General medicine

Welcome. My name is Spencer. I'm a general physician in Toowoomba and one of the physician training medical directors for Queensland Health, responsible for the advanced training general medicine network.

Charlotte joins us as a general medicine advanced trainer and has some slides to present towards the middle of the talk. We talk about general medicine advanced training from a registrar's perspective and from the perspective of regional hospitals and health services.

So there will be, as I've just mentioned, we are recording and we'll be keeping an eye on the chat and we can use that or indeed an unmute to ask questions as we go along and we'll pop up a sort of pausing now for people to ask questions kind of slide here and there as we go along.

So to begin, what's the aim of tonight's session? Well, it's very similar to the same one we did last year. We're going to talk to you about general medicine and what advanced training looks like in Queensland.

I'll talk to you about the college's training requirements. And then we'll talk about what we like about training from a regional perspective, which is Charlotte's opportunity to sell you on training outside of the Southeast Queensland corner.

And then I will talk a little bit about the network, so Queensland Health structure, the application selection process. And as we do those three things, there'll be plenty of opportunities for you to ask questions and talk as we go along.

So I presume that most of my audience are currently basic trainees, and many of you will be in the throes of exam preparation. So I appreciate that is not much fun. So let's get some definitions. IMSANZ, the Internal Medicine Society of Australia and New Zealand, is responsible for many things general physician-like, and they say we are highly trained specialists who provide non -surgical healthcare to adult patients caring for serious or unusual medical problems and that we continue to see the patient until these problems are solved…which is not a very helpful definition but I guess it tells you roughly what a general physician does.

Unfortunately there's a perception in the community that general physicians are largely the leftover cruft so people who didn't qualify for a proper subspecialty and on my original version of this slide actually named some of those proper subspecialties and I thought no, you'll know what the proper subspecialties are but I've put this picture as simple as up to remind you that medicine and indeed internal medicine is a really really broad church and sure there are some people out there whose brains are designed for them to become left lobe of liver specialists and to know everything that there is to know about that half of the organ and to be able to exclude all of the other work and all the other things in their world to be international experts but there is a tremendous need for people who have broad knowledge and the ability to integrate different subspecialty illnesses into one care pattern and as our population ages and the care needs of our community change, general physicians are going to be a critical part of that workforce and it is something that you can choose to do because it's challenging and it's fun and it's problem solving and it's not limited by a single organ system or a single portion of an organ system.

The current general and acute care medicine advanced training curriculum from the college says that we're experts, we're diagnosticians, providers of integrated care, problem solvers, patient advocates, communicators, negotiators, innovators, system leaders, teachers and mentors and while some of those are probably a bit aspirational, it's actually true. This is a role that many general physicians are filling. We're going to talk about the spectrum of practice of general medicine and initially the regional and sometimes even rural and remote. In Queensland, we have some very remote physicians who will do flying clinics up on Cape York doing outreach medicine in resource constrained environments.

And across the state, you will find solo physicians or small groups of physicians living in regional towns and providing physician care in environments like Atherton or Mareeba or Innisfail. Down here, closer to the southeast corner in Toowoomba, where I work, we have a scree, a huge collection of general physicians now and we look after general medical inpatient units. General physicians look after our medical assessment and planning unit. But we also are represented on the endoscopy roster and on the stroke thrombolysis roster. And when COVID physicians were a thing, they were all general physicians at our hospital.

We provide the perioperative medicine, the obstetric medicine. We do non-biological rheumatology clinics. respiratory clinics, several dual trained specialists doing ID and antibiotic stewardship and elsewhere you will find people dual qualified in gen med and dermatology doing infectious disease providing bronchoscopy or facilitating chemotherapy in environments where they don't have access to an oncologist.

If you are going to work in a metropolitan area, then general medicine looks a little bit different but you will still find general physicians in general medical units in acute medical units and MAPUs. You'll find them doing perioperative medicine, doing residential outreach, hospital in the home, hospital admission prevention programs or HAPPs, sometimes complex patient or multi -system disease clinics and then providing niche expertise in clinical pharmacology or health information systems and change management.

So you can see that becoming a general physician requires you to acquire and become expert in this complex and diverse array of skills and so from the college’s point of view, how do they ensure that when they hand someone an FRACP in general medicine that they can do any or all of the jobs that I've just described and you know have a think about how you train somebody for those roles, what sort of skills they need to acquire, where they'll acquire them, what it will look like and have a think about how this applies to you, where are you going to train and where are you going to work.

