General medicine

Good evening. So this is a session primarily designed for people who are contemplating starting general medicine advanced training in 2027, so it's an information evening. My name is Spencer Toombes. I'm a general physician and currently, for my sins, the acting director of medical specialties at Toowoomba Hospital.  But I'm also one of the medical directors of physician training for Queensland Rural Medical Services or Queensland Medical Specialty Training.  We've got a few different acronyms for this crew, and we run a general medicine advanced training network.  I'm going to spend some time this evening telling you about it.  I'm very grateful to Ange Wieser, who's with us as a key organiser for the network from Queensland Health. And we're also fortunate to have Dr. Kate Raine, who is one of our senior general medicine advanced trainees, dual training in geriatrics.  In fact, completed dual training in geriatrics, I should say, specialist geriatrician and general medicine advanced trainee at Toowoomba Hospital, and she'll be jumping in to speak a little bit later about the benefits of regional training and also to give you an idea of how she has entered and achieved the dual training space.

There will be opportunity for questions as we go along. But to kick us off, we will start with an acknowledgement of country. So I would like to acknowledge the traditional custodians of the lands from which we are meeting today and to pay our respects to elders past, present, and emerging, recognizing their continuing connection to land, waters, and community, and also to state overtly both The College of Physicians and  Queensland Health's commitment to the health, wellbeing, and medical education of Aboriginal and Torres Strait Islander people.  I'm coming to you today from Toowoomba, where we're on the lands of the Jarowair and Giabal peoples.

Okay. So let's jump in and tell you what we're going to be doing over the next hour.  I should probably point out, again, just the usual niceties.  Make sure you know where the exits are. Please make sure that your microphones are muted unless you are overtly asking us a question. There will be some key points where we'll stop and invite questions from the audience. I can't see the chat easily while I'm hosting the presenting screen, so we'll negotiate that as we go along. And of course, we are recording tonight's session, and this will be uploaded to the Queensland Health General Medicine AT website for others to review later. So what are we going to do? Tonight, hopefully, we will give you an introduction to general medicine, advanced training in Queensland, how it works, what the network's up to. I'll talk a little bit about The College of Physicians' training requirements for gen med, general and acute care medicine, and then we'll talk about how you navigate the network.  Dr. Raine will talk to us a little bit about regional training and also the way she has chosen to navigate the network.  And then we'll cut back and outline the application and selection process that Queensland Health applies to prospective trainees. And we'll certainly have the live chat window open.

Feel free to type some questions in there. There'll be pauses where you're welcome to unmute your microphone and ask us in person.  All right. So let's talk about general medicine.  It's actually really hard to define what a general physician is and what general physicians do. And even when I sit down with the Internal Medicine Society of Australia New Zealand group or look on their website or chat to the college people about curriculum,  we tend to define ourselves negatively in terms of what we aren't, rather than positively in terms of what we are.  And essentially, we are specialists, we are highly trained,  and we provide non-surgical healthcare to adult patients, usually difficult,  serious, unusual, or complex medical problems.  And we continue to see those patients until we have resolved or stabilised their issues. While much work occurs in hospital settings,  and you've undoubtedly already encountered that as basic physician trainees,  you'll come to realise that many general physicians work and consult in outpatient clinics or in private rooms and private hospitals.

The thing that really differentiates generalists from the subspecialists, or we say single organ doctors, is the breadth of expertise. We choose not to limit our practice to a single body system or a narrow field of knowledge. And what this means is that we have to become experts.  Experts at diagnosis, at providing integrated care, at solving problems, at being advocates for patients, being good communicators and negotiators,  innovators, system leaders, teachers, and mentors.  And this list of factors comes from the college's advanced training curriculum, and it's pretty aspirational. We're going to be experts in all of these domains.  But it doesn't miss the mark by much, and most general physicians will find their work involves these aspects.

The other thing is that we have to become experts at undifferentiated medical problems and also at taking the specialist opinions of our subspecialist colleagues, which sometimes conflict with each other, and then curating those for an individual complex patient and  helping them find their way through the complexity to a  negotiated destination.  So where do you find general physicians? And the answer is there's a really wide spectrum of practice.  We do lots of things. And so in regional hospitals, where I work and where I've trained, you'll find individuals who are flying physicians who hop in planes and go to tiny communities and do outreach medicine, and that's very popular from Cairns in Far North Queensland and from Townsville in North Queensland.  Around the country, you'll also find solo physicians who live in regional towns or even remote communities, some in the Northern Territory, certainly some in North Queensland. And they will usually have a community of practice with a larger regional hospital, but they provide care for some very isolated people.

