Welcome
As Convenor of MedEd2007 and on behalf
of Medical Deans Australia and New Zealand our co-sponsors from leading medical organizations and the support of the Australian Government Department of Health and Ageing I am delighted to announce the Seamless Medical Education Conference as the topic of MedEd 2007 to be held in at the Grand Hyatt Melbourne on 11 - 13 April 2007.
The committee and working group co-convenors have developed an exciting program which aims to develop a white paper on the critical issues affecting Medical Education in Australia and New Zealand and where the effort should be placed in moving forward. The outcomes will be developed further to introduce new actions and priorities for all stakeholders.
We look forward to your continued support of these valuable initiatives to the future of seamless medical education in Australia, New Zealand and the region.
Professor Paul Gatenby
Chair
MedEd2007 Steering Committee
MedEd 2007 Conference
The MedEd 2007 Seamless Medical Education Conference is a follow-up to the successful Medical Education Towards 2010: Shared Visions and Common Goals Conference (MedEd2005) held in Canberra in 2005. MedEd 2005 was the first of its kind in Australian medical education, reflecting on the fundamental role of medical education in providing and shaping the future medical workforce. This inaugural conference represented a broad cross-section of the major stakeholder groups and organizations in medical education in Australia and included invited speakers and delegates from Australia, Canada, New Zealand and Fiji.
One of the most immediate and visible outcomes of MedEd 2005 has been a greater awareness amongst individual and organisational stakeholders of the intrinsic linkages between the different stages in medical education, training and practice, and a shared commitment to building further collaboration and cooperation across the sector. The outcomes of
MedEd 2005 are accessible on this website.
The Joint Medical Education Working Group was formed by
Medical Deans Australia and New Zealand, the Australian Medical Council, Committee of Presidents of Medical Colleges and Confederation of Postgraduate Medical Education Councils as an outcome of MedEd2005. The Working Group and its stakeholders are committed to working together to further develop national policy and planning on some of the priority issues and recommendations generated at MedEd2005 such as establishing a National Health Education Council.
The Joint Medical Education Working Group representatives together with the New Zealand Medical Council are the sponsors of MedEd 2007.
In revisiting medical education in MedEd2007 the convenors look forward to working with their peers, colleagues and partner organisations in studying the progress and realizing the future vision articulated at MedEd 2005.
Review of MedEd 2005 Conference
This review has been based around the recommendations from MedEd
2005. These will be examined in the light of changes that have
occurred since that conference. Of the changes the most important
relate to the Productivity Commission Report; “Australia’s Health
Workforce” and the DEST (Department of Education, Science and
Training) Study “Medical Education in Australia: What makes for
success?” The former is published, the latter we will hear an update
at this conference.
Recommendation 1: Establish a national health care education council
A national health care education council should be established and
funded by the Australian Health Ministers' Advisory Council (AHMC),
(and therefore report to AHMC) but should be independently incorporated.
Membership should include all stakeholders, including universities and
other education providers, consumers/community, regulators, government
and other health providers, professional associations and unions, and
students.
The terms
of reference for this council would be to:
-
establish a framework for policy development for health care
education in Australia
-
collect appropriate evidence to inform policy development
-
develop policy to address identified problems in health care
education
-
promote collaboration between stakeholders in health care
education.
The council
should cover the entire spectrum of health care (including workforce
needs etc), rather than looking at medical education in isolation.
It would seem to me that much of what it was envisaged this
body would do will fall under the overarching body to consider
Registration and Accreditation in the major health professions. Such a
body has been proposed by the Council of Australian Governments (COAG)
following the Productivity Commission Report. Accreditation and indeed
Registration mandate educational policies.
Recommendation 2: Define competencies and curriculum content for
different stages of medical education and develop processes to achieve
these
Currently, registration and accreditation focus on
processes rather than outcomes. The conference favoured a more flexible
approach that would link progress to competencies rather than time spent
in education and training. This was illustrated using the concept of a
career ‘escalator’, where it would be possible to get on and off at
different professional levels, rather than everyone following a single
pre-determined path (see discussion Group 4 — Medical Workforce
Planning). Delegates identified the need for a framework, so that
individuals would be aware of the ‘escalator’ concept and the career
options available to them.
It was
suggested that the Committee of Deans of Australian Medical Schools
(CDAMS) could establish a taskforce to look at all basic sciences
(including behavioural and social sciences) and other clinical
discipline areas (the relative contribution of some basic sciences and
clinical disciplines will continue to change, as will the point in
training at which individuals need to acquire specific knowledge and
skills). The taskforce would need sufficient resources to get views from
different stakeholders on the competencies and curriculum content
required. The aim could be to create a ‘core curriculum’ (although this
should not be prescriptive).
Recommendation 3: Review clinical teaching and learning
Delegates agreed that there needs to be further thought and planning on
how to improve clinical teaching and learning — how and where it is
delivered, and how it is resourced. Australia needs a national taskforce
to examine worldwide best practice in this area. This could be a
partnership between universities and colleges. Given that any changes
should be informed by evidence, it may be necessary to look at
international theories about work-based learning.