If you're going to be one of those regional hospital physicians, you probably need to know how to put in a chest tube and how to do a lumbar puncture. If you're going to work in a metropolitan hospital there's very likely a sub-specialist or an anesthetist who can come and do that for you and so the skill set that you acquire and the kind of medicine that you practice will depend very much on where you're going to train.

From Queensland Health's perspective, our network is designed to try to help you acquire the set of skills that you need. So let's quickly describe the key players. You guys were already exposed to the College of Physicians and so hopefully you know the difference between the training network, which is a Queensland health structure or construct, designed to facilitate selection into training and to make it easier for people to move between hospitals and to complete their training requirements.

We have the RACP, which continue to provide their role of accrediting terms and accrediting hospitals and ensuring that the training program meets the overall goal of the handbook that describes what a general physician needs to know before they get their fellowship.

And obviously each year your employer is an individual hospital and health service. And you might work in that hospital for six months, more likely for 12 months or even two years before transiting to another hospital on the network to continue your training.

So let's quickly talk about what the college's requirements are for training. So each advanced training fellowship. consists of a minimum of three years of training and of that three years of training two of those years are core training.

In order for a term to be regarded as core by the college it needs to be ideally six months in duration so six months FTE but because of a number of historical factors there are certainly some four-month terms that the college will regard as core and if you are part-time then three months full -time equivalent within a say six month or a slightly longer period of time with appropriate assessments and negotiated with the college will be regarded as a core term.

Now in that two years of core training the college wants you to spend a minimum of twelve months. The college would like you to spend a minimum of 12 months doing general medicine and six of those months need to be in a core general medicine term, you know which looks and smells like general medicine, and the other six months can be in core general medicine or it can be in a general medicine related term and we'll talk about those in a moment.

Your second year of core training needs to be two separate, and ideally completely unrelated core subspecialties, looking to achieve breadth and depth of expertise. The one year of non-core training is sometimes mistakenly to be regarded as an unimportant or irrelevant year, I could do anything I like in that year, the college isn't really interested in it. In fact the college wants you to use that year to facilitate high quality-training and so in that 12 months of non-core you might do your six month high acuity term which is a separate but related requirement that you need to do at some point in your three years. That non -core year might be 12 months of a dual training specialty there's a slide on dual training in a moment. It might be an extra six months of a core that you were particularly enjoying or wanted to get more depth on, or it might be a year that you use to acquire a procedural skill.

There's some other considerations. The college thinks that you should train at at least two hospitals, and the network thinks that too. I'm a bit distrustful of a trainee that as an intern at a big hospital and then a junior house officer there, and then a basic trainee and then an advanced trainee, you can develop a great deal of expertise in an expert environment, but ideally you need experience of how other people think and other people work and other people approach the clinical and nonclinical aspects of being a physician.

Night shift is something that usually doesn't count towards advanced training, and that's pleasing because many hospitals don't give you any night shifts. Now that's obviously not the case if you're doing an ICU term, there's a recognition that night's rotations are part of ICU and they will count as core. And there's also a recognition, particularly for smaller regional hospitals, that sometimes advanced trainees need to contribute to night shift because of a workforce requirement. And in that setting, the college will let you get away with up to four weeks of night shift in a six month period as part of helping out a roster. But you will find that many hospitals, including many regional hospitals, do not require advanced trainees to do nights.

As with basic training, AT has prep tools. So there's a learning needs analysis case -based discussion and professional qualities reflection each year. The cultural safety module is mandatory and the supervisor professional learning is recommended. You'll be assessed using supervisor reports. And over the course of a three year advanced training period, you need to do one decent sized advanced training research project. And we've got a separate talk that we do for people who are doing advanced training to help them work out how to plan and prepare for the advanced training project. I’ll quickly talk about dual training. So because most subspecialties require two core years, general medicine requires two core years, but have a three year requirement in total, you can overlap your two sets of two to achieve dual fellowship in a four year period. And so one year will be core gen med, one year will be core subspecialty. That's opposite ends of this diagram. And then your overlapping years can be a mixture of non -core for your subspecialty or core for your for your gen med in order to achieve all the requirements.

