14 Mar 2018

Full-Time Advanced Trainee

NSW Health Service – The Entrance, New South Wales, Australia

Job Description

NSW Health Service require a “Advanced Trainee” in Central Coast NSW:

Advanced Trainee

Position Number

Employment Status
Full Time – Exempt

Applications Close

Local Health District
Central Coast Local Health District

Wyong Hospital Specialty

General Medicine

Sub Specialty

Public Hospital Medical Officers (State) Award

Resident Medical Officer

Current Rotations/Networks (which may change from time to time)
You may be required to work at the different facilities and locations within the NSW public health system as part of Central Coast Local Health District which includes Gosford, Wyong, Woy Woy and Long Jetty Hospitals. In addition to the facilities and locations listed above you may be required to work at different locations and clinical departments within NSW Health during your employment as may be reasonable in the circumstances which may change from time to time.

Main Purpose of Position
This General and Acute Care Medicine Advanced Training position with the Royal Australasian College of Physicians (RACP) is a leadership development role within Wyong Hospital.

The Advanced Trainee will manage their acute sub-specialty and general medical patients with advice and supervision of their consultants in order to provide effective medical services to patients under supervision, while developing expertise in medical practice, in a complex clinical environment in inpatients and outpatient areas in the public health organisation. Responsibilities include:

 Taking a leadership role in coordinating the admission, management and discharge planning of patients seen in or admitted to his / her team, and ensuring that the admission and plans are documented and communicated effectively.
 The day-to-day assessment and management of the patients in his/her team, communicating with them and their family the nature of their condition and its treatment.
 Communicating and coordinating care with their team, arranging consultation with other staff when appropriate, then arranging discharge and liaising with local medical officers and other community based care modalities.
 Communicating effectively and efficiently decisions concerning the patient(s) in consultation with their immediate supervisor and admitting medical officers.
 Participation in the afterhours and relief roster. under the supervision of the on call physician.
 Provision of a leadership role in the development of quality programs for General Medicine and sub-specialty teams. In particular, the role will have a high level of involvement in coordinating and effective handover at each of its points, and a high level of involvement in clinical governance sponsored activities inclusive of root cause analysis, coordination of the mortality and morbidity meetings for the Physicians group at Wyong Hospital, and other related investigations.
 Provision of clinical leadership in current organizational priorities inclusive of antimicrobial stewardship, hand hygiene, VTE prevention, the risk minimization of high risk medications, the introduction of a medication management plan and the implementation of the Eurotam Directive to reduce unnecessary radiation exposure to our patients.
 Provision and coordination of high quality education, supervision and support to prevocational and basic physician trainees.
 Presentation at grand rounds to a level as detailed within the section Position Requirements that follows.

Position Requirements
1. Clinical

The Advanced Trainee is clinically responsible for:

 Management and coordination of the clinical team in the diagnosis and management of the patient’s condition, including the requests for tests, medication, interventional treatment and consults. Initiation of changes to management plan with limitations set out by agreement with the Attending officer.
 Management of unstable patients and ensuring an adequate hand-over to after-hour’s medical staff.
 Assessment of all patients admitted under the team from the emergency department or otherwise, including assessment during services when rostered after hours.
 Assessment and management of patients attending the team’s outpatients clinics, under supervision, including an active role in a roster of involvement in rapid review clinics once established at Wyong Hospital.
 Communicating with the patient about his/her condition and management, or with the immediate family if the patient is unconscious or otherwise unable to comprehend or consent. Ensuring ongoing support and information to the patient, carers and family as appropriate.
 Communicating and coordinating effectively with nursing and other staff in regard to management plans, diagnostic requests, consultations and the management of unstable patients, inclusive of ensuring that a member of the team are present at the M3 bed board ward rounds.
 Ensuring that review of all pathology, radiology and other diagnostic reports is undertaken and the Admitting Medical Officer is advised of relevant results.
 Communicating any significant change in the patient’s condition to the Admitting Medical Officer and undertaking appropriate action. This may include initiating immediate treatment as appropriate in consultation of nursing staff. This may include cardio-pulmonary resuscitation of the patient.
 Ensuring that all admissions, changes in clinical condition and deaths of patients are notified to the Admitting Medical Officer and to the General Practitioner. This may require notification during normal working hours when the consultant or general practitioner is not immediately available.
 Ensuring the arrangements for autopsy, death and cremation certificates are made expeditiously and appropriate support to other staff and family is given including the completion of any incomplete documentation.
 Reviewing patients in the Emergency Department at their request or at the admitting medical officers ensuring appropriate referral to the relevant team and ensuring that the transfer of patients to the wards within four hours is not impeded.
 Ensuring the clinical team has prepared and completed all patient related documentation to ensure an effective, timely and accurate discharge plan for the patient, family and other caregivers and an adequate and timely discharge summary is provided to those involved in after care including the General Practitioner and the Attending Medical Officer. Including liaising with the bed management and patient flow teams/units.
 Ensuring appropriate liaison occurs with the general practitioner (or other primary care personnel).
 Responding to cardiac arrest, clinical review, medical emergency team and Clinical Aggression Response related calls immediately on being paged, whenever a member of these teams.
 In the case of a Clinical Aggression Response related call, remaining at this call until discharged by the team leader.
 Assessment of consults referred to sub-specialty team as appropriate with liaison and review with specialist

