The Emergency Medicine Capacity Assessment Study: Anticipated impact of a major increase in intern numbers in Australian ED

Abstract

The increase in interns peaking in 2012 represents a significant change to the health system that will challenge the capacity of ED. Although ED internship is perceived as an indispensable learning opportunity, maintaining the ED experience with a rapid influx of interns will not occur without problems.

Impact of a structured intern education programme on clinical documentation in the emergency department

“…For this reason, EDs have been heavily impacted by the dramatic increase in trainee numbers. Ensuring a sufficient number of placements has proved challenging and, in some jurisdictions, the ED term has become a major ‘bottleneck’ in intern training . The availability of senior ED staff to provide effective supervision has been identified as the most significant constraint in expanding capacity …”

“…Ensuring a sufficient number of placements has proved challenging and, in some jurisdictions, the ED term has become a major 'bottleneck' in intern training. [3][4][5] The availability of senior ED staff to provide effective supervision has been identified as the most significant constraint in expanding capacity. [3][4][5] Growth in medical graduate numbers has been particularly marked in Queensland, with internship • From 2008-2011 there was an 80% increase in intern numbers at The Townsville Hospital.…”

Enhancing capacity for intern training in the emergency department: the MoLIE project

“…Graduates must progress through further years of training while working as junior doctors, and require adequate clinical and educational supervision, with sufficient exposure to patient care. The traditional apprenticeship model in teaching hospitals is unlikely to be able to absorb a doubling of intern numbers without reducing the quality of training or leaving clinical service provision less safe and efficient 3 , 4 . This challenge is most immediate in intern and prevocational training, 5 and pertains to both metropolitan and rural settings 6 .…”

Lessons from the 4‐hour standard in England for Australia

“…I caution against overly enthusiastic support for the 4‐hour rule being instituted in Australian hospitals as a panacea to access block in the ED, and stress the need for better discharge planning, experienced patient flow and bed management, and improved hospital staff rostering for after hours. The latter include rethinking of ED doctors’ 24‐hour staffing, with ED specialists attending to patients primarily, 7 and junior doctors as assistants (if a 4‐hour standard is to be attained), especially when facing an imminent glut of junior doctors, who will require close supervision, rotating through the ED 8 …”