Now, if you're going to do this, you need to really think about it in advance. It's not something that you can you can easily negotiate. Each of those terms has to be carefully chosen, needs to meet the requirements of both of the advanced training committees at the college. And you also need to be careful because Gen Med requires certain things as too similar to be separate subspecialties. So occasionally you get someone doing gastroenterology dual training who thinks that their hepatology and their endoscopy should count as separate core subspecialties. Not the case from Gen Med. Similarly sleep medicine and respiratory medicine tend to get lumped into one box for the Gen Med perspective. The other thing to be aware of is that there are two subspecialties at present, one being renal and the other cardiology that require three full core years. And so if you can dual train in either of those specialties it will take you five years rather than the four years that we've got on this slide here.

Okay so I guess what I'm saying is that with all of these things, all these subspecialties, the option of dual training, the option of skilling up in procedures or skilling up in a paying procedure like ultrasound, echo or endoscopy, you need to think about what sort of physician you want to be. You want to think carefully about where you're going to work when you finish, what size, what subspecialties will be available, what subspecialty skills will you have, what will you want to do with them, what will you need, how will you acquire those skills and where will you acquire those skills? And in thinking those thoughts, you can lay out a rough plan for your three years of training and then find a mentor or an expert to have a chat to about it, recognising that there is plenty of flexibility in the system and you don't have to commit to getting everything exactly the way you planned it over the three years.

So at this point, I'm going to hand over to my colleague, Charlotte, to talk to you about the AT training perspective and in particular to answer the question, why should you consider regional training?

Thank you, Spencer. Can everyone hear me okay? Yes, lovely. So thank you for asking me to come and talk about this. I'll just tell you a little bit about myself for some context. So I am a third year advanced trainee. I'm currently at the PA hospital, but I was working in Cairns for 12 months last year and I loved it, so I'm very happy to plug regional training, basically. I grew up mostly rural, semi-rural [area], spent a bit of time in Melbourne since I finished high school, I was desperate to get to the big city and then throughout uni, I went rural a few times. I went to Rockhampton as part of the UQ thing. It was really fun. And then I moved to Cairns as a JHO. It was really fun. and did my BPT at the big bad Princess Alexandra hospital. For my gen med training, my first year was my non-core year, which I kind of fell into and I did a year of hypertension and UQ education role as my non-core year. So kind of like extra interesting hypertension, which is a great, I think a great gen med and kind of special interest by the way. And then my second year of training, I did a gen med-related and acute term, my first term, because I felt that I'd done enough acute stuff. I'd done six months of ICU in my BPT time, and then endocrine for my next six months. And then this year I'm doing neurology for six months; and that's because I felt like I had a clinical skills gap in neurology and then my core gen med for the last term. So that's how I've set up my training. Yeah, so next slide please. So I'm going to talk a few things about why I'm working in the regional spot, particularly somewhere like Cairns or Up North, or Toowoomba is great.

So some of the reasons why other people say they love it. So the medicine is really like pure gen meds in places like that. So instead of having some of the cases filtered off, which still happens a little bit, depending on where you're working, you get most patients under gen med. So you get a big variety, you get to see lots of different things. There may or may not be a tendency for patients in rural regional areas to present a bit more advanced. So sometimes you see more advanced presentations that you might see in the big city, which is a shame, but makes for interesting medicine.

It tends to be really well supported. So there's usually lots of gen med consultants around compared to the number of ATs. And they're usually most of the time very keen to teach and very keen to teach and they are often really dedicated general physicians who are really highly skilled and invested in your success basically. And because of all that, it makes for really great presentation to be really well rounded, preparation, sorry, to be a really well rounded consultant.

I think there's lots of opportunities for leadership roles. I think it's partly because often in regional areas, general physicians are in the leadership position. in the hospitals and that's true for more urban centres as well, but I think you've become exposed to the leadership side of that through your consultants that you're working with and the general physicians tend to be managing the core business of the hospital.

So an example of that is we had a big cyclone in Cairns last year coinciding with the COVID outbreak, we had 40 med regs down including the chief med reg and so I was asked to be chief med reg for a week and coordinate the cyclone response and stuff.  So I think that was like basically an example of a way that you might be kind of drawn into leadership roles more than in a big bigger hospital where you can kind of disappear into the cracks a little bit.

We also got to, for example, like last year IMSANZ came to Cannes and we got to be part of the organizing committee just because it's a small place. I probably wouldn't have found myself on the organising committee if I wasn't there.