Where I work in Toowoomba, general physicians look after general medical inpatient units. A different group of general physicians run our medical assessment and planning unit. But here we have general physicians who are on the endoscopy roster doing endoscopies and colonoscopies, participating in the after-hours stroke reperfusion roster. When COVID was a separate specialty, the general physicians were the COVID physicians. But we also do perioperative medicine, obstetric medicine, and contribute to specialist clinics in rheumatology and respiratory medicine. And a couple of us are departmental directors. In other parts of the state, I'm aware of general physicians contributing to dermatology, to infectious disease, and potentially prescribing chemotherapy or providing bronchoscopy for patients.  Metropolitan hospitals, you think, oh, well, it must be all very bland down there, but in fact, it isn't, and you'll find metropolitan general physicians in acute medical units and MAPU doing perioperative medicine. And that's certainly very popular in the private hospital setting, but also providing hospital in the home or residential outreach, participating in hospital admission prevention programs, running complex patient  or multi-system disease clinics.  And then certain of my colleagues, some with just niche expertise and many of them with dual specialist training, will do clinical pharmacology  clinics, de-prescribing. They'll look after lipids. They'll do epidemiology.  They'll be part of clinical decision-making units. And a number of us are in health information systems and change management. So it's a wide spectrum of practice, both regionally and in the southeast, and it requires a complex and very diverse set of skills.  And so if you look at that from the perspective of the College or indeed from Queensland Health or from our network, the challenge for us is how do we ensure that when someone graduates from the process, finishes their advanced training with a fellowship, how do we know that they can do any or all of these jobs? How do you train someone for these roles? And the question is, where are they going to train? Where are they going to work? And so for you, I would like you to actively consider the question, where do you want to work? Recognising that there are relatively competitive jobs in the metro. There are certainly enormous workforce pressures and needs across the state in regional Queensland. And if you're going to train, you will find training positions and training workforce needs across the state where you have the capacity to acquire the skills that you need to do these jobs.

All right. So for Queensland Health and for training in general medicine and acute care medicine in Queensland,  these are the key players. And you'll see, obviously, the, at the core of it is you, the trainee. But you need  to train in a system and that system and the accreditation of the training and the signing off of the components of training,  the person who dictates the curriculum and what training needs to happen, of  course, is the General and Acute Medicine, uh,  Training Program Committee of the RACP.  And then you need a job, and that job will be provided by a hospital, and those hospitals are almost all Queensland Health organisations, but there are certainly a small number of hospitals, certainly, Greenslopes and, Mater in particular, but some others,  that are private or non-QHealth hospitals that are going to give you a contract and employment and a supervisor and pay you while you train.

And then the interface in terms of working out where the jobs are, ensuring that the, uh, selection processes are fair and transparent and equitable, uh, and that the education is consistently  applied and supported. Well, that's the job of the network, and all of these parts interact with each other.  So let's quickly talk about the College training requirements.  What does it take to become a general physician? And this can be kind of difficult to work out, particularly as the College of Physicians' website is legendary for its impenetrability and the challenges involved in getting information out of it.  To complicate matters, the College has developed new curriculum for pretty much all of their training, and that includes general medicine.  That new curriculum has kicked off this year. So the first year gen med advanced trainees this year are on the new curriculum, and if you're applying afresh, that'll be you too. So how do you find out about it? Well, if you click on the College website, you can find a button that says Trainees and then Advanced Training and then New Curriculum, and that gets you to a site which lists all of the subspecialties.  When you tap the button, New Curriculum General Medicine, you get this page, and it's quite busy, and if you click the wrong thing you can find yourself in a world of complicated curriculum elements, and particularly the entrustable professional activities and bits and  bobs. The bit that I think is most helpful when you are trying to plan your overall training is this thing, the learning, teaching, and assessment program, which is towards the bottom of the webpage. And when you click on that, it pops open a PDF that you can download and keep for later. That talks about the kinds of terms that you need to do, what they need to look like, what rules the College applies to training in both Australia and New Zealand. And that's a good read, and I commend it to you.

Just to distill a couple of slides, from what it contains to explain. Overall, advanced training will take you three years. There is an absolute push to what we call competency-based training, and in fact, the assessment and factors of this training are all competency based. But it's a hybrid model, and we still use...  or the College still uses time in training as one of the markers of experience and as a sort of substitute, for pure competence. The idea is that you do three years of six-month terms, so a total of six terms. You can count a term of more than four months as a core term, and if you are working part-time, then you need three months full-time equivalent to count a term. Of your three years of advanced training, two years are required to be what  we call core terms. Twelve months of those are supposed to be spent in core general medicine. There's a verbose definition of what core general medicine looks like in the training handbook that I've shown you on the previous slide.  But essentially, that's a general medicine job, working in a general medicine unit, looking after general medical patients, supervising junior doctors, reporting to a general physician.  So that's one year, two six-month terms.

