Medical Education in Australia and opportunities for China-Australia Collaboration - Undergraduates. Alastair Burt

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1 Medical Education in Australia and opportunities for China-Australia Collaboration - Undergraduates Alastair Burt

2 Historical perspectives 1862 School of Medicine established at University of Melbourne 1883 First intake of students to Sydney Medical School 1885 University of Adelaide establishes Faculty of Medicine 1890 UK GMC recognizes UoM medical qualification

3 Medical Education in Australia: an overview Initial medical education provided by 18 university medical schools in Australia and 2 in New Zealand Traditional route: 6 year UG course leading to MBBS degree Increasingly moves to 5 and 4 year (graduate entry) programs Recent trend towards MD degree as initial qualification Substantial growth in Federal Government (Commonwealth) funded places with significant growth in number of Medical Schools over past decade 1837 to 3686 commencing students from 2002 to 2012 All graduates undertake internship before general registration University of Adelaide 3

4 Immigration Healthcare demands Patterns of work New graduates Workforce Retirement Working time directives Changing skills mix Emigration After Hays R, Clinical Teacher 2007; 4: 213-7

5 Total medical student load in Australia University of Adelaide 5

6 Growth in graduate numbers University of Adelaide 6

7 Predicted future medical graduate pool University of Adelaide 7

8 Selecting medical students Application of Clinical Aptitude Tests: (Adam et al, 2011; Wilkinson et al, 2011) Widening participation: addressing inequalities Use of structured interviews Multiple mini-interviews (Dowell et al, 2012) Assessing for attitudes and professionalism

9 Funding of medical students University of Adelaide 9

10 Age at entry of medical students University of Adelaide 10

11 Health Workforce Australia 2025 Workforce planning analysis for supply and demand of healthcare professionals Modelling incorporated effects of innovation and reform, immigration, training, working time cap Predicted continuation of health workforce shortages for doctors (modest) and nurses (severe) in Australia Geographical distribution of doctors identified as continuing concern

12 Health Workforce Australia 2025 Efficiencies in clinical placements Use of innovative training methods such as simulation Consistency in clinical placement supervision and accreditation requirements Generating work ready graduates

13 Rural and remote healthcare Need to attract and retain workforce in areas of need Rural background entry: 25% Medical student bonding schemes Rural Clinical Schools established All medical schools: 25% students one year in rural setting; all must spend at least 4 weeks Need for rural PG pathways

14 Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) Aims Provision of effective evaluation of long term outcomes of educational programs, particularly those aimed at addressing future medical workforce needs National dataset to explain career choices and workforce patterns and to inform policy Collection of data started in 2006 Comprehensive coverage: questionnaires to date Key findings include predictive model and index of rural medical practice based on medical students characteristics; role of rural placements in shift towards rural practice intentions (Kaur et al, 2013) University of Adelaide 14

15 WHAT Medical Students WE Prevocational COLLECT Years 1 & 2 Trainees MEDICAL SCHOOL PGY1/2 Vocational Years VOCATIONAL TRAINING Medical Practioners MEDICAL PRACTICE Commencing Medical Students Questionnaire (CMSQ) demographics, rurality, previous tertiary education, income, scholarships, career intentions PGY 1 Questionnaire (PGY1Q) current situation, work locations, internship rotations, additional tertiary education, career intentions, update demographics, contact details for tracking PGY 3 Questionnaire (PGY3Q) current situations, work locations, career intentions, update demographics, contact details for tracking PGY 8 Questionnaire (planned) Workplace location, Specialty type, Professional issues/ satisfaction, Mobility & career changes Medical Schools Data Collection clinical placements, enrolment status, rural club membership, electives PGY 5 Questionnaire (planned) Training opportunities, Intention to practise, Specialty type, Training locations, Training Issues Exit Questionnaire (EQ) internship location, career intentions, factors influencing most preferred type of medical practice, satisfaction with medical program, additional tertiary qualifications, updated demographics, contact details for tracking

16 Collaboration in Indigenous Health University of Adelaide 16

17 Collaboration in Indigenous Health Incorporation of Indigenous health content into curricula Development of culturally appropriate pedagogical approaches with quality immersion learning experiences in an Indigenous health context Professional development pathways for Indigenous staff Providing support for growth in numbers of Indigenous students: new enrolments equivalent to proportion in community Focus on improving retention and graduation: 61% increase in number of Indigenous doctors University of Adelaide 17

