The Medical Director role has provided vital clinical input and insight to the PMCV team since the early years of the organisation. As part of our journey to uncover our rich history in celebration of our 25 Year Anniversary, we delved further into the Medical Director role and how it has developed over time.
We had the incredible opportunity to speak with both the inaugural Medical Director of PMCV, Dr Ian Graham, and our current Medical Director, Dr Sarah Rickman, about their experience in the role.
Ian was appointed the inaugural PMCV Medical Director in 2005 and remained in the role until 2010. Throughout his extensive career, he has covered the whole expanse of medicine, taking on roles in major metropolitan centres, and also in regional and rural settings. He has just concluded his tenure as Chief Medical Officer at Latrobe Regional Health.
Sarah was appointed as Medical Director in September of 2023 and is a practicing Emergency Physician with over 15 years of experience. She has also been the Supervisor of Intern Training and Clinical Lead for the implementation of the National Framework at Austin Health.
Q: Why did you decide to take on the role?
Ian Graham (IG): I’d had some involvement with PMCV prior to the appointment being made, and I’ve always had a passion for the prevocational phase of training. I think it’s just so vital to the development of young doctors to get that broad experience in the prevocational years.
Sarah Rickman (SR): I love the prevocational doctor space, and it has been my biggest passion for many years. As I’ve done more work in that space, I realised there were areas that needed to be improved upon, areas that needed better cohesion across the state, and areas that needed a strong voice supporting them. It’s hard to achieve that at just a local hospital level but by doing work at a more jurisdictional level, you can actually try and get some of the patterns that might be beneficial for all heard.
Q: Can you describe the responsibilities of your role as Medical Director?
SR: I think some of it is working out what parts are most valuable for me to be involved with because I could work forever in this role and there’s no capacity for that. So, I think it’s about understanding where oversight is required. I think it’s important for hospitals, particularly the medical education community, to know that there’s a clinical person here. Building links and being able to get the collaborative voice for everything that we design or develop is an important role.
Q: Did the Medical Director role evolve?
IG: Yes, the role did evolve. The Medical Director is obviously involved in all the senior committees of PMCV and provides that link between those committees, which is important. But equally the Medical Director needs to liaise with medical colleagues around the state at all different levels. We were trying to strengthen clinical governance and the academic governance of PMCV through the role of Medical Director. And I think over that period and of course the many years that have elapsed since, PMCV has had very robust governance mechanisms, and they’ve developed further, along with the changes in clinical practice that have occurred across Victoria and across Australia
Q: What was your approach to handling different aspects of your role?
SR: I think my Emergency Department (ED) background helps as I can keep a broad, generalist approach to the constant juggle, shuffle, and triage of tasks. Working in ED means you’re always working with prevocational doctors and doctors of different levels, so I actually see some of the challenges faced in prevocational training. I think it keeps me very in touch with and therefore aware of what it is that’s important.
I also recognise the need to be flexible by moving to whichever area that needs my attention at the time. Never plan too much for one day because it won’t turn out how it looks at the start. Recognising that I might be working with Accreditation one week, Framework implementation, and Education the next week. Sometimes I feel like I’m chasing my tail, but I still find the time to work across the whole team who supports me.
Q: Have there been any proud moments?
IG: My single proudest moment was when we joined with the other Prevocational Medical Councils (PMCs) around Australia and produced the Australian Curriculum Framework for Junior Doctors that was published in 2006. I led that and facilitated the writing of the curriculum. There were curricula in each of the states and territories that have been developed locally, but we wanted to have a broad, wide-ranging curriculum that covered the entire spectrum of the prevocational experience. We set out to make it something that was simple and understandable by the trainees. I think it has served that purpose very well.
SR: I think we’ve had some amazing successes and highlights, particularly around the National Framework. What we’ve really done is improve and elevate the profile of prevocational doctors and the importance of training prevocational doctors.
I have particularly enjoyed running some of our ACE (Annual Collaboration Events) and symposium events. To see 60 to 140 people from hospitals in a room all interested in the prevocational medical space when I know that it is something they must make an effort to attend has been valuable and fulfilling. I feel very proud when I hear that what we’ve put together has been helpful to people and is making some difference.
Q: What impact do you believe PMCV has had on prevocational medical training in Victoria and beyond?
IG: Having Prevocational Medical Councils like PMCV in each state and territory has been critically important. PMCV understands the Victorian health care and medical education systems as well as the cultural, organisational and operational context of postgraduate medical education across Victoria. This allows the best systems, processes, and solutions to be developed and implemented successfully across the Victorian healthcare system. PMCV has done an excellent job in connecting with the hospitals, the employers of the junior doctors, and with the junior doctors themselves. To make sure that the competency frameworks and governance processes work in all different environments, we deliver clinical services across the state. PMCV has helped it move from a very service-oriented model to caring about the education and the wellbeing of the trainees while they’re in the clinical workplace.