Those
delivering health care need to think about their responsibilities to
teaching providers. For example, hospitals could have a line item in
their budgets for training (at present, hospitals may be receiving funds
for this area but not providing sufficient training). Making changes to
funding of clinical teaching and learning may require costs to be
‘unbundled’, so that it is possible to determine where current funding
is sourced.
Recommendation 4: Review use of potential teaching environments
Currently, many clinical teaching sites with excellent educational
potential are not being utilised. Therefore, each site should be
considered in light of the educational benefits, appropriate teaching
methods, educational environment and resources, indemnity issues and any
other relevant factors. This could be a national project by the national
health care education council. Any initiative should be evidence-based,
and should look first at existing literature and research on using
community-based sites as teaching environments.
One of the
themes of MedEd2007, “Do we need teaching hospitals” will explore
this in greater detail.
Recommendation 5: Marry medical education with
other health care workforce needs
Medical education must match the needs of the health care
workforce, at a whole-of-system level. Suggestions included:
-
reviewing admission policies
-
defining the goals of the undergraduate period
-
defining the role of the prevocational period
-
developing flexible models of specialty training
-
scoping
for models of education and service delivery in areas such as
Indigenous health, mental health and aged care.
Currently, every part of the health workforce is
understaffed, so the strategy of substitution (eg of nurse practitioners
for doctors) solves some problems but creates others, as it simply
leaves different areas short-staffed. Other suggested solutions
included:
-
more
specific education (eg some tasks require technical expertise rather
than a broad education)
-
a
shorter route to specialisation for those wanting to specialise
early (coupled with flexibility, so that people are not constrained
later by early career decisions)
-
admission policies tailored more strongly to workforce needs (eg
policies and practice of tailoring to Indigenous needs)
-
more
flexible graduate programs, to encourage recruitment into areas of
need and to make it easier for people to change careers.
Changes should be evidence-based — there is extensive
literature available on what systems have worked (eg New Zealand has a
successful program that takes students after a year in university). The
issue of quality is also important; for example, adequate resources,
backup support and infrastructure are essential for trainees sent to
areas of need.
This area
will also be subject to further analysis, although we have in the background documents steered
away from horizontal curricula.
Recommendation 6: Ensure that the wider health sector recognizes that
education and research are intrinsic to health service planning and
delivery
Safety and quality should be valued at a local as well as a national
level. In looking at any potential changes to the system, consideration
needs to be given to how educational principles are embedded, what
outcomes are expected and how to ensure that the desired outcomes are
achieved. Expertise in educational theory is required when designing
these programs, and needs to be valued in our undergraduate and graduate
training programs just as research skills currently are.
Recommendation 7: Provide a more rational and transitional process for
career development and change
The ideal situation for career development and opportunities is to have
‘pluripotent’ doctors who can re-differentiate as required. Currently,
there are many barriers to this situation. A possible solution could be
for a recent medical graduate to become a provisional member of a
medical college, which would then determine the focus of the student’s
first two postgraduate training years. Such an approach could ensure
that the graduate receives the maximum benefit from training, with later
recognition by the appropriate college. The colleges need to develop
mutual recognition capabilities that allow for doctors to move
efficiently from one clinical discipline area to another if they choose
to, without compromising standards in any way. This can be achieved by
all groups (undergraduate, early postgraduate and specialist groups)
defining the outcomes required for each level of education and training,
and identifying the core competencies doctors are expected to
demonstrate irrespective of their stage or area of practice.
These matters will be considered in themes 3 and 4,
“Organization and co-ordination of the continuum” and “Vertical
Curricula”
Recommendation 8: Define good medical practice
The Australian Medical Council (AMC) should lead a
project to clearly articulate core features of medical practice. The
results should be used to underpin successful reform of the continuum of
medical education and health service delivery. A final draft could be
prepared by mid-2006, in time for accreditation by 2008.
The core features defined by the AMC should be included in an
overarching framework for a true continuum of medical education (from
undergraduate to continuing professional development) that addresses
individual appraisals, the culture of the learning environment at the
organisational level and sentinel/adverse events.
A scoping study is necessary to provide directions for
implementation, including a cost–benefit analysis that would encourage
stakeholder commitment (eg by universities, PGMC, colleges, the AMC, and
the Department of Health and Ageing (DoHA). Implementation would involve
piloting the appraisal process and integrating the accreditation
process.
‘The Bridging Study’
which we
will hear about at this meeting should accomplish this.
I believe that one can say that much was initiated at MedEd
2005, some of the issues raised can probably be signed of on, but hardly
surprisingly what were issues then are issues now for MedEd 2007. Our
aim must be to put some practical detail on these through our four
subthemes; this would then allow them to go forward, hopefully to policy
and practice.
Professor
Paul Gatenby
Chair
MedEd2007 Steering Committee
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