You also need a six-month term in a core subspecialty. So this is a subspecialty that is not general medicine, and you need six months of core something else, and that something else might be more gen med, or it might be a different subspecialty. You've got plenty of flexibility there.  At some point in the three years of advanced training, you're also required to do a high acuity term, and the high acuity term, again, is defined fairly clearly in the handbook.  But essentially, you need to demonstrate your ability to manage unstable patients and to make decisions in a time-critical manner. And so clearly, a term and an intensive care unit would be a high acuity term. But there are a number of stroke reperfusion jobs,  a number of coronary care unit type jobs, even a number of medical assessment and planning unit jobs, particularly if you're helping to manage monitored patients  or non-invasive ventilation,  which would meet the criteria for high acuity.  Now,  obviously, you've got two years of core training and one year of non-core training. Really, really important to emphasise that non-core is not the same as unimportant or irrelevant.  The non-core training is there, and it's called non-core training  primarily so that you have the flexibility to craft the training that you need to meet your learning needs to turn into the kind of  general physician that you want to be.  And so that non-core training might include your mandatory six-month high acuity term. It might be a whole year of acquiring a procedural skill,  like point-of-care ultrasound or echo or endoscopy. It might be an extra six months of a core specialty that you're particularly interested in, or, if you're going to be a dual trainee, it can actually be a whole 12 months of your dual training specialty, and we'll talk a little bit more about that now.

When we come to the issue of dual training, dual training is tricky because you've got to get a lot of training to line up to achieve it in the four-year minimum. And in fact, many people don't get all of their terms to line up, and it takes them more than four years, and that's okay if time is not super important to you. It's also important to remember that there are a couple of RACP specialties, specifically cardiology and nephrology, that require three core years of training for their subspecialty. And the result of that, if you're going to dual train in one of those specialties, it's going to take you five years rather than four years to achieve your outcome. Essentially, the way this is designed to work is that the non-core year of your general medicine training overlaps with a core year of your dual training specialty.  And if you can achieve that overlap, with planning and attention to detail, then you can achieve all of the requirements for both specialties, the general medicine and the additional subspecialty, in four years. A couple other quick things to say about this. The first is that the training program committee for general medicine regards some things as the same. So for example, they regard gastroenterology and hepatology as roughly the same thing. They regard sleep and respiratory as roughly the same thing. I fully appreciate that they are appropriately separate specialties. But when you are choosing your additional specialty in general medicine, the goal is to do something that is different to your dual specialty to give yourself breadth of experience as well as depth of  experience.  It's hard to get it right.  But a lot of people do dual train and enjoy it, and come out with a very unique skill set that makes them extremely valuable to Queensland Health and indeed to the regional or metro hospitals where they find themselves.

All right. A couple of other considerations just in terms of planning your training, and this is certainly designed to be a big picture look rather than a narrow focus. Both the College and the network strongly recommend that you train in a minimum of two hospitals, and I would argue you should also train in hospitals that are different to the hospital that you did your basic training in. Medicine is a very broad church, and people do it very differently in different places. And having experience of different supervisors, different ways of doing business, different ways of management, it's actually incredibly valuable and useful. And this unfortunately does mean a little bit of travel, although there are plenty of hospitals within driving distance of each other that make this straightforward.

The next is night shift. So the vast majority of Queensland Health hospitals do not require advanced trainees to do night shift.  But the College will let you have a very small amount of it if you're working in a small centre that needs you to help out from a workforce point of view. You can get a few weeks of nights in without losing your training. An exception to that, obviously, is intensive care units, which usually run rostered night shift for all of their registrars, and that counts as core training from the College's point of view.  There are also one or two hospitals that use an evening roster or even a nights roster with a specific advanced training role as sort of the overarching controller and the manager of the hospital at night.  And a number of those across the country have been accredited as core training, although the College is watching that very closely because it's got to be more than just scut work, and it has to be appropriately supervised and appropriately trained.  What are you going to do for assessment? Well, the new curriculum requires you to do a learning plan for each rotation, and then through the course of a 12-month year, to do one learning capture and observation capture for each year or phase of training. Those learning captures are something that you do when you reflect on learning  within your term. The observation captures are things that your supervisor or occasionally a different supervisor or a different part of the ward care team will do, documenting your skills. There are also formal supervisor reports, which you do one every three months, and an advanced training research project that needs to be done at one point in the course of your three years.

Although, the College is busy reimagining what that's going to look like and also making it clear that if you have done a research master's or a  PhD or something along those lines, you can certainly claim recognition of prior learning for that.  You're not required to do further research.  While it's interesting, you find that people who have already got a PhD tend to like their research and they'll crack on and do some more, more often than not.  All right. So it's a lot to take in, a lot to think about, but the fundamental thing is that you have to plan your training.  And we're going to repeat this phrase about planning training a number of times more through the course of the next half hour.  But you need to think about what sort of physician you want to be. You want to think about where you're going to work. Where are the jobs? How are you going to acquire one of those jobs? What skills will you need for that particular environment? And what training pathway is going to help you acquire those skills? And what places are you going to acquire those skills? And then you bring that to the network and say, "This is where I want to go. This is what I want to do."

