Learnings on the Integrated Rural Training Pipeline

The Integrated Rural Training Pipeline (IRTP) was established in 2015 as part of the Specialist Training Program (STP) in an effort by the Department of Health to extend vocational training for specialist registrars into settings outside traditional metropolitan teaching hospitals, including regional, rural and remote and private facilities. The aim in creating the IRTP is to help build a sustainable Australia-trained future workforce for regional, rural and remote communities.

The College now fills four IRTP training posts within Victoria and Queensland, Australia. Training sites need to meet different eligibility requirements to the traditional STP model to participate in the IRTP. Namely enabling a trainee to complete the majority of their training—66 per cent—within a rural or regional location and making sure that the trainee selected has shown a real commitment to working rurally or regionally post fellowship.

In the first of a series of articles chronicling our connection to the training pipeline, for this edition of Inside News we hear back from site and trainee at one of the Victorian training posts: Dr Richard Ussher, former Director of Training, and Dr Scott Robson, IRTP trainee, at Base Imaging Group (Ballarat Health Service).

The Ballarat IRTP Experience

Firstly, Dr Richard Ussher spoke to us about the experience of establishing an IRTP training post from a practice perspective.

“When the IRTP post at Ballarat Health Service was established in 2017/18, the site was already an accredited training site, having level A partial accreditation linked to the Royal Melbourne Hospital. The training site was pleasantly surprised to receive 50 applications for this regionally modelled post, which was advertised ahead of the metropolitan teaching hospitals’ recruitment.”

What measures were put in place to prepare for the training post?

It was imperative to the success of this model that an assigned radiologist was responsible for the management of the trainee to ensure appropriate supervision could be met. The training schedule was also carefully prepared to ensure that the trainee had satisfactory exposure across a range of modalities in the regional setting. Clinical meetings were also reviewed to determine which sessions would be most suitable for registrar involvement and at what stage of training.

The site offers involvement in a shared educational program with weekly teaching sessions dedicated to the trainees, and in the practice peer review/ journal club which runs monthly.

In addition to educational resources in the hospital library and online resources such as StatDX and UptoDate, the site applied for funds to purchase an electronic teaching file for its PACS (Intelerad), as part of the Private Infrastructure and Clinical Supervision Allowance. This additional funding is available through the traditional STP model, which the site is also involved in.

Who was the successful candidate and how has the experience been for the practice?

Dr Scott Robson commenced in January 2018 and will complete his training with us after his present rotation to Melbourne. Over the last two and a half years, Dr Robson has become a very competent third year registrar, passing the Part 1 examination at first sitting. A number of radiologists are involved with training and teaching, and to date Dr Robson has completed a research project which looked at predicting the likelihood of pneumothorax post lung biopsy, as well as doing a number of journal club reviews. We regard the experience as very successful, to be recommended.

Postscript from the site: We are pleased to further report that Dr Robson successfully passed all components of his Part 2 examination on his first attempt. Congratulations, Scott!

Lake Wendouree in the centre of Ballarat

The Trainee Perspective

Dr Scott Robson offers his insights into the IRTP experience and his return to Ballarat where he grew up.

Are there any advantages in your opinion of training at a large regional hospital compared to a metropolitan hospital?

Naturally as you work with a consultant for a long period, they become aware of your strengths and weaknesses, and know your diagnostic and procedural limitations. As I was working with a smaller group of consultants for a longer period this meant that comfort with me performing procedures was fast tracked, leading to significantly more experience.

Dilution of training, as the only registrar, or in Ballarat’s case one of two, you get to see all the interesting cases and take part in all the interesting procedures where usually there would be more senior registrars and fellows diluting this experience.

I perhaps didn’t realise until coming to Melbourne, but the number of studies and procedures performed in Ballarat is likely equivalent to or in some areas greater than metropolitan hospitals due to the large outpatient department. This means that there are no issues with the volume of studies for registrars to report or the number of procedures they perform.

I have ties to Ballarat with both family and friends having grown up there. Completing my training here has allowed me to move back five years earlier than I otherwise would have and spend time with nieces and nephews and reconnect with friends in a location where I ultimately plan to set up my life.

Are there any disadvantages in your opinion of training at a large regional hospital compared to a metropolitan hospital?

Post-operative imaging, as Ballarat does not have a Neurosurgical or Cardiothoracic unit, therefore I have not seen the common follow-up scans that these patients undergo. Meaning I have less confidence in this area. This is a deficit I will rectify during my metropolitan rotation.

With only two registrars it can be difficult at times to gauge how you are progressing in training and be aware of upcoming events and deadlines for the College. I was lucky to be supported by the Royal Melbourne trainees and Director of Training with this and so quickly became part of their extended cohort.