So I think you're more exposed to that kind of thing. And if you've got even smaller places, you might be the most senior edge. For example, I know my colleague Mel, who did this talk last year, she was the only AT at Mackay Hospital. And as far as I know, the only Gen Med AT and therefore kind of was an automatic leader for many reasons. And there's lots of opportunities for education stuff as well. And I know there's really good things about going regionally. And if you haven't done it already in your career, you probably should do it at some point because it's important to understand the environment of a regional place, what's available, how things work, I think to effectively work with your regional colleagues, basically. I don't think you can really understand until you've done a little bit of time. Next slide, please. So this is me, Mel and Liana in IMSANZ last year in Cairns. It was really fun, plug for IMSANZ as well..good conference. Thank you. Next slide.

So why I loved it, particularly, so my favourite, well, yeah, one of my favourite things is the small hospital vibes. So I've worked at the PA for so long. And I often just feel like a bit of a cog in the giant machine, whereas by the end of the year in Cairns, I knew everybody basically would walk around the hospital and be like, hello, hello, hello. And you kind of knew all the other subspecialties, you knew the surgical specialties, etc. I think that really helps you kind of, it's like really good for networking. And also, you can get lots of informal clinical support if you've got that kind of relationship with other colleagues. So I really, really like that about Cairns and I'm sure the similar kind of situation other smaller places. It was a fantastic opportunity. It was a really good a really great privilege to work with and learn more about Aboriginal Torres Strait Islander people and their culture which yeah I think was invaluable to my role as a clinician basically and I'm certainly applying that all the things that I've learnt in the bigger city now.

My other favourite thing about living regionally and I think it applies to everywhere I've moved to, Rockhampton, Bundaberg, Cairns is extra fun because there's so much touristic stuff around but it's lots of fun so there's always opportunity to do fun things especially if you like things like camping or hiking or that other thing. It's an opportunity for adventure even if you don't plan to live there for your entire life but to see something different and meet lots of new people and the lifestyle is pretty nice. Like I said, I couldn't wait to get to the big city when I finished high school, but I sit in the traffic at the moment driving to work. So it's really easy lifestyle to live in a smaller town and most of the time you've got access to everything you need and I didn't miss being in the city at all. And finally, I think a lot of people will appreciate this. There's lots of unique opportunities for training in gen meds that you might not get elsewhere at regional centres. So things like outreach trips, things like special skills like point of care ultrasound or echo where you might have people who are willing to train you that maybe wouldn't be about that a second.

And can I move to the next slide? Thank you. And I was also just asked to give some things about what I wish I knew at the beginning of my gen med training or some things to consider. So a lot of the things that I've kind of thought to talk about are similar to what Spencer's already talked about. But yeah, I think you really need to plan your training. I didn't know exactly what I wanted out of my training and it's changed a bit from the beginning. But I think you at least have to have a few different options that might work so you can know if I do it like this, then these are my options. I think you really have to kind of have an idea of how it's going to fit together. So you're kind of not running out of time and finishing later than you would have otherwise. And because of that, that's why you really have to talk to the gen med department directors about what going to work and work out what other rotations are available to you and what ones have been approved for what kind of rotation and yeah and work out how you're going to manage that and that's why it's important to meet with people early.

I think it's a bit of a regional problem again but think about how your hospital is set up for Gen Med training so some places don't have such great access to subspecialty rotations like your core subspec rotations so you just have to work out what's going to be available to you.

In cases like Cairns, there's lots of gen med ATs that have good relations with other hospitals so they might be able to facilitate more subspec rotations a bit easier but just something to think about. Where you might be able to do research it's going to be anywhere you're going to be able to have other people around you who can mentor you anywhere that you work.

Your network. So I really find the term networking really icky. I really hate it. I really hate the idea of meeting people for your benefit and choosing. But I think that I've really enjoyed like meeting my network. So all of the people that all the other general positions and general positions to be. And that's a really important part of training, I think. I think it comes in any advanced training and much more than BPT. Because in BPT, I don't know, you feel like a little bit of a, you're a cog in the machine, and kind of leave after a few weeks or three months. But yeah, and doing things like going to IMSANZ or getting involved in committees or that type of thing is a really nice way to do that. So I'd recommend getting involved.

When you're planning your training time, I think it's worthwhile considering things like Chief Med Reg roles, because it kind of looks good on your CV, but also it's good for developing managerial skills and administration skills and that type of thing. I haven't done it myself, but I kind of wish I had, I'm not going to go into it now. I don't think, but yeah, a lot of people said that's been really valuable in their time. So something to consider.