All righty. So I'm going to hand over now to Dr. Raine, because she's got a couple slides to talk to you about regional training. And then after that, we're going to pause for some questions.  Perfect. Thanks so much, Dr. Toombes. So, hi, everyone. I am Kate. As Dr. Toombes said, I'm a geriatrician and final year general medicine advanced trainee.  As an intro, I did my training, my advanced training, so this is now my  fourth year. I did it across three different hospitals. I've done some time in Toowoomba, and I've done time in Brisbane at two different tertiary centers.

All righty. I don't think I managed to steal control from you, Dr. Toombes.  Perfect. Okay. So my talk, I guess, when we think about why you might want to do training in a regional environment, there's sort of a number of reasons, but I guess we'll look at three real main themes, and that's what benefits does it have for your training as a general medicine trainee? What benefits can we find for your longer-term career? And then what benefits are there for you in your personal life? So if we go...  And of course, I'm going to scatter photos of my experience in regional and rural life throughout.

And so this is Toowoomba in spring, one of the beautiful benefits of training in a regional area. So if we start with your general medicine training, I think one of the things that really stands out when you train regionally is that you get that in your core Gen Med term. You get really true general medicine, because you're dealing with undifferentiated patients where you don't have every scan, every test, and you also don't have every subspecialty involved.  And so the patient's admitted under your bed card in general medicine in a regional environment, are not just maintenance patients awaiting nursing home. They are complex, undifferentiated patients, where you get to do the really heart of Gen Med, as Dr. Toombes explained in that sort of definition of a general physician. I think you really experience that regionally.  Lots of late presentations and presentations from different populations leads to interesting medicine and medicine that you don't necessarily see regionally. Particularly if you train up north, you get exposure to tropical medicine and indigenous medicine. And then some of the rotations you can have access to can be different as well to metropolitan. And so your outreach rotations, your fly-in fly-out clinics are all available as you go more regionally. And then speaking of outreach, if you click again, this is less than 20 minutes from my home. Lovely views. Easy to get to. Yes, they are some views metro, but rurally, I think takes the cake.

All right. So next, we're going to think about your career, so longer term. You've got through training.  How are you building this training to meet your needs longer term? And so regionally, you're working in a small hospital with smaller teams, and so your supervisors, they really start to see you as a future colleague.  You're not just one of many advanced trainees, you're one of a handful, and so that peer relationship is really valuable. Again, because it's a little bit smaller, there's more access to some teaching and committee exposures.

One of my colleagues who trained up in Cairns got to help organise the IMSANZ conference, which you wouldn't necessarily get access to working in a bigger centre. Dr. Toombes will talk shortly about the GMATS scholarship program, but certainly there's opportunities regionally to work as a senior AT and to gain some of those proceduralist skills that he's been talking about.  And then even if you don't want to work long-term regionally, having some exposure to regional medicine can be really useful to help you  understand the challenges faced with regional medicine, which is often a sneaky interview question, and so having some insight into  that can definitely be useful.

Now, thinking about the challenges of rural medicine or regional medicine. This is the road that I take from my house to the hospital, that not infrequently has a very cute cow escaped from the paddock.  And I think I put the photo of the birds in as these are some of my colleagues that I get to hang out with if I'm working from home.  All right, so personal benefits. Regional lifestyle, I think has a lot to offer. So, commute, cost of living  are all a little bit different to metropolitan.  Your workplace culture, as I've alluded to, a smaller environment, all peers, more personal is amazing. And then that transition to consultancy and leadership. So, we're all thinking about long-term, where do you want a job?  And finishing your training or spending some time in your training in the hospital where you wish to, hopefully end up with a job long-term, is really valuable. And certainly, we know that the regional  environment is a growth area, and there are jobs  for general medicine physicians regionally and rurally.

So, those I think are all my thoughts and things to think about. I think I've got one last slide.  Personal benefits, plenty of dogs regionally, plenty of room for your fur babies to run. And then, so the final slide, I was like, what will be the slogan for general medicine? I thought, regionally, you get real general medicine, you get real opportunities for your training, and there are real benefits to you long-term. So I've got the standard photos.  These are photos from colleagues who've done this talk in previous years who've worked up north. So, some flying doctor outreach clinics, the classic reef and waterfall, and then the last one's a photo of Toowoomba, the sunrise.

Yeah, happy to take any questions about regional medicine.  I've spent plenty of time metro, I've spent plenty of time rural, and regional is where I choose to make my career and my home.  Thanks, Kate. And in fact, we're just going to put a question slide there. So, this is really the bit where we've talked about what training looks like and what regional training looks like. So any questions about how the college works? Any particular questions for Kate about how she finessed geriatrics and general medicine training into her four years? Any questions about the regional hospitals, now's the time to probably jump in with those.  If I can make the chat window work. I think the cat looks empty to me. Window is empty and nobody has unmuted, so I think we're just going to keep going, and then we'll obviously pause for some more questions at the end.

