eMJA: Breen, Professional development and ethics for today's and tomorrow's doctors

Editorial

Professional development and ethics for today's and tomorrow's doctors

There is no lack of ethical and professional challenges for doctors

MJA 2001; 175: 183-184

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In this issue of the Journal, Braunack-Mayer and colleagues present a manifesto for an ethics core curriculum for Australasian medical students.¹ It is a position paper by teachers of ethics from most of the medical schools in Australasia. The authors wisely "offer" this curriculum framework and ask that it be a "living document, open to challenges . . .". Some will debate its contents, while others will debate whether an ethics curriculum should be delivered separately from other key areas of the curriculum needed to train new doctors. Both these debates will be more productive if the ethics curriculum is considered from other perspectives, which include context, continuity and challenges.

Firstly, the context. There has been a quiet revolution taking place in medical education in Australia over the past 10 years, with origins traceable to the Doherty Report on medical education and the workforce,² and encouraged and fostered by the medical schools accreditation system of the Australian Medical Council.³ Australia now has four medical schools with graduate-entry programs, and virtually all Australian and New Zealand schools have made significant changes to their curricula as they seek to train doctors to meet the needs of our society.⁴ Foremost among the changes has been the vertical integration of the theme of "professional and personal development", a domain that covers elements such as communication skills, professional attitudes, ethics, health law and issues of health and fitness to practise. The core ethics curriculum outlined by Braunack-Mayer et al should form part of this domain, and, if delivered effectively, may not be readily visible. Similarly, assessment of the acquisition of the skills, knowledge and attitudes of the ethics component of this domain should be fully integrated into the broader assessment of professional skills.

Secondly, achievement of continuity between undergraduate and postgraduate curricula needs to be considered. Some attention has been paid to ethics and health law as part of the professional development programs offered to interns,⁵ but our specialist training and continuing education programs have lagged behind. The most common response when a problem relating to doctors' professionalism arises is to add the topic to the undergraduate or primary medical curriculum! Few of the medical colleges responsible for postgraduate training address or examine important aspects of professionalism such as communication skills, professional attitudes and ethical and medicolegal issues. A notable exception is the Australasian College of Dermatologists, which, every two years, gathers its trainees for a four-day course that includes a day of interaction between trainees and dermatologists on ethical and medicolegal topics. Other colleges need to take up the challenge and devise their own ethics programs. It is to be hoped that the proposed process of external accreditation of providers of postgraduate education currently being piloted by the Australian Medical Council (in concert with the colleges) will give impetus to this.⁶

Thirdly, there is no lack of ethical and professional challenges for today's doctors. The changes to the medical curricula reflect responses to community concerns about communication skills, attitudes and common ethical and medicolegal problems, as identified by consumer groups, healthcare complaints commissions and medical boards.⁷ More recent challenges include the possible adverse consequences for patient care of corporatisation of medical practices, the risks of unfettered advertising, and dilemmas for doctors who are expected to act as patient advocates as well as "gatekeepers" of the public purse. Most currently practising doctors were not required to consider these issues as part of their medical training. It is unwise for the medical profession to put its efforts solely into training tomorrow's doctors and overlook the need to engage today's doctors in the challenge of meeting changing community expectations. If we can successfully implement postgraduate training programs in ethics, some of the difficulties that our ethics teachers have identified (eg, faculty awareness and role-modelling) might be more rapidly overcome.

No one today should argue against the need for medical ethics to be a central element of medical education, but we do need to debate how this can best be done. Braunack-Mayer and colleagues seem to suggest, by their request for resources and recognition, that they are not truly committed to an integrated curriculum. I argue that, if ethics teaching is not fully integrated, medical ethics risks being perceived by students as irrelevant to medical practice. The new curricula introduced throughout Australia and New Zealand have been designed with this integration in mind. The Association of Teachers of Ethics and Law in Australian and New Zealand Medical Schools is well positioned to examine whether our current approach is working. My own belief is that medical students are now very aware of ethical issues, but that there is a failure to build on this in the early postgraduate years.

Kerry J Breen
Immediate Past President, Australian Medical Council, Canberra

Association of Teachers of Ethics and Law in Australian and New Zealand medical Schools (ATEAM). An ethics core curriculum for Australasian medical schools. Med J Aust 2001; 175: 205-210.
Doherty RL (chairman). Committee of Inquiry into Medical Education and Medical Workforce. Australian medical education and workforce into the 21st century. Canberra: AGPS, 1988.
Australian Medical Council. Guidelines for the assessment and accreditation of medical schools. Canberra: AMC, 1998.
Lawson KA, Armstrong RM, Van Der Weyden MB. A sea change in Australian medical education. Med J Aust 1998;169: 653-658.
Australian Medical Council. National guidelines for intern training. Canberra: AMC, 1996.
Australian Medical Council. Specialist recognition and accreditation. AMC, 2001. Available at <http://www.amc.org.au/nsqac.asp>. Accessed 10 July 2001.
Daniel AE, Burn RJ, Horarik S. Patients' complaints about medical practice. Med J Aust 1999; 170: 598-602.

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