2. Quality and Clinical Governance Related Activities:

The Advanced Trainee is responsible for the following key quality related activities:

 Secretarial duties associated with the Department of General Medicine meetings inclusive of the general medicine mortality and morbidity meeting.
 Active involvement in departmental quality activities including clinical trials, research, peer review and audit projects. The trainee is expected to complete a minimum of two clinical audits within twelve months of commencement.
 Active management of the handover process, inclusive daily management of case load discussed at these meetings, development and improvement of the structure used within these meetings, and creation of additional tools to support the handover process.
 .


The Advanced Trainee will be required to provide supervision support to Basic Trainees, Resident Medical Officers and/or Interns allocated to his/her clinical team during normal hours as well as providing supervision support and guidance whilst undertaking duties after hours.

Some of these duties include the following:

 To perform and/or supervise junior medical staff in procedures as approved and/or supervised by the Attending Medical officer.
 Ensure that the junior medical officers complete an accurate history and examination, review management plans, investigations and action taken are recorded in the patient’s medical record including regular progress notes and arranging procedural lists as required.
 Regularly reviewing the junior medical officer on the team to ensure the management plan is carried out and outcomes assessed.
 Ensuring that junior medical officers have completed a discharge summary in the case of death, in order to provide a backup method of notification of the general practitioner. Supervision of death certificate and related paperwork when this is being completed by junior medical officers.

4. Teaching
The advanced trainee role supports the transition of a doctor in training into their specialist role, and as such a proactive approach to teaching is expected as befits a doctor that is about to achieve their specialty qualifications. The Advanced Trainee will pro-actively support, teach and watch the performance of Trainees, RMOs and interns on the team, including the active support in order to allow for the junior medical officers to attend their scheduled teaching sessions. The advanced trainee will participate in the training programs for JMOs especially Basic Physician Trainees and provide education sessions for nurses and allied health staff as requested.

The Advanced Trainee is responsible for the following teaching related duties:

 Coodination and organisation of the BPT teaching rosters ensuring specialist are aware of their teaching commitments and organization of cases for short case teaching
 The effective teaching of junior medical staff, medical students and multidisciplinary team members (e.g. allied health staff) and nursing staff.
 The presentation at Grand Rounds at a minimum of two occasions in twelve months, with an intent to increase the quality of Wyong Hospital as an academic institution according to the following expectations –
 The presentations should have at a minimum at least one peer reviewed article of relevance that is no older that six months.
 The presentation should be accessible to all clinical staff within the organization, inclusive of nursing, allied health and medical staff.
 The presentation should be at a level that allows for consultant staff present to actively learn as part of their own continuing medical education.

5. Continuing Education
 Attend at least 50% of weekly Grand Rounds and relevant Trainee weekly meetings.
 Attendance at a minimum of 50% of Mortality and Morbidity meetings.
 Obtaining and maintaining Basic and Advanced Cardiac Life Support accreditation.
 Participation in relevant college training program and exam preparation.
 Provision of evidence of continued professional development and commitment to self-education.
 Completion of College related research and presentation requirements, using these requirements in a positive manner in order to improve the reputation and quality of care of both the trainee and the District.

6. Orientation

The Advanced Trainee will be required to undertake the core mandatory orientation inclusive of both mandatory modules listed under the HETI managed program, and additional modules as detailed by Central Coast Local Health District.

7.Other responsibilities

In addition to the core competency standards, the Basic Trainee is expected to comply with legislative, policy/protocol requirements as they relate to:

 Compliance with all applicable public health organisation and hospital policies and protocols, and with applicable Policy Directives and Guidelines issued by the Ministry of Health, as amended and as in force from time to time, including the NSW Health Code of Conduct
 Ensuring that all services provided to patients are consistent with any instructions issued by your supervisor, the DPE or Head of Department or any conditions imposed by the Medical Board of Australia;
 Maintenance of adequate hospital clinical records, including completion, within a reasonable time period following the patient’s discharge, of patient discharge letters;
 Observance of general conditions of clinical practice applicable at the Public Health Organisation where you will be working from time to time;
 Demonstrating at all times courteous and professional behaviour towards patients, their relatives and other staff.

Local Background & Environment
The NSW Central Coast is positioned between Sydney and Newcastle; with a population that is expected to grow from the current approximate 350,000 to 450,000 before 2030. The Central Coast is a popular destination for holiday makers and retirees, but is also a growing center for day commuters into Sydney, Newcastle and the Hunter Valley.
Central Coast Local Health District (CCLHD) provides over 700 beds across its network facilities comprising Gosford Hospital, Wyong Hospital, Long Jetty Continuing Care Unit, Woy Woy Hospital and various Community Health Centre’s and Services. CCLHD has strong connections with Hunter New England’s physician training program and is affiliated with the University of Newcastle.
Wyong Hospital is an acute major metropolitan hospital providing inpatient, outpatient and emergency services to residents in the northern part of the NSW Central Coast. Wyong Hospital has approx. 300 inpatient beds and provides a range of medical and surgical services, and rehabilitation. Specialty services include Coronary Care, Stroke, Drug and Alcohol and Mental Health.
It is anticipated that Wyong Hospital will further develop its role as a district general hospital for a growing population with well established patient transport and referral links with Gosford Hospital for patients with a need for more complex or intensive clinical services.