All righty. Thank you, Dr. Raine. Next, so we need to go down to the talk, don't we? Too many buttons, too many screens. All right. So let's quickly talk about the Queensland Health General Medicine Advanced Training Network. So, the network serves a whole pile of purposes. Some of them are related to the needs of the hospital, some of it's related to the needs of continuing trainees.  But for you as new trainees, the fundamental thing that the network provides is a centralised, essentially transparent, criteria-based, multimodality rank-order, and allocation process for trainees who are trying to step onto general medicine advanced training.

Each year, we allocate approximately 60 new positions.  The number's a bit variable, and the reason for that is that general medicine's one of these sort of flexible things where people will flex into and out of our positions when they are doing dual training.  Some of them will flex in and out of our positions from overseas, New Zealand particularly, or from interstate. But yeah, we usually wind up allocating between 50 and 60 new people into jobs each year and moving additional players around the network into appropriate training places.  So again, we come back to the issue of hospital and term places. So the hospitals will allocate terms, but the network will allocate hospitals. And as a network trainee, you need to plan your training. So on our network webpage, again, you can find us very easily at the careers.health.qld.gov.au  website or just punch General Medicine Advanced Training in Queensland into your favorite search engine, and we're usually the first click on the list. But each of the hospitals that are accredited for general medicine training, and I'll pop a list of those up in a couple of slides' time,  have a page in a document that lists the terms that they have available, and some of those are obviously likely to be general medicine core terms, some are general medicine-like terms, and then a bunch of them will be subspecialty terms or other things.It's important to recognise that we've got over 100, 120 trainees cycling through the system at any given time. And so potentially coveted positions, maybe a particular procedural training position or certainly a general medicine position at a large metropolitan hospital, there'll be more than one person applying for that position. And it's important to understand that trainees who are already on the pathway are placed into positions first, but that individual hospitals need to balance up the number of first-year advanced trainees they have versus their second and third-year trainees.  And for this reason, both in order to clarify your training plans, but in order to clarify what terms are available at the hospital that you're putting on your list, we ask you to have a conversation with the departmental directors of the hospitals that you are interested in working at. And that is a conversation. It is not a job interview. It is not a pre-screening process, but is an opportunity to talk about your training needs with the departmental director to make sure that those terms are potentially available to you in the year that you want them. And if they aren't, to make plans to come back to them in a subsequent year.  Alrighty, so that's the term placement and the term moving around.

What else does the network do for new trainees? We provide a thing called the Queensland Internal Medicine Education Program, or QIMEP. Many of you, if you've been basic trainees in Queensland already, will know about this because you come to it every fortnight on Wednesday evenings. But the QIMEP program and the QIMEP committee is a registrar-led training program. It's there to be practical and clinically relevant, to give you professionalism and training-related topics.  For example, we'll often do a QIMEP talk every year or two on how you get a research project done, or how you do leadership or communication within a department in addition to clinical topics from generalists and from subspecialists. But the topics are chosen by registrars and then presented for registrars by usually subspecialists.

The other thing that we want to bring to your attention is this General Medicine Advanced Training scheme. So this has been going, in fact, for longer than the network has been running. But Queensland Health provide a small, but nevertheless rich funding pool, which allows us to provide up to five positions per year for final-year trainees to have supernumerary funding. And so maybe you really want training with an echocardiologist at The Prince Charles, or maybe you really want to do some outreach endocrinology with an endocrinologist in Cairns. And those positions are not usually available for general medicine trainees, but if you turn up with your position funded, you'd be amazed how many departmental directors can make room for you and can help you to craft a bespoke training program for your own needs. And so the idea is that you think about this in your first year of training. You apply for it towards the end of your first year of training. You tee up a two-year mentored program, and you get that supernumerary funding for the final year.

The other thing that people often use this for is a junior consultant role as a final-year trainee. It pays for you to be sitting in that interface between the basic training registrar and the consultant. Annually, we'll advertise this. People apply for it. We've got a small judging panel that decides where the money is going to be spent. But it's been extremely valuable, and a number of graduates have got little bios on the website, so you can have a look at what that involves. Another quick mandatory conversation about flexible training. So clearly, flexible training is supported both by the College of Physicians and by Queensland Health. It's incumbent on me to point out to you that it is hard work to do flexible training because with this hybrid of competency and time-based training, if you are doing a fractional appointment, the duration of training that you need to meet the college's requirements will be prolonged, and that can be hard work.

I previously said that some hospitals were better than others at doing flexible training, and there's probably a little bit of truth in that still.  But it's fair to say that there are some hospitals that are very experienced at providing a bunch of different flexible roles.  But pretty much every hospital in Queensland now, and certainly our goal is to make sure that every hospital in Queensland is able to meet the flexible training needs of both basic and advanced trainees. So we're doing it, and we're progressively getting better at it.