And yeah, Dr. Toombes has already mentioned this, but you can kind of negotiate your own adventure and work out what you want from your career and try and make your training fitting around that. Hence, like I wanted to do education stuff and I also now have a kind of niche thing that I can do, which is the hypertension thing. And that's an example of how I've used that kind of non-core time to make my, like, you know, suit my career, basically the kind of career I see myself having.

I think you should think about what your gaps in your skills are. So if you've done like, already done like a full BPT term or three months in respiratory, maybe doing a six -month sub-spec term in respiratory isn't the best way to use your sub-spec time. And I wish I'd planned my conferences better. So you have to kind of plan, like, kind of now ensure you know, the next few months for your leave next year. I find that, like, last year I had to apply for my leave in like September, October for this year. So I think having an idea of what conferences that you might want to go to and, yeah, getting that organised fairly early, working out when their submission dates were like abstracts and stuff are so you can get some stuff in there if you've got a case report or something like that.

Again, a plug for IMSANZ, it's really fun. You can come to Melbourne in September. It's a general conference, great way to meet people. And yeah, you can submit something to present as well. Yeah, and the final thing is, I guess, yeah, project. So a lot of people have their training, like finishing time delay by the project. And it can get really, really, really stressful because everything takes so much longer than you think it's going to take. So from ethics to doing actual work for it, to getting it marked, et cetera. So I would make it a job for you in your first year. And that way you'll just have a much better time if you can. It's a do as I say, not as I do kind of thing. But if you, I wish I'd done that, I wish I'd done that. But anyway, yeah, so do your project, work it out early, plan ahead. Training goes really fast. Unbelievable that I’m almost done. Yeah, yes, that's all I have to say.

That's all right, because the next slide says, ask us some questions and you don't have to, but if there are any questions about planning your training or putting it together or specific questions for Charlotte about being an IT or regional training, we’ll get you to fire them up now. And then we'll move on to the next part of the talk, which is about the mechanics of applying to the network.

I forgot to say actually, that just about the GMATS [General Medicine Advanced Training Scheme]. So if you're currently, I don't know how it'll be, it'll be a few years away, but this year my position is funded by GMATS. So I was able to negotiate a job basically anywhere I wanted because you bring your own funding. So it's only for people who are single training. It's not for people who are dual training as far as I'm standing.

We are changing that rule. Oh, are you? Oh, okay. We are, but we'll come for that. Yeah, anyway, but it's a great way to build your career. So that's how I'm doing it. so build your training and work out exactly how you want it to be, so that's what I'm doing with my year this year.

You get to talk about it more. Very good. All right, now I can't see the chat. The chat is quiet. All right, we might give it another moment for the crickets and then we'll proceed forward. All righty, let's talk about the network.

So the network, as we said, is a Queensland health construct designed to facilitate general medicine directors to talk to each other about where their trainees are and what they're up to, but more importantly, so that we have a fair, transparent, centralised, multimodality assessment and allocation process to get everybody into the jobs across the state.

Each year we have approximately 60 new positions, although that number sort of flexes up and down a little bit depending on you know, how many people pass the exam in a given 12 month period and what our other advanced training subspecialty colleagues are up to.

Now, despite the fact that we have a network and it says network and some of you probably still think about a network as being where you get offered a, you know, a line of three years of training that you have to choose, the advanced training network is still very much about flexibility and getting you to plan your own training.

The network, the webpage, again, Queensland Health webpage, slightly easier to negotiate than a college webpage, but only marginally, has a list of all of the hospitals that are offering general medicine advanced training and the terms that they have always available. And, you know, for many hospitals, they're sometimes available terms that are a little bit dependent on what other ATs are kicking around and which way the wind is blowing. For coveted positions and for some coveted hospitals, the competition is actually quite significant as, you know, a hundred and something trainees racking around the state, there's probably only one position where you'll get to do any immunology. There's only a handful of positions where you might get to do rheumatology, for example. Trainees who are already on the pathway, will get first placement at our annual allocation meeting. And then everybody else gets pushed in, essentially on a merit -based order. But as Charlotte's already suggested, when you are nominating what hospital you want to work at, it's essential that you pick up the phone or get on the email and talk to the director of general medicine at the hospital that you are preferencing first and ideally second and third, because you need to have a conversation, not to prove that you're good or that you're able to work at that hospital, but to find out what terms they have available and how your training plan is going to plug into into that hospital and if you guys are going to be a good match for each other.

