To the Editor: In his article on medical specialist education and training in Australia, Phelan1 raises two major issues: financial and educational.

On the financial front, Phelan asks about the advantages and disadvantages of the new funding model for specialist (pre-Fellowship) training. One of the advantages of the model is that it makes the funding process more explicit. We believe that all who benefit from this educational exercise — trainees, supervisors, private hospitals and society