What’s on the cards for DiTs at King Edward Memorial Hospital? | AMA (WA)


What’s on the cards for DiTs at King Edward Memorial Hospital?

Wednesday February 21, 2024

Dr Thomas Drake-Brockman

The future of our specialist Obstetrics & Gynaecology (O&G) hospital has been the topic of much discussion recently, with concern that recent decisions have failed to consider patient or staff perspectives. The 2023 Hospital Health Check (HHC) also highlighted issues at King Edward Memorial Hospital (KEMH) in terms of the wellbeing, workplace entitlements, training and morale for doctors in training (DiTs). 

DiT Committee Co-Chair Dr Thomas Drake-Brockman interviews Dr Rosie Browne, the outgoing Co-President of the KEMH RMO Society, to find out how DiTs are going at King Eddie’s – and what’s on the cards for 2024. 

TDB: The 2023 HHC highlighted some ongoing issues at KEMH, but we know that not everything can be captured in one survey. What do you think is the most important factor in the DiT experience at KEMH? 

RB: Being a standalone hospital comes with so many benefits, but unfortunately some downsides too. The turnover of medical staff is rapid, particularly from the point of view of junior medical officers (JMOs). On the other hand, many of the other staff (e.g. clerical, nursing and midwifery, theatre) are part of the furniture and have been here for a long time, which creates a unique dynamic. The pace at which JMOs come and leave KEMH makes it difficult to build relationships or forge career progression.  

Many of the procedural experiences are well sought after, such as instrumental births, caesarean sections and laparoscopic surgery. So DiTs can find themselves at the bottom of the pecking order for hands-on teaching. Fortunately, our leaders have acknowledged this and embedded a strong teaching agenda with daily RMO teaching from well-respected consultants; entire Friday afternoon protected teaching; and many practical professional development leave opportunities like neonatal resuscitation and the O&G in-time courses. Regardless, it can be difficult to meet career goals in a short period of time, and many of them are protected for DRANZCOG and FRANZCOG trainees. 

TDB: What’s the best thing about working at KEMH? 

RB: For me, it’s the people – both the staff members and patients. Our little hospital looks after WA families during some of the happiest and saddest moments of their lives. Each and every member of the team acknowledges this responsibility and gives 100 per cent. Whether it’s the smile that Noels and the team at the café give you when you finally order your lunch at 2.30pm after a long antenatal clinic, or Rob the anaesthetic tech who knows how to make a patient laugh as they tremble with anxiety before their caesarean section, or the senior midwives who guided you through our first ever spontaneous vaginal delivery. 

As doctors at KEMH, we rely on everyone in the team to make the experience for ourselves and our patients amazing. Similarly, the patients we have are just incredible. They are some of the strongest women I’ve ever met, and they continue to exceed my expectations every day.  

TDB: What has most improved the DiT experience at KEMH in 2023?  

RB: In 2023 we saw the motivation of our hospital to respond to both the AMA (WA) HHC and the RANZCOG accreditation report. These have brought the experience of the JMOs to the forefront, and our voices became louder and more unified. We have seen a number of working groups formed, including the reignited Welfare Committee and the new JMO Taskforce – modelled off Sir Charles Gairdner Hospital. But I think the greatest outcome of this has been the coming together of JMOs as a unified cohort to improve our culture by supporting one another, becoming involved in sporting and social activities, and prioritising work-life balance and mental health.   

TDB: Conversely, what’s the biggest problem to solve for DiTs for 2024 in your opinion? What do you think needs to be done? 

RB: Medical rostering is being overhauled this year. There has been leadership change from the executive level, and acknowledgement that expectations at the coalface for doctors is beyond what is possible. Our work has changed – increased acuity, increased complexity, increasing documentation requirements, increased medico-legal implication; and no longer is there an appetite for unsafe working hours.  

This has required introspection at all levels on whom to roster when, and where. This comes at a time when PMCWA has changed its requirements for RMO terms, and RANZCOG training has created Advanced Training Modules which require altering the previous ‘Generalist’ Senior Registrar rosters. The registrar term commences in one week, and we still don’t know what the day-to-day staffing will look like at our hospital. This uncertainty is compounded by the feeling of ‘how long will this hospital even be here’ to create apathy around change and improvement at KEMH.  

TDB: I’ve heard that you have a JMO Taskforce, with some big names – Dr George Eskander and Dr Gareth Wahl – involved. What are you hoping to see from the taskforce? 

RB: The Taskforce has come in at a time when our ship needed steering. We have the crew, and a motivated one at that; but having an executive team that are willing to say “yes” has improved the morale and culture. KEMH is undergoing a huge change in what the experience of our DiTs will look like through 2024. 