SR: Prevocational medical training has started to cement its place a lot more. I think it has always sat there in the background of most people’s thinking, both in education, in medicine, for clinicians and for hospital administrators. It never will come completely to the front of people’s minds, but it hasn’t even come to the middle level for everyone. But it’s become a much more prominent discussion. People are now used to thinking, ‘oh, we must actually ask PMCV what they think about this’. They are not surprised to hear somebody say, “what about the prevocational doctors?” when we’re developing a new system. I think we’ve got more and more people who can’t argue when you say to them, ‘why would we not train and support our doctors in the first two years?’ because that sets the tone for the rest of their career. I think more people are coming to that thought of their own accord.
Q: How do you envision PMCV’s role evolving in the future?
IG: I hope that in the future PMCV and all the other PMCs and the Australian Medical Council itself will start to move away from what I think is a very bureaucratic compliance-based approach that we have now in prevocational and, for that matter in, vocational medical training. While standards, governance systems and standardised operating procedures are critically important, we’ve still got a lot of tick boxes and complex assessment forms whether they’re paper-based or digital and this can really impact both trainees and their supervisors in the busy clinical workplace. We do have the opportunity with newer digital technologies and more flexible operating procedures tailored to the local clinical setting whether it’s metropolitan, regional or rural to help postgraduate medical education gradually move from a compliance-based approach to, what’s happening in many of the places I see overseas to a growth and development mindset. And that means that every prevocational doctor is nurtured and guided appropriately on their individual pathway into a chosen area of medical practice.
SR: What I would like is for PMCV to have an even broader remit. I’d love PMCV to be able to have an education and research element. We do so much good work and to be able to develop that into evaluation, research and publication would be fantastic. We can’t do it in the current form, but that would further build the profile of the importance of medical education, training, and linking in with educators at hospitals. Being able to answer the question ‘why should we hire junior doctors?’ with evidence supporting the benefits, it would be great.
I’d love to see PMCV become a bigger group where we’ve got even more voices built in. I don’t think that’s going to happen in the near future. Having said that, I think we should continue to advocate for it because it’s also a way of saying our hospitals would benefit from some consistency in what is done. We can see people continue to understand that they don’t have to reinvent everything themselves, that there’s a centralized ‘go to’ for all this.
Q: Do you have any anecdotes you would like to share?
IG: The things that stick most in my mind are where we have been able to help individual trainees who have perhaps drifted off the pathway or have had some difficulties. And I think taking a trainee in difficulty through a remediation process and seeing them back in practice and doing well provides a great deal of joy and those experiences stick with me as being some of the greatest achievements of PMCV and I guess the Medical Director being closely involved in those things. Every time we can sort of change that course of someone who’s underperforming a little bit it is a special moment, and we all treasure them.
In addition, when I was Medical Director, we started to think about a national framework, and I vividly remember back in those days when all the PMCs around Australia were arguing about who had the best curriculum. We had national teleconferences where people were actually yelling at each other over the teleconference as they defended their own curricula or their own prevocational training program. So CPMEC convened a national conference in Sydney to try and find some common ground, and they asked someone to step forward to coordinate a national approach. I guess from my point of view, it seemed that everybody else took a step back and I was elected to the role. So, it was after that, very special day in Sydney that we convened the National Working Party, which I ended up chairing and that started what was probably a 14-month process that eventually produced the Australian Curriculum Framework, which we published in 2006. So, yeah, it was an exciting journey.
Q: Were there any collaborations worth noting?
IG: We tried to maintain a strong connection with the undergraduate training sector. At that time, we were doing a lot of work on the intern computer match, for example. Having strong connections and strong communication with the university sector was very important to the development and improvement of the computer match. I think prevocational training is vital phase in a very long continuum of training. It is incumbent on us to connect to the undergraduate level and to articulate with the college vocational training level.
SR: Well, I think the biggest one would be the Clinical Educators Network. This was an idea that I came into this role with as there were a number of times in my own hospital I would think ‘gosh, I wonder how other hospitals are doing this?’ That ability to try and bring people together from different hospitals and share experiences is so important, and I think most educators across the state benefit. Having said that, I don’t think it’s got to the point where we want it to be so far, and I think that’s because people are busy doing just what they need to do within their own silo without knowing that they all have the same frustration. We’ve got a long way to go but have at least made a start to improving this community.
Q: In hindsight, would you have done anything differently?
IG: I don’t think I would have, I think we achieved a lot. PMCV has continued to develop and improve. We put robust governance processes in place back then and that’s served the trainees, the supervisors, and the healthcare system very well. The governance models have evolved over the years with advances in PMCV’s Accreditation processes and the implementation of the new National Framework.
SR: I don’t know about differently because I think there was just so much stuff we just had to just get going with. I think there’s things which you think, if the entire system had its time over, I wish we could plan things around how we set up PGY2, how we set up term descriptions, and how we set things up differently. But I think that’s had to be part of the process, to try once, you learn from that and then try a different way. I’m not a big one for looking back and saying I’d do things differently with regret because that is how it was done.
PMCV would like to thank Dr Ian Graham and Dr Sarah Rickman for sharing their experiences and insights with us.