18 Australian Medical Council Accredits medical programs on behalf of Medical Board of Australia (& NZMC) assesses all according to one set of standards regardless of qualification assesses whether the medical program produces graduates who: are competent to practice safely and effectively as interns in Australia or New Zealand i.e. are eligible for provisional registration have an appropriate foundation for lifelong learning and further training in any branch of medicine University of Adelaide 18

19 Australian Medical Council Graduate Outcome Framework Science and Scholarship: the medical graduate as a scientist and scholar Clinical Practice: the medical graduate as a practitioner Health and Society: the medical graduate as a health advocate Professionalism and Leadership: the medical graduate as a professional and leader Clear graduate attributes in each domain University of Adelaide 19

20 Australian Medical Council: Accreditation Standards Context of the medical program: governance; leadership; management; resources; interaction with health sector Outcomes of the program: domains Medical Curriculum: domains; design; breadth and diversity Learning and Teaching Assessment of Student Learning Monitoring of the Curriculum: evaluation; feedback Implementing the Curriculum Students: intake and admissions; student support Learning environment University of Adelaide 20

21 Collaborative medical education assessment and benchmarking Australian Medical Schools Assessment Collaboration (AMSAC): UoS International Development of Excellence in Assessment and Learning Consortium (IDEAL): Bond Australian Medical Assessment Collaboration (AMAC): UQ/Monash Australian Collaboration for Clinical Assessment in Medicine (ACCLAIM) Australian Medical Council item bank International Foundations of Medicine (IFOM): Go8 initiative utilising US National Board Medical Deans: Benchmarking Medical School Assessment and Graduate Outcomes project and MECC University of Adelaide 21

22 Current challenges in medical education in Australia/New Zealand Developing a balanced workforce: excellence in generalist and specialist provision Declining clinical academic pipeline: research and medical education Federal government base funding levels (international benchmarking) Competing demands in secondary and tertiary healthcare: erosion of pro bono teaching Indigenous healthcare provision Remote and rural provision Future proofing programs: ensuring graduate outcomes remain fit for purpose University of Adelaide 22

23 Predicting the future "The abdomen, the chest, and the brain will forever be shut from the intrusion of the wise and humane surgeon." - Sir John Eric Ericksen "I think there is a world market for maybe five computers." - Thomas Watson, chairman of IBM, 1943 "640K ought to be enough for anybody." - Bill Gates, 1981

24 Technical advances in healthcare Genomics and transcriptomics: DNA on a chip Personalised medicine Digital medicine Remote monitoring: health and ill health Robotics and remote interventions

25 Attributes of the doctor of the future Facilitator of patient understanding Advocate of healthy living Aware of global/rural health challenges; addresses health inequalities Able to cope with uncertainty and change Aware of (and embraces) scientific and technological advances that will influence practice

26 Team based learning and inter-professional education Changing skills mix in healthcare: nurse practitioners; physician s assistants Increasing emphasis on working in multi-professional teams Need to apply TBL strategies to enhance abilities in practice Scenario based approaches with ward based simulation Poorly planned IPE can be counterproductive, reinforcing negative stereotypes

27 Communication skills and the modern curriculum Recent focus on face-to-face communication and active listening skills Training for communication with new media: telemedicine; e- consultation; social network Netiquette/digital professionalism Critical appraisal of the unregulated internet Guidance for patients: facilitating decision making

28 Communication skills and the modern curriculum Recent focus on face-to-face communication and active listening skills Training for communication with new media: telemedicine; e- consultation; social network Netiquette/digital professionalism Critical appraisal of the unregulated internet Guidance for patients: facilitating decision making

29 Go8/C9 Medical Deans: opportunities for collaboration in medical education Benchmarking of assessment and outcomes Joint symposia: sharing best practice and future proofing curricula Student and staff exchange Research pathways: sustaining a clinical academic pipeline Mutual understanding of QA and regulatory issues Others University of Adelaide 29

31 Clinical Academic Training: UK model Includes MRes and MB/PhD Academic exp in years 1 and 2 Wellcome and NIHR programmes

Selection of Future Medical Practice: Using the Australian Medical Schools Outcomes Database to inform national workforce planning

Selection of Future Medical Practice: Using the Australian Medical Schools Outcomes Database to inform national workforce planning Author: David A Kandiah Date: 19 October 2012 I do not have an affiliation