Position Details
Position Title Advanced Trainee
Position Number 14660
Employment Status Full Time - Exempt
Applications Close 21/07/2017
Local Health District Sydney Local Health District
Facility Royal Prince Alfred Hospital
Specialty Palliative Medicine
Sub Specialty None
Award Public Hospital Medical Officers (State) Award
Classification Resident Medical Officer
Registrar
Main Purpose of Position To provide an opportunity to undertake advanced training in palliative medicine within a specialist palliative care service.

The Advanced Trainee in Palliative Medicine will provide quality healthcare to patients under supervision, while developing a broad knowledge of the principles and practice of palliative medicine and a satisfactory level of competence in palliative medicine as required for Advanced Training.

These positions will have supervision from specialist medical staff whilst undertaking learning and professional development as outlined by the Chapter of Palliative Medicine, Royal Australasian College of Physicians.

PRINCIPAL DUTIES: The duties of the Palliative Care medical officer will vary according to the particular location and context of the post; for example:

• HOSPITAL CONSULT TERM (mainly hospital consults)
o Review patients as requested by other medical or surgical units (on the same day as requested or as close to the same day as possible).
o Review the patient within 24 hours or as close to this as possible with an AMO from the affiliated palliative care service hours
o Communicate with other units the objectives of care and assist in resolving conflicts between therapeutic objectives of units
o Hospital Consults rotations may also involve some inpatient work

• INPATIENT TERM (mainly in-patient care)
o Daily ward rounds of every patient in the unit.
o Careful documentation in the case notes of patient progress (and tests, etc).
o Responsibility for communication with AMO about any relevant change in patient’s condition.
o Fully admitting or at least examining all new admissions
o Responsible for ordering and chasing results of all appropriate investigations (either self-initiated or AMO-initiated).
o Discharge planning, together with patient and paramedical staff and family.
o Ensuring appropriate post-discharge follow-up.
o Supervising discharge summaries and communication with the patient’s general practitioner (LMO)
o Liaise with and counsel the family or guardians of patient as required.
o Prompt implementation of management changes suggested by senior staff.
o To supervise resident medical officers or interns attached to the inpatient palliative care unit
o Liaise with external medical services, such as, General Practitioners, in a professional, succinct and courteous fashion


• COMMUNITY TERM (mainly community consults)
o Notify AMO of new referrals on day of assessment
o See all new referrals within 3 working days, and within 24hrs for urgent referrals
o See patients with the AMO as directed
o Liaise promptly with the patients general practitioner after each visit
o Regularly review unstable patients in collaboration with the GP
o See patients in all home settings as directed (residential homes, hostels, nursing homes) - Liaise regularly with the GPs and Care givers as appropriate to the patient - after carers/allied health/health providers
o Provide systematic management of the community case load


• OUTPATIENT CARE
o Attendance at unit outpatient clinics
o Assessment of unit patients in the emergency department
o Enhance skills in handling problems on the telephone and deciding the situations in which this is appropriate

Communication
The doctor is a key person who works closely with all members of staff and must:
• Work as part of, and contribute to a multi-disciplinary team.
• Deal with matters of an urgent or sensitive nature.
• Exercise discretion and sensitivity, and maintain confidentiality.
• Demonstrates leadership within a team environment and actively contributes to team activities including meetings and decision making processes.
• Demonstrate an ability to initiate and undertake discussions with patients and their families regarding their hospitalisation, treatment and progress.
• Communicate effectively and in a timely fashion with consultants regarding the patients under their care.
• Produce correspondence to GPs, Specialists and others involved with a patients care as appropriate.

Decision Making
• Close and effective liaison with consultants allows the trainee demonstrate their level of ability and understanding of patient care with the aim of expanding the trainee’s level of responsibility.
• All patients managed within the hospitals of the health service are under the direct care of a specialist medical practitioner.
• All decisions regarding their care are to be clearly communicated with the specialist responsible for that care.

ON-CALL ROSTER (each site will vary)
• Telephone inquiries from patients, relatives, ward and Community Palliative Care staff.
• Weekend ward rounds as appropriate.
• Admitting particularly ill patients through the Emergency Department or to the Palliative Care Unit and supervising their initial management in consultation with the AMO.
• Review sick patients on the wards of the inpatient units at if appropriate

Research and Teaching
• Demonstrate commitment to Palliative Care Training program and the service requirements of the organisation including rosters.
• Demonstrated interest and willingness to teach Junior Medical Staff and research.
• Participate in teaching the junior medical officers and nursing staff on the ward in theoretical and practical aspects of patient management
•Participate in Quality Activities of the Palliative Care Department
• Teaching of medical student attached to the unit in theoretical and practical aspects of patient management
• Medical officers are expected to participate, organise / present unit meetings, eg, journal club, case presentations, clinical unit meetings, as directed by the Head of Department. Assistance with the presentation at Grand Rounds may be required
Position Requirements Qualifications
• Primary undergraduate degree registrable with the Australian Health Practitioner Regulation Agency (AHPRA).
• RACP advanced trainees (Palliative Medicine and other subspecialties), Australasian Chapter of Palliative Medicine trainees, Clinical Diploma of Palliative Medicine (RACP) trainees, Faculty of Pain Medicine trainees and Family Medicine Program trainees
• Passed Part I FRACP (or equivalent) or be eligible for advanced training in Palliative Medicine by the possession of a Fellowship in another college recognised by the Chapter of Palliative Medicine.
• Completed at least four years residency since graduation.
• Current Drivers licence.