There's a couple of other things that the network do. So we have this thing called QIMEP, which you're probably already aware of. So every fortnight, a general medicine focused or internal medicine focused education program on a Wednesday, sometimes general physicians, sometimes subspecialty, always focused on what we think ATs in gen med need to know. And of course, the BTs think it's a good idea as well and come along. This is a registrar-led initiative, a small committee of advanced trainees, design the program, find the speakers, put it together so that it's as practical and clinically relevant as we can make it.

As Charlotte has already intimated, we have a thing called GMATS, the general medicine advanced training scheme. This has been kicking around for many years now. In fact, it's been kicking around longer than we've had the network. Queensland Health recognises how important general medicine is to the wellbeing of Queenslanders. So we have money to provide essentially a year of supernumerary funding which you can apply for and use to obtain difficult to obtain training. It might be neurology at the Princess Alexander Hospital or it might be an endoscopy teaching position at Cairns Hospital or in a lot of places, final year trainees will use this so that they can be a junior consultant and have a basic trainee registrar and interns working for them as a mechanism of easing into the consultant role the following year.

This has previously been restricted just to people who are doing solo general medicine training but this year we're going to try opening it up to dual training specialties as well as a mechanism, not for people to do extra cardiology or extra gastroenterology as part of their dual training specialty, but for people who are returning from their dual training to general medicine to finesse high-quality training terms.

The structure of GMATs is probably going to change as the new college curriculum is introduced but at the moment this is what it looks like and there's a web page with information that you can read about it. Certainly for the people who get this money it can make their final year of training very interesting and quite flexible.

Really important that we talk about flexible training. So by flexible training I mean not one FTE or one full-time job type training. Now both the College of Physicians and Queensland Health are highly supportive of flexible training. I do have to point out that it's hard work because at the moment you still need to do three years of full-time equivalent and so if you're doing that at point five it's going to take you six years to complete training that would otherwise be done in three so it's a time commitment and that can be challenging.

Some hospitals are more experienced than others at making flexible training work, although I think you'll find across the state just about everybody is getting on board with this. What I can say is that there is no process through the RMO campaign for you to nominate that you want to be a flexible trainee in the general medicine space. Again, the programming of that web page is pretty ugly and hard to do. But if you want to do flexible training, then this is something to discuss early with the director of medicine at the hospital that you're planning to go to. And I would expect that conversation would go well and that most, if not all, of the Department of General Medicine are getting on board with this now.

So I might not stop the questions there in the talk about how to apply. So the key dates are the same for everybody, whether you're a resident or a basic or advanced training registrar. RMO 2025 will open on the 3rd of June and close on the 1st of July and I fully appreciate that there are going to be many of you who are going to be a little bit distracted with a tiny little clinical quiz about the time that this is happening, but do recognise that closing date and if you're examining late in the season then set some time aside to look at the web page and at least to start getting your application ready.

The process is a little bit complicated because it's a whole of Queensland Health thing, but it's not too bad. So again, if you go to your favourite search engine and say, General Medicine Advanced Training Queensland, it'll dump you very quickly to this website where you can look at the Medical Specialty Training Program.

The question to say yes to is the are you applying for a position on the AT network for General Medicine and then just work your way down and complete all the relevant questions. You will need to upload some of your planned General Medicine Advanced Training, which involves a curriculum vitae, ideally using the Queensland Health Template that you're already using and a short statement that indicates your plans for training and your plans for practice when you finish advanced training.

How do you write that short statement? We'll be marking it. I can tell you that the criteria or the key selection criteria that we're looking for in advanced training is on that web page and I'll pop them up on a slide in a moment and that should help you to construct your short statement.

Next, you need to preference your hospitals and you need to preference up to six hospitals that you will work for. We would suggest that you only preference hospitals that you are prepared to work for. And as we've already said, I've said and Charlotte said really important that you talk about your proposed application and the rotations that you are looking for with the Director of General Medicine at those top three hospitals.

Those Directors of General Medicine are ready for your call and anticipating them over the next month or two. You probably don't have to get that done by the 3rd of July. You probably do have to get it done by the time we're interviewing in August.

Now, there, as we said, about 60 or 70 positions, there's a bunch of hospitals. These are accurate. I think we are likely to be adding Harvey Bay to this list, but we're just waiting for the college to tick some boxes on their accreditation paperwork. But information on all of these hospitals is contained in quite a large PDF document that you can download from the webpage, and that document will tell you what specialty terms they have and what training at that hospital looks like.