Key Internal and External Relationships
Key Internal Relationships
 Patient
 The multidisciplinary team
 Specialty teams both within the Division of Medicine and within other Divisions such as surgery, geriatric medicine and Kids and Families
 Hospital Administration, including Medical Workforce and Education Unit, Nursing Administration and Divisions

Key External Relationships
 Carers, family and friends of patients
 General Practice
 Police, Ambulance and other emergency services

Supervision Arrangements
Supervision of the Advanced Trainee in normal hours of work:
 The Term Supervisor listed in the term description listed on the MWEU site shall be the considered as the directly appointed nominee of the DPE, with other admitting medical officers providing additional support.

Supervision the Advanced Trainee after hours:
 The Advanced Trainee will be able to call the Consultant on call for support and supervision after hours.

Supervision of prevocational trainees by the Advanced Trainee in normal hours of work:
 The advanced trainee will provide direct supervision of prevocational trainees attached to their team.
 The advanced trainee will provide additional support for Basic Physician Trainees attached to medical and geriatric terms as required.

Supervision of prevocational trainees by the Advanced Trainee after hours:
 The advanced trainee will provide direct supervision of prevocational trainees performing after hours duties.
 The advanced trainee will provide additional support for Basic Physician Trainees and other specialties requiring physician support after hours.

Challenges/Problem Solving
Major challenges for the Advanced Trainee include:

 Balancing mandated training and education requirements with service provision, within the limitations of a busy public health service.
 Maintaining a professional role and responsibility for patient care, in close liaison with supervising consultants.
 Working collaboratively with other staff in a multi-disciplinary team.
 Maximising the efficient utilisation of the physical resources of the Health District.
 Being flexible with the work required in a range of specialties and locations.
 Maximising the efficient use of the physical resources of the Health District
 Responsibility for supervision and teaching of more junior medical staff (i.e. junior medical officers and Basic Trainees) attached to the medical team.

Decision Making
The Advanced Trainee will have a high level of clinical independence. All patient related decisions which are clinically, organisationally or socially significant should be discussed with the consultant.

This will require close and effective liaison with consultants will allow the Advanced Trainee to demonstrate their level of ability and understanding of patient care and enable you to expand your areas of responsibility.

The Advanced Trainee is a key person who works closely with all members of staff and must:

 Deal with matters of an urgent or sensitive nature.
 Have the ability to exercise discretion, sensitivity and maintain confidentiality.
 Work co-operatively within a multi-disciplinary team environment and actively contributes to team activities including pro-actively participates in team meetings and decision making processes.
 Be accountable for supervision and teaching of junior medical officers attached to the medical team.

Performance Monitoring
The Advance Trainee is required to maintain a continued satisfactory performance and successful compliance with the requirements of the RACP training program, including progression through the program at the expected rate. Progress will be reviewed by the Admitting Medical Officer on each term

 Satisfactory progress with college requirements
 Attendance at Departmental training sessions and term meetings
 Regular Performance Evaluation & Development Review (e.g. in-training assessments)
 Maintenance of Advanced Cardiac Life Support Accreditation
 Demonstration of leadership skills consistent with this transitional role, including satisfactory leadership in quality of care related projects detailed within this document and otherwise entrusted to the advanced trainee during the period of employment.

Additional Information

Additional Documents
no addditional documents have been provided

Royal Australasian College of Physicians

Organisation Chart
Organisational Chart Advanced Trainee General and Acute Medicine Wyong 2018.docx

Job Demands Checklist
Click Here to View

Selection Criteria
1: MBBS or equivalent, currently registered or eligible for registration with the Medical Board of Australia

2: Completion of both part 1 and part 2 of the RACP Fellowship examination and evidence of continuing training since completion of these examinations. Working towards achievement of RACP fellowship.

3: Completion of at least four postgraduate years working as a medical officer with demonstrated competence and eligible to be accepted into a recognised training program.

4: Demonstrated commitment to general medicine training program and relevant experience.

5: Demonstrates ability to work independently within a supervised complex clinical environment utilising excellent clinical skills (at the required level of competency) with good clinical judgment.

6: Demonstrates leadership, teamwork, time management and problem solving skills as part of a multidisciplinary team and a commitment to quality improvement, patient safety and risk management. Demonstrated excellent communication skills (verbal & Written) and computer skills.

7: A professional attitude and flexibility in work role with a preparedness and ability to participate in after-hours overtime and on-call rosters and the required rotations both between services and geographical location to deliver patient care (including rural locations).

8: Demonstrated commitment to Caring for the Coast vision, goals and strategies, with demonstrated behaviours which align with the NSW Health CORE values and CCLHD Values and behaviours charter.

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