Teaching and learning in an era of time-based access targets: Impact of a new model of care on junior medical officers

In order to address the challenges associated with ED overcrowding and access block, governments in the UK then Australasia have implemented time-based access targets for emergency presentations.1–4 In 2011, the Council of Australian Governments (COAG) adopted a National Emergency Access Target (NEAT) for public hospitals, with the intention that, by 2015, 90% of ED patients would be admitted to a ward or discharged within 4 h of arrival.4 The target has driven many Australian EDs to introduce models of care that facilitate early disposition decision-making.5–7 Although data are emerging about the impact of NEAT on quality and timeliness of care,5–11 little is known about its effects on the education and training of junior medical officers (JMOs). Trainees have voiced concerns about potential negative implications, 11,12 but it is unclear if these have been realised. This article draws on qualitative data from a broader study to illustrate teaching and learning practices before and after the introduction of a new model of care at a large metropolitan ED.