Dr Scott Robson with Dr Alicia Wang at one of the practice social functions

Is there anything you think that was done particularly well in the IRTP?

Co-location is very important; being in the same room with the consultant was invaluable to me especially in the early period. All of the consultants that I worked with were approachable and happy to be interrupted by me for questions and clarifications. This led to a fast tracking of my knowledge in the first several months with a tight efficient feedback loop.

On call practice taught me a great deal about being a safe radiologist, satisfaction of search and when to call for help. A good mix of procedural and diagnostic work in all modalities meant that I had an excellent well-rounded early training period.

There are several other areas that were done particularly well in Ballarat.

I remember often in the early phase when approaching procedures I was asked “do you want me to scrub in?” this changed to “do you want me in the room?” to “I’ll be here if you need me don’t hesitate to let me know if you have any issues.” This meant that I had great support but was also given a great deal of trust to perform procedures with a level of independence that I felt comfortable with.

All of the consultants throughout have been great at asking how things were going, regularly checking in, and asking if there were areas I felt deficient in. This led to a lot of focused impromptu teaching or the loan of texts in areas I was struggling with.

I was always encouraged to step out of my comfort zone and report the studies that I found difficult or attempt the procedures that made me nervous. The consultants were always willing to look through them with me in real time or after to help work out what to do better in future

What advice would you give to a trainee commencing training in an IRTP position?

Get involved with your colleagues at your sister hospital. The first part exam requires a significant degree of book learning both for the physics and anatomy sections that is not necessarily all that related to radiology or your day-to-day job. Getting involved with the registrars at a sister hospital will get you access to a physicist for tutorials and anatomy resources that will help you pass the exam. At the same time, being around the others will encourage a little extra study.

Have a go! Most consultants in the regional setting are happy for you to attempt a procedure with their supervision. The more you put yourself outside your comfort zone (safely) the faster you will learn.

Enjoy the social side; get to know the people you work with whether they are consultants, other doctors, radiographers, nurses or receptionists. In a small department it makes work an enjoyable place to be.

What advice would you give a hospital/practice looking to start an IRTP program?

The person you pick is important. The program is designed to favour a registrar who wants to settle in the country and enjoys being there rather than one who sees it as time in purgatory until they can get back to the city. The right pick makes a big difference.

The IRTP program builds a relationship for life—it may be difficult and timeconsuming to train a registrar especially in the first six months, but ideally it builds a strong relationship that means the registrar wants to return to work the rest of their career at the practice. The practice has had the chance to train them just the way they like.

More information on the Australian Government Department of Health Specialist Training Program

The Specialist Training Program (STP) aims to have a positive influence on future workforce distribution and quality. In 2010, the STP became the single Commonwealth grants support program for specialist training in Australia. The program now encompasses three complementary streams:

• Specialist Training Placements and Support

• Integrated Rural Training Pipeline

• Tasmanian Project

The College administers funding on behalf of the Department for training posts across all three initiatives in clinical radiology and radiation oncology.

Colleges receive a set allocation of posts under individual agreements. Training sites must apply for the program through an expression of interest process, which is managed by the Department in conjunction with

each state jurisdiction and colleges. Successful posts are placed on the College’s reserve list and must be accredited to fill vacant positions.

The College currently has 27 clinical radiology regional training sites (19 posts are STP-funded) and 13 radiation oncology regional training sites (10 posts are STP-funded).

To find out more about the program and funding opportunities, please contact the STP team at STP@ranzcr.edu.au

Reference 1.

Australian Government | Department of Health | Specialist Training Program: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ work-spec

Facts & figures - Ballarat

Population: 101,578 (City of Ballarat shire), Victoria’s third-fastest growing city

Distance from Melbourne: 110 km north west

Universities: Australia’s Federation University and the Australian Catholic University’s Ballarat Campus

Hospitals: Ballarat Base Hospital (Ballarat Health Services) and St John of God Ballarat Hospital Art galleries: the oldest and largest regional art gallery in Australia www.artgalleryofballarat.com.au

Festivals: the biggest regional winter festival in Australia, visit the 2021 Ballarat Heritage Festival www. ballaratwinterfestival.com.au

Main towns: Ballarat (main suburbs Wendouree, Buninyoung, Learmonth), nearby are Creswick, Smythesdale and Clunes

Geographic features: Mount Buninyong, Mount Warrenheip and Lake Wendouree

Climate: Moderate, prone to cold winters with light snow falling on local mountains

Fascinating facts: Home of the Eureka Stockade and Steve Monaghetti, and the location for ABC TV series The Doctor Blake Mysteries

The Mining Exchange Gold Shop Building at 8 Lydiard Street North

The famous Pinnacles rock formations in Grampians National Park