Clinical
• Proven satisfactory clinical performance, supported by submissions of two current referees.
• Demonstrated excellent clinical skills, judgment and expertise.
• Demonstrated teamwork within a multidisciplinary team, time management and problem solving skills in a complex clinical environment.
• Preparedness and ability to work independently in a supervised environment.
• Participate in clinical duties as arranged by the Director of the Department of Palliative Care/consultants.
• Compliance with authorised requests to attend the hospital whilst on call.
• Be familiar with opioid and other analgesic pharmacology in order to provide advice to junior staff.
• Competency in the management of subcutaneous infusion devices for pain and other symptom control.
• Developing competency in abdominal paracentesis.
• Develop competence in Thoracocentesis, in close consultation with a respiratory physician, where applicable.
• Demonstrated commitment to quality improvement, patient safety and risk management.

Research and Teaching
• Participate in the teaching of undergraduates, JMOs and other clinical staff.
• Participate in the FRACP Chapter of Palliative Medicine teaching program.
• Undertake a research or quality project.
• Maintain records and statistical data in the Department.
• Participate in all relevant Departmental Quality Assurance activities
• Presentation of cases at weekly meetings
• Participation in the Hospitals Grand Rounds
• Participation in Journal Clubs
• Compliance with Supervision of training assessment of academic and clinical performances as well as attitudes and relationships
• Participation in departmental:
- Continuing education programs
- Research programs where appropriate
- medical Undergraduate and post graduate education
- Nursing and allied health education

Orientation will be provided at the employing site.

Supervision
The Advanced Trainee in Palliative Medicine will be responsible for the supervision of junior medical staff ie. interns and residents assigned to the various terms.

Other responsibilities
In addition to the core competency standards, the below requirements relate to the position:
• Ability to move between services and geographical locations to deliver patient care.
• Ability to work in a computerised environment or a preparedness to learn.
• Prepared to participate in overtime and shift work as required.
• Contemporaneous documentation in the medical records in accordance with hospital policies.
• Satisfy any other criteria of the RACP for satisfactory completion of the year of advanced training.
• Actively participate in the meetings of the Department of Palliative Care.
• Working as an efficient and effective member of the multidisciplinary team.
• Develop Adequate verbal, written and listening communication skills.
• Participate in special working groups or projects relevant to your department from time to time.
• Complies with Occupational Health and Safety policies and demonstrates knowledge of changes.
• Maintains personal immunisation/screening records in accordance with Department of Health requirements.
• Able to demonstrate awareness of Culturally & Linguistically Diverse (CALD) Groups.
• Knowledge of local Service Risk Management policies and integrated Risk Management Strategy.
• Participation in risk management activities and implementation of quality
improvement plans.
• Maintains professional standards of conduct reflecting the mission and values of the employers.
• At all times during normal working hours, the applicant will have a more senior doctor on site available to help. i.e. In-hours, the applicant is never the most senior doctor on site.
• If the applicant will be working after hours, on call or overnight, there will always be a more senior doctor on call and available to help
• The applicant is expected to supervise junior medical staff
Local Background & Environment Royal Prince Alfred Hospital Palliative Care consult service incorporating The Chris O'Brien Lifehouse Cancer Centre.
Key Internal and External Relationships The Advanced Trainee in Palliative Medicine is a key person who works closely with all members of staff and must:
• Work as part of, and contribute to an inter-disciplinary team.
• Deal with matters of an urgent or sensitive nature.
• Exercise discretion and sensitivity, and maintain confidentiality.
• Demonstrates leadership within a team environment and actively contribute to team activities including meetings and decision making processes.
• Demonstrate an ability to initiate and undertake discussions with patients and their families regarding their hospitalisation, treatment and progress.
• Communicate effectively and in a timely fashion with consultants regarding the patients under their care.

The Advanced Trainee in Palliative Medicine is required to communicate at a high level with a wide range of internal and external stakeholders. The Advanced Trainee needs to display sound communication skills to deal effectively with administrative and medical staff.
Supervision Arrangements The Palliative Medicine Advanced Trainee will be under the day to day supervision of the senior palliative medicine medical staff.

Within hours: Clinical supervision will be provided by the specialist medical staff for Palliative Care. On specific days, this is provided by the on call specialist for Palliative Care. Immediate supervision is available for outpatient clinics, community consultations, and regular ward rounds by the specialist medical staff. For inpatient problems at other times the Palliative Care specialist is available by telephone and will attend on request to supervise the more complicated cases.

After hours: Clinical supervision provided by the on call specialist for Palliative Care by telephone and to attend on request. Immediate supervision is available for procedures through attendance of the specialist. In some positions within the rotation, the medical officer will be required to supervise Resident Medical Officers (RMOs) attached to the Palliative Care unit.