Now, when you are, again, this is the Queensland Health website thing, but you need to nominate your training program preference, and that is... I, when you say, so you've told us what facility you want, but when you are logging in, you say college pathway or network determined for the facility, position is registrar, specialty is medicine, subspecialty is general medicine, advanced training.

And in your preferences, consider putting PHO in medicine somewhere down the bottom of the preferences on the off chance that you miss out on your subspecialty of choice or general medicine, advanced training and still need to be in a slot going forward, a paying job as it were.

Let's go to the next slide. Now, dual training, there's a lot of rumor and a lot of rubbish in the Twitter sphere or the X sphere, whatever we call it now about dual training in general medicine. And indeed, in terms of getting into your subspecialty of choice, if you had the temerity to put general medicine as your second preference.

So let's see if we can deal with some of these myths and rumors. So the network will support dual training applicants. If you apply for general medicine as your first preference or if you put us as second preference with some other key specialties, which are these ones, geris, palliative care, pharmacology, obstetric medicine, recognise that clinical and obstetric medicine are very much intimately related to the college's supervision of general physicians. We will interview all of those candidates. Now, if you are applying for a different subspecialty as your first preference, then we are not guaranteeing an interview. Now, I can tell you that we will almost certainly be doing interviews. The one year where we couldn't interview every trainee who wanted to train in general medicine was the COVID year where nobody got to do an exam. And we had people who were doing provisional advanced training. And that was hundreds of trainees who had not yet done their exam and were putting general medicine down. We simply didn't have the reserve or the capacity to interview everybody. But pretty much any subspecialty you put yourself down with, we merit rank everybody. The remote possibility that we are overwhelmed with applicants, then it will be the merit rank that determines whether you get an interview or not. But it's likely that we will have capacity to interview everybody most probably.

The other rumor that kicks around is that if you desperately want to be a cardiologist or a gastroenterologist and you put general medicine second, that that will somehow poison your application for gastro or cardiology or insert name of super popular and difficult to get into subspecialty here. We meet regularly with the chairs of all of the subspecialty groups and I can tell you that 99% of them, and I hope by June the 1st, 100% of them are very clear that the only number that they are interested in is who put them first. They will consider your application transparently, openly and merit ranked with everybody else's. It doesn't matter whether you put our second or third or fourth or fifth. So the order of preference is only relevant to that extent.

So even ICU, and I should say that dual training with ICU is complicated because our two colleges got on very well about 15 years ago, and then it was a great schism, turns that two colleges did not get on particularly well, but you can even dual train in general medicine and ICU recognising that there are some challenges, but we can generally overcome those challenges with open communication and a bit of advanced planning.

All righty, moving on, you need to have a couple of referees. These guys are gonna be asked to fill out the same Queensland Health referee template. Do make sure that you check with them for their approval, check the spelling of their email address, and make sure that they're not on leave, ideally in June when they can be emailed and asked to fill out your referee report. Ideally, we want someone who has worked with you directly in the last 12 months.

We will do a multimodal selection process that involves assessing and marking your referee reports, your curriculum vitae, your short statements, and then that generates a number, and to that is added your score in our multiple mini interview, which as you have experienced in the basic training space is essentially speed dating. We used to do that live before COVID happened, and now we've discovered that it's actually much more efficient, both time efficient, transport efficient, carbon cost efficient for us to do that in an online format. And if you are shortlisted for interview, which we, as we've said, is pretty much everybody who puts us first or second, both the interview dates are the 20th and 21st of August, and you can predict what the interview content will be from looking at our selection criteria. I'm not going to read these out to you and you can certainly find them written pretty prominently on the General Medicine Network website.

So once we've done all of those things we generate a essentially a merit ranked list of the new applicants. We have an annual meeting with all of the directors of General Medicine. We allocate the people who are already on the network to terms and then we allocate trainees to 12 months in a particular hospital.

The employing hospital will arrange your contract, and at this point, you can while there is no box to tick to say make me a flexible trainee there are plenty of spaces for free text answers where you can where you can make that clear and have a conversation with the director when you are when you when you are chatting them about flexible training.

All right. We are nine minutes ahead of our scheduled finishing time, which is handy because I think we've nearly at the final slide here. So the summary of what we have given you tonight hopefully is one, plan your training and that involves thinking about who you are, what your skills are, where you want to work, what you want to do and how you're going to get there, what skills you will need to acquire in order to be the kind of general physician that you want to be.

