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

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.

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