G Couser

Twelve tips for developing training programs for international medical graduates

Background: International Medical Graduates (IMGs) are a diverse group of doctors who provide essential health services in many western countries, and hospitals are increasingly relying upon IMGs to fill vacancies in all staff grades. Clinical skills and experience vary greatly between doctors, and orientation and clinical skills training is a way of addressing any identified deficiencies. Work done: This paper relates the experiences of establishing a training program and support services for IMGs working in the public hospital system in Tasmania, Australia, and offers advice for other agencies contemplating establishing similar programs. Conclusions: A ‘hub and spoke’ model is a useful model to adopt: a central coordinating office designs and implements programs informed by best available evidence, and clinical educators on site at healthcare facilities implement programs and provide direct assistance and orientation. Broad-based programs attending to orientation, doctors families’ needs, communication skills and clinical skills training are required. Support from health administrators is essential. Practice points Understand the practices and certification requirements of your jurisdiction. Involve IMGs with the planning and implementation of programs. Consider the needs of spouses and families. Orientation to health systems is of paramount importance.

Perceptions of the ACEM trainee research requirement: the case for improving access and enhancing the experience.

Dear Editor, The study by Mitra and colleagues regarding the ACEM trainee research requirement (TRR) provides important insights into the perceived value of the two options available to trainees: the coursework pathway (CP) and the trainee research project (TRP). A significantly higher proportion of trainee respondents rated the CP as being useful for meeting the College’s learning objectives for research, with many commenting that it is an easier and quicker alternative to the TRP. These results help explain the overwhelming popularity of the CP. ACEM data (Table 1) indicate that over 90% of trainees now choose this option, with only 34 TRPs completed in the 12 months to July 2014 (ACEM Trainee Research Committee, pers. comm., 2014). Anecdotally, many elect to incorporate CP subjects into higher degrees, such as Masters of Public Health. The resounding message from Mitra and colleague’s study is that trainees consider the TRP to be a less efficient and effective means of achieving the TRR. Other commentators have previously asserted that the bar for the TRP is set too high, thereby discouraging trainees from participating in research and disadvantaging those who do. The primary purpose of the TRR should be to meet the College’s learning objectives for research. While the College has a responsibility to encourage scientific discovery, the TRP is a blunt instrument for doing so. A 2009 review, conducted prior to the introduction of the CP, established that the overall quality of TRPs was poor. For these reasons, alternate strategies (beyond the TRR) are required to foster trainee interest in research and grow the clinical academic workforce. At a minimum, the College must comply with the Australian Medical Council standards for specialty education. These require that all training programmes include ‘formal learning about research methodology, critical appraisal of literature, scientific data and evidence-based practice, and encourage the trainee to participate in research’. Australasian critical care colleges have adopted varying approaches to meeting this standard. For instance, all trainees in intensive care are required to undertake at least one formal research project. In anaesthetic training, the options are performing a clinical audit or critical appraisal, undertaking a postgraduate degree in research or contributing to a research project culminating in publication in a peer-reviewed journal. ACEM’s current approach is laudable because it gives trainees choice. While Mitra and colleagues have established that the CP is the preferred option of trainees, accessing recognised courses is not without challenges (mainly related to time and cost). For this reason, concerted efforts should be made to both improve access to the CP, and enhance the experience (and therefore attractiveness) of the TRP. Cost subsidisation is one mechanism of meeting the former objective, and might be achieved through partnerships with local universities. Given that EM trainees frequently provide voluntary teaching and supervision of medical students, universities could recognise this by subsidising