Communicate your intentions early. Have a chat with a general physician or the director of general medicine at your local hospital. Read the website and particularly the selection criteria. And I would encourage you as someone who did all of my advanced training regionally in Townsville and Cairns and now work in a reasonably at least pseudo regional hospital here in Toowoomba, I think regional careers are terrific. It's a flavour of general medicine that is very different to the flavour of general medicine in the city and we'd love you to consider regional training and ultimately that's where the public hospital jobs are now and where they are going to be at the time that you emerge from your training in the next three to four years’ time.

I will finish by wishing you all the very best for your clinical exams, those of you who are sitting. And our final slide is to invite questions, but I will in fact unshare the screen at this point so that I can have a look at the chat and feel free to whack a question in the chat or to unmute and ask one using the old-fashioned technique of the human voice.

Okay. All righty, so the question about, there is a question in the chat already about merit ranking. So look, the merit ranking essentially is the selection criteria applied to your curriculum vitae, to your short statements and then your scores in the interview questions. And if you look at the selection criteria, you will work out that the interview questions are going to assess your communication skills. There'll be a minimum of one clinical question, which will be advanced training level rather than basic training level. And then we'll cover off some of the other elements of advanced training in medicine in those interviews. So essentially it's a score in comparison to your peers across those domains assessed against the selection criteria.

Thank you. So, yes, the dual training is a good question. So, in general, recognising that there are some other specialties that have large numbers of trainees that are relatively straightforward to get into, and I'm looking at new geriatrics when I say that. For many other specialties, there are smaller numbers of advanced trainees and the competition for those positions is quite significant. And so if you are passionately pursuing dual training, it would be fair to say you should be preferencing your dual training specialty first and general medicine second as part of your assessment process.

Now, once you arrive in your dual training specialty, then it's time to have a conversation with your dual training specialty supervisor and the general medicine folk at that hospital about accrediting that term for both specialties with the college. But that gets a bit complicated and probably beyond the scope of this afternoon's conversation, but it gets done. If you are, if you have completed your training or you are already on a dual training specialty and you want to come to general medicine, that's where you put general medicine first because that guarantees that we will interview and have a look at you.

Sorry, could you just say that again? So in retrospect, if I've done a subspecialty training and I want to do a dual training in GenMed, I can do it again in the future time, like in my second or third year, I can sort of do my year.

Absolutely, put us first and we'll interview you and then put you on the, and then you might not be ready to start the general medicine component in your training that year, but again, ideally you apply that the year you're ready to start the general medicine component. And then we put you on the network, you’re given access to the spectrum of hospitals, conversation with the directors of general medicine and we add your general medicine training after your dual training specialty, absolutely.

But if you are a non, if you're not started training yet, you're a basic training at this stage and you want a dual train, I would advise you to put your dual training specialty one, general medicine two. You'll get interviewed for both, hopefully.

Yeah, so exactly, if your merit ranking will determine which hospital you're placed at or how likely you are to get your first preference. But remember, there is a broad church of people applying for these positions. Not everybody wants to be at the really big Brisbane hospitals. And so, for that reason, while a merit ranking is relevant, because we want our placements and allocations to be as fair and transparent as possible, there is, even if you are not placed in the upper quartile, there is a very good chance that you will still get your first preference hospital depending on which one it is.

So, I think the merit ranking is important from a fairness perspective, but it is not something that you should be lying awake worrying about in the general medicine space, particularly as even if you don't get your first preference in year one, maybe that regional hospital experience will do you a lot of good and then you'll be ready to have a chat to the tertiary, you know, super specialised hospital de jure for your second or third year of training or do it the other way. I don't mind. There's flexibility in the system.

All righty, it sounds like we might be running out of questions, and that suits all of us, I'm sure. Certainly, if you have questions after the event or questions that you are not prepared to put in today's chat, feel free to email me or indeed Charlotte through physician_training@health.qld.gov.au, and Ange will ensure that that email gets where it needs to go and we'll do our best to answer you after the event.

And similarly, if you are watching a recording of this and you've got questions, email physician_training@health.qld.gov.au. Yes. Okay, I think we're done, Ange. Thank you, Charlotte, very much appreciate your input and the positive vibes for Cairns, which we just need to keep sending out, it's an amazing experience.

We look forward to receiving your applications, thank you.