So I'm going to jump over that question slot and just move straight on to talking about how you apply for general medicine advanced training.  So this is the RMO and Registrar campaign, or Queensland Health RMO 2027,  will be opening in just a few short days,  and then closing, or the room for applications will close  at the end of June.

The application process is accessed through the careers.health.qld.gov.au website, and I presume that many of you are already familiar with this website and its many iterations and frustrations. Nevertheless, a guideline for which buttons to push and which things to slot in is also provided on our part of the website. But essentially, you say yes to applying for a position on the General Medicine Advanced Training Network, and then there'll be a series of questions that you are asked to complete. You will be asked to upload evidence of planning for general medicine advanced training, and that involves a curriculum vitae, a short statement, which both allows you to indicate your plans for training, but also to address the key selection criteria that we are looking for when we are selecting advanced trainees. And we're asking you to fit that into one A4 page because brevity is the soul of wit.

We're also asking you to upload a separate statement or attach to that statement if you have rural origin or rural clinical experience because Queensland Health, and the College of Physicians are incorporating, essentially, selection criteria that incorporate rural origin and rural clinical experience as an advantage for people entering training on our program.  And there's research that shows that this is a good idea, and it's been endorsed by the committee of chairs or presidents of specialist training colleges in  Australia.

Alrighty. At some point in the process, in fact, it's step seven, you'll be asked to preference up to six hospitals that have general medicine training, and we ask you to only preference hospitals that you would be willing to work at if a position was offered to you.  And then it is critical that apart from just filling in the paperwork, that you have a conversation with the listed contacts, which is usually the director of general medicine at your top three preferred hospitals, and also with the director of general medicine at the hospital that you are currently working at, because they are often one of the people that you'll be using to provide a referee report.  Where can you train? As I said, we've got approximately 100 positions across Queensland hospitals that stretch from Cairns in the north down to, well, probably Gold Coast in the south, by the time we map it out on the latitude. Bundaberg Hospital has an application in for accreditation. We're waiting for that outcome, but all these other hospitals have accredited training positions. Just pointing out that both the Mater and Greenslopes are technically not Queensland Health hospitals, but we have a process for continuity of employment with Queensland Health when we use those individual places.

Now, dual training gets a bit of press. So back in the rush of misery that was COVID,  we had a period of time when our interview capacity was being sorely tested, and at that time,  we made it clear, and indeed you will be aware that there are some specialties who are unlikely to consider application if you don't apply for them as your first preference. Now, clearly, if you're applying for general medicine with geriatrics, palliative care, clinical pharma, or obstetric medicine, or as general medicine as your first preference, then we will undertake to find interview capacity. Now, if you are another dual training subspecialty, and it's not listed there, and you put general medicine in as your second preference, then we are very happy to interview those individuals. But if we do not have sufficient interview capacity, then those people will be shortlisted, and only offered interview if we have capacity in merit order. Now, if you are already on a dual training specialty and you have finished that training and you are now ready to dual train in general medicine, clearly you can put general medicine as your first preference and we will guarantee you an interview, and that's how we're working it as best we can.

Alrighty. You will need to nominate two referees. Ideally, one of them will be the director of general medicine at your current hospital. They certainly need to be people who can comment on your skills and experience and who have worked with you directly in the last 12 months.  As with any referee, please check with them for permission first, check the spelling of their email address, and make sure that they are going to be in town between June and July when those referee reports need to be submitted through the Queensland Health  process.  And then we will undertake a selection process. It's multimodal.  We assess your referee reports. We assess your curriculum vitae. We assess the short statements, and then we generate a multiple mini interview format, which we've been doing multiple mini interviews since before the basic trainings were doing them, but we've moved it to an online format since 2020 when COVID made it difficult for everybody to get down to Brisbane and do the speed dating in person.

The two interview dates for this year will be Tuesday and Wednesday, the 18th and 19th of August, and you will need an hour, probably 90 minutes, by the time you get in and get out of that process.  And you'll need a quiet place with a computer and a stable internet connection in order to undertake the MMI.  The selection criteria, and again, I don't need to read these out to you, but they are listed here, and they are listed overtly and separately on our recruitment website. But essentially, you need to be committed to general medicine.  You need clinical expertise, good communication, teamwork, leadership, management skills.  We're interested in research, but we are equally interested in quality improvement and teaching and a commitment to the wellbeing of medical students and juniors, and we're looking for high standards of professionalism.  And when you look at those criteria, they will be very helpful to you when you are generating your short statement, thinking about how to frame your CV or indeed planning for the  interview questions.

Once that process is undertaken, and in fact, very shortly after those interviews are completed, we rank order and merit list our candidates. We allocate the current candidates, and then we allocate everybody else to employing hospitals, and then that individual employing hospital arranges employment contracts, and we'll talk to you about your term allocation. And again, this is an opportunity to reemphasise that we support flexible work practice, including part-time employment and job sharing. So if you want to be considered for this, make sure that you have indicated it in your application so that we know what we're doing with your allocations.  All righty, we're nearly there.  But these are the key messages from today's talk.