We will be moving from six terms to five terms for residents; we are aiming to adopt more proactive part-time recruitment and flexibility for DiTs from other sites to transfer for short-term roles (one term, six months, etc); and we are recruiting for service registrar positions for the first time. Similarly, the Taskforce will also focus on improving the experience of trainees by adopting new rosters that align with safe working hours and ensure rostered administration, research and education time.  

This cannot, and will not, be achieved without the feedback provided by DiTs past and present, as well as support from the AMA, RANZCOG, and others within the organisation who continue to support positive change. Gareth has extended his contract, which we hope is a reflection on all of our hopes to implement these changes as soon as possible. He’s even taken on a few shifts in our Emergency Centre to observe the DiT experience in real life. 

TDB: In a specialist hospital like KEMH, I suppose it would be unsurprising if the culture was heavily influenced by the O&G training program and focus – what do you think the impact of this is for DiTs interested in O&G? 

RB: I think DiTs interested in O&G will have a good experience at KEMH. The current landscape of RMO jobs is geared toward increasing the level of experience and exposure to prepare them for applying to the RANZCOG training program. Many of the consultants are involved in the college and training applications, and PGME focuses their teaching on those sitting CWH and DRANZCOG examinations. Similarly, there is a mentor program that sets RMOs up with a supportive senior, which can be a huge advantage when navigating the tough application process. My mentors have become some of my closest friends whom I can still call on any day for a debrief or advice.  

TDB: Do you think the substantial centralisation of O&G training in WA puts DiTs at a disadvantage? 

RB: This is such an interesting question, because I think in recent years there has been a decentralisation of DiT positions with O&G experience. However, KEMH remains the mothership for RANZCOG trainees. For example, both JHC and FSH have great DRANZCOG RMO positions with successful applications to the training program over the past few years. But KEMH certainly has the vast majority of RMO positions that cater to those seeking O&G experience, and the labour ward and Emergency Centre provide exposure that is difficult to get elsewhere.  

From a training point of view, as long as the training is effective, I think the centralisation is okay. In the past, feedback from WA trainees regarding experience – particularly procedural – has been up there with some of the best in the country. Similarly, the senior registrar jobs have previously been coveted for providing excellent ‘step-up-to-consultant’ opportunities, and we have strong Fellowship opportunities.  

But when the morale and culture at the primary training site is faltering, we certainly need leadership to step up and intervene. The college has been to KEMH in early 2023 and listened to trainees about some of our major concerns. Some of these have been heard and actioned by the hospital, but we are still awaiting a response for many of them.  

TDB: The announced relocation of the proposed site for the new obstetric hospital to the Fiona Stanley Hospital site has been big in the news – what’s the impact on this for DiTs working at KEMH right now? 

RB: One of our most experienced Consultants, Dr Nic Tsokos, said to me this year that when he was a first-year trainee at KEMH (year unspecified) they announced the move to SCGH would be within 10 years.  

As a current first-year trainee, I’ll be interested to see how the next 10 years pan out. But for our consultants and other staff members who have given up their time to be on many working groups over the past however-many years, and who have spent many hours on drafts and guidelines for the QEII site, we are all offended by the lack of consultation – and it will take a lot to get this disheartened staff community back on side. It couldn’t have come at a worse time for morale and culture with many senior nursing and midwifery staff noting they will retire if we are to move. That said, with the level of building works going on at KEMH currently, including multiple new theatres, none of us are holding our breath for a move anytime soon. 

TDB: Tell us a bit about what the JMO society at KEMH is up to in 2024. I see the bar at Royal Perth Hospital was reopened recently – any upcoming announcements at King Eddie’s? 

RB: Being a co-president of the KEMH RMO Society (Obstetrics Doctors Society of WA) this past year with Dr Jasmin Sekhon was an absolute honour. We had multiple sunken bar tabs at our local institutions (Unicorn Bar, Little Things Gin, Juanita’s) which continue to provide an opportunity to laugh, say goodbyes, and debrief at the end of terms. We brought competition into the society this year with a Consultant vs DiT netball match which will go down in history with as many injuries received as goals scored.  

We managed to avoid a COVID-19 outbreak despite a roaming golden cup of Golden West Brewery’s finest ale doing the rounds to ‘We are the Champions’. This was followed up with our inaugural Christmas Ball at Oyster Bar in Elizabeth Quay, which saw the consultants put on a flashmob in front of a record multidisciplinary turnout.  

We love our little hospital. We all know we can call on one another for support whenever needed, and those who spread their wings to work in metro, rural or remote general practices and hospitals will always be part of our community.  We have handed over the Co-Presidentship to Grace Crawford and Hilary Goldsmith, and I wish them all the best in 2024.