SUPERVISING RMOs (where applicable):
• Daily ward rounds with the resident staff.
• Responsibilities for ensuring tests are ordered and results chased.
• Ensuring quality control of resident staff in clinical clerking.
• Supervision, teaching, support and assistance of junior medical staff in their daily duties.

Other responsibilities in addition to the core competency standards, the medical officer is expected to comply with legislative, policy / protocol requirements as they relate to:
• The supervision requirements as set out by the NSW Medical Board;
• The Area Health Services Performance Management Policy;
• Occupational, health and safety requirements as an employee;
• The NSW Health Code of Conduct.
• Knowledge of relevant NSW Health, relevant Hospital policies, including EEO and OH&S.
• The NSW Health Occupational Assessment Screening and Vaccination against specific Infectious Diseases Policy.
Challenges/Problem Solving •Matching training requirements with service provisions, within the limitations of a busy public health service,
• Maintaining a professional role and responsibility for patients’ care.
• Working collaboratively with other staff in the team.
• Being flexible with the work required in a range of Health Services and locations.
• Undertaking the responsibility for mentoring of JMOs.
• Ensuring that the requests from other Staff Specialists for advice or review are responded to promptly
Decision Making • Close and effective liaison with staff specialists 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.
• To ensure appropriate input from key decision makers and achieve consensus when possible.
• The Advanced Trainee is encouraged to make decisions and then discuss those decisions with the Staff Specialist supervising him/ her. This is the case for the initial few months and as experienced is gained the trainee develops confidence and makes and carries out decisions. A key goal is the development of clinical insight knowing when to seek help.
• All patients managed within the hospitals of the health service are under the direct care of a specialist medical practitioner.
• All decisions regarding their care are to be clearly communicated with the specialist responsible for that care.
• To appropriately allocate teaching time according to evidence of learning need.
• To deal with matters in a confidential manner.
• To respect the professional values of staff.
• Clinical decisions should be guided by relevant Commonwealth, State, and Local Health District policies and guidelines, and Palliative Care unit management protocols. Policies and guidelines are available on the relevant Hospitals intranet.
Communication The Advanced Trainee is a key person who works closely with all members of staff and must:
• Demonstrated sound, effective communication skills with patients, medical colleagues, nursing staff, allied health staff, relatives and patients.
• Work collaboratively with other staff in a multi-disciplinary team
• Deal with matters of an urgent or sensitive nature
• Have the ability to exercise discretion, sensitivity and maintain confidentiality
• Demonstrate an ability to initiate and undertake discussions with patients and their families regarding their hospitalisation, treatment and progress
• Work co-operatively within a team environment and actively contributes to team activities including pro-actively participants in team meetings and decision making processes
• Maximise the efficient utilisation of the physical resources of the Health Service
• Be responsible for supervision and teaching of junior medical officers attached to the medical team
Performance Monitoring The Advanced Trainee in Palliative Medicine is responsible for:
• Participating in ongoing review of their clinical practice as per conditional registration guidelines;
• Participating in continuing medical education and professional development as covered by the supervision arrangements stipulated by the Medical Board; and
• Maintaining his/her professional competence.

Reports on the medical officer’s progress will be provided by the specialist nominated to be the supervisor for the individual medical officer during their program at the hospital. The specialist will be a specialist in Palliative Care. The trainee will be continually assessed and given feedback informally on these objectives by the supervisor during the period of training, with reference to the expected standard for a specialist palliative medicine medical officer. Formal feedback and written assessment of these objectives will occur at least every 3 months, but more frequently if necessary.
Performance Monitoring will involve, but is not limited to, the following:
• Maintaining an effective personal and professional development plan.
• Identifying own learning needs.
• Seeking learning opportunities relevant to identified needs.
• Accessing appropriate resources to enhance skills and knowledge.
• Conduct reflects the mission and values of the workplace
The Advanced Trainee is responsible for planning and management of their leave entitlements and Rostered Days Off (RDO’s) in consultation with the term Supervisor or as per term procedure. RDO’s must be taken regularly. Periods of leave for longer than a two week period is generally not encouraged unless it ‘straddles’ the term rotation and approval has been given in writing by both term Supervisors. Accumulated leave may not be honoured at the next rotation.
Additional Information

Orientation will be organised by the employing site

Additional Documents no addditional documents have been provided

College Australasian Chapter of Palliative Medicine
Organisation Chart RPA_orgchart.pdf
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: RACP advanced trainees (Palliative Medicine and other subspecialties), Australasian Chapter of Palliative Medicine trainees, Clinical Diploma of Palliative Medicine (RACP) trainees, Faculty of Pain Medicine trainees and Family Medicine Program trainees or passed Part I FRACP (or equivalent) or be el

3: Completed at least four years residency since graduation

4: Current Drivers licence

5: Proven satisfactory clinical performance, supported by submissions of two current referees.

6: Demonstrated sound, effective communication skills with patients, medical and surgical colleagues and other staff

7: Demonstrated commitment to own personal and professional development

8: 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 if applicable to the stream
Contact Details Dr Maria Cigolini
95157755
Maria.Cigolini@sswahs.nsw.gov.au