The first is to think about what advanced training looks like and to plan it. Secondly, communicate your intentions to the network and to the directors of advanced training in the hospitals that you are applying for. Read and consider the selection criteria before you put together your application. And I, as a person who has trained regionally and who currently works regionally, would strongly urge you to consider both a regional training component and regional career component as you go forward.

And that leaves me to talk about questions. Now, I see a question has already popped up in the chat, so let's quickly look at that.  So first of all, is it possible to start advanced training mid-year, e.g., if you have done a resit on the clinical exam and passed and you've already completed all the phases of training for basic training?  The answer to that question, Patrick, is yes, absolutely. However, we  like you to have applied to The Network.  So obviously, both the clinical exam and the network  selection process should both be finished before the due  date for mid-year applications to the college. And so the directors of general medicine across the state, if they are talking to you about slotting you into advanced training mid-year, will be talking to you about sitting and being successful in our selection process. But yes, if you have a job that is compatible with advanced training, you have the permission or the encouragement of your local DPO, local director of general medicine, and you have passed our merit-based selection process, there is nothing to stop you from commencing training mid-year.

Are there any other questions? And at this point, feel free to type them in the chat or indeed to unmute your microphone and jump in with a whole verbal question. I guess I've got one that trainees might be thinking of off the back of Patrick's question.  Because we now have the written exam that is out of sync as well with the October sitting, can you have an accredited Gen Med AT term accredited by the ATC, not on a network, and then join the network the following year, so that you only need two and a half years of network time? If that makes sense. Yeah. We would much rather, and in fact, both we at The Network and the College would much rather, that you have a selection process that is defensible. And that's why for mid-year... And it's convenient for us because both our selection process and the mid-year entry fit together from a time perspective.  We do obviously make allowance for trainees who  have potentially come back from flexible training arrangements or extended  leave, or trainees who are moving from interstate or from another  country.  And again, to try to keep the playing field as fair and as even as possible, the directors of general medicine have a set of guidelines that they try to apply uniformly to those individuals. But fundamentally, the idea is that unless there's a good reason for not being able to sit the network process, we want you to have been selected into training before you commence advanced training.

Yep. All right, another question there. Do you need to reapply each year after the contract expires? No. So the idea is once you're in the system, we only select you once. And I guess there's a subpopulation. So if you are already training, then you will be asked to nominate the hospital that you want to work at next, and that will happen through the RMO campaign. But you'll also need to have those conversations with directors of general medicine to make sure that the jobs are available, that they have the terms available to meet your training needs. And we do allocate all of those trainees before the new trainees on the system are allocated.  We do get the circumstance where people apply successfully for general medicine and then they are offered the dual training specialty. Suddenly there's a neuro position or a geriatrics position somewhere.  If you decide to commit to that geriatrics...  Or commit to that, I'm being very specific, aren't I?  If you decide to commit to your dual training specialty, obviously, you're not  going to be a general medicine trainee for that first 12 months.  We can use your old score from your previous year, or you can choose to resit the interview if you want to redo your score. So yeah, we don't require you to re-interview.  You may choose to re-interview if you're moving back from a dual training  specialty.

Are there any specific requirements for the two hospitals? No, there are not. So, the idea of two hospitals is to give you a breadth of experience and the breadth of experience is the goal here. If there was some very specific moral or practical reason why you had to stay in the one hospital, and I can think off the top of my head of a couple of trainees who were thoroughly socially connected to the Cairns or the Townsville environment, it was going to be very difficult for them to move to other hospitals.  Both the College and the network are happy to be flexible around that. So it's not strictly speaking completely compulsory to move, but it's certainly strongly encouraged. And similarly, there is no compulsion if you're bound to a metropolitan space by ties of blood and pets and children at school or those sorts of things.  No one is going to force you to go regionally. And we probably don't have enough regional places that every single person could be forced regionally. Nevertheless, there's a carrot here rather than a stick. The regional hospitals have jobs. The regional hospitals have really interesting medicine.  And even if you are going to be a long-term metropolitan doctor, there is still  a good argument for taking a year regionally if you are socially mobile  enough to do that.  We think it's good, but we're not going to compel you to do it.

Pretty good questions so far. Any other burning questions? I would imagine there aren't because you would've typed them already.

I'm happy to answer questions on fitting dual training into four years as well as Dr. Toombes.  Yeah. Actually, that's a really good question.  Kate, did you do it in four years or did it take you a little bit longer? No, I did do it in four years. Good on you. It needed, as you said, a lot of planning, and I think I was talking to directors for my hospital in three years' time to make sure that the terms I needed aligned.  I also did the palliative care diploma in that four years, so that needed some stars to align as well. But it's possible.  But you do need to sit down with both curriculums and both rotation requirements and make things match. I was lucky that I could make my high acuity Gen Med. That high acuity requirement was one of my Gen Med related terms, so I managed to fit that in. If I couldn't, I would've probably sacrificed the palliative care term for, say, an intensive care term, but I did that as a basic training, so I wished to go a different way. So yeah, it's very possible, but you have to plan.

