in parallel with full-time appointments, noting a danger that they could be viewed as poorer options or steps towards full-time positions.

“This pilot suggests that flexible positions can be designed to harness existing training opportunities and enhance clinical departments,” it concluded.

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