Yeah. No, Kate, you're particularly good at planning, and you're being very modest because I can also point out that you've managed to put a stroke reperfusion term into the equation as well. So you're going to come out with a really interesting set of skills at the end of that time.  Yeah. Thank you. Yeah. I think it's, probably the other thing to say out loud is that the College hasn't given quite enough thought to how the new curriculum and dual training learning captures and observation capture requirements are going to overlap with each other, and that space is still evolving. Having said that, there is clear direction from both the senior college committees and from the Australian Medical Council, that we need to make it work and dual training is, from a college perspective, is going to be a thing. But there are some little kinks in the system that are going to get worked out over the next couple of years.

A question from Patrick is, what if you don't get a position in your preferences? Do you get allocated somewhere else? The answer to that is, no one's going to force you to do anything.  So the lovely thing about general medicine is that there are a lot of hospitals involved, and there's a lot of flexibility around. And so year on year, we have these complex allocation meetings, and we-- I was going to say almost universally. I can't say universally.  I say almost universally, we offer appropriate jobs within the preferences to all of the trainees in the system up till this point. Now, certainly, it is possible that you might not, again, depending on your merit ranking and depending on where the positions are available and what the current trainees are doing in the system, that you get offered something that you think is suboptimal. No one is going to force you to take a job that you don't want.  And every now and again, there are one or two trainees towards the bottom of the merit rank list who are getting offered jobs that are perfectly appropriate training jobs but which are not in their top three preferences. And if that is you, then you need to make a decision about where your values are and what you want to do.  Certainly, anecdotally, a number of those trainees have wound up loving the roles that they were not sure that they wanted to preference, and have done well through it. And then we certainly do get trainees who vote with their feet and move interstate or do other roles instead of taking low preference positions. But certainly, no one's going to force you to do a job that you don't want to do.  You are senior doctors. You are highly employable individuals. Generally, those things work out.

All right. Ah, the advanced training project from a dual spec. Yes, absolutely. So from the College's point of view, it's one training project per advanced trainee. And so if you're a dual trainee, then you can do your project in the general medicine component, or you can do your project in the advanced training specialty, and that is usually one is enough.  Some people choose to do two. Those people, from my perspective as a non-researcher, are gluttons for punishment, but it is A-okay to do that.

Is it mandatory to attend IMSANZ during your training period? Oh, God. I'll have to go and look at the college. This is a website for that one. It's certainly strongly encouraged. Okay. IMSANZ, the Internal Medicine Society of Australia and New Zealand, is the specialty craft group for general physicians. They have really good conferences.  Some of those conferences are in New Zealand and are crazy fun. Some of those conferences are done in North Queensland. So yeah. But you're certainly encouraged to go to IMSANZ. I don't think we made it compulsory yet, which is a two-edged sword. Do we make it compulsory so  that hospitals have to give us time, or do we not make it compulsory so that trainees have flexibility?  And that argument sort of does the rounds.

Do you have to apply for RPL twice if you're doing dual training?  Gerald, I'm not sure what you mean by... So RPL's obviously recognition of prior learning. Presumably for the project.  Yeah. No, I wouldn't have thought so. I think if it's the project, you RPL it once and you should be good to go.  Having said that, the college, they're in a process of simplifying that aggressively as we speak.  Has it come through? For a research project. Yeah, no. If you've RPL'd it once, you're good to go.  There's a whole pile of college-related problems associated with the research project, which we're trying to sort out. Do offers of place come from the general medicine advanced training pathway? Yeah, they do.  So when you get offered a job at the end of the process, the offers come through Ange at the network. But once the offer is accepted, then the individual hospital will provide you with the HR paperwork because each of the hospitals are in their own health service district with their own individual HR processes. But yeah, we centrally allocate, we centrally offer, and then the contracts come from the local hospitals.  Okay. Have I missed anything there? I may not have.

All right. Well, Team General Medicine, it is now half past six. We've taken an hour of your time.  I would like to take this opportunity to thank all of you for giving up an hour to come and talk about general medicine training. I want to thank Ange because none of this happens without her. We very much appreciate her organisational skills and commitment. And I want to thank Dr. Raine for committing this time to answer your questions and to talk to you about regional training.

Enjoy the rest of your evening. If you have further questions, feel free to email us at physician_training@health.qld.gov.au, or Dr.  Raine put her email up there if you've got specific questions about geriatrics or general medicine or regional medicine or her pathway through the training program. But at that point, we're going to stop the record button, and we're going to call it an evening.  Enjoy the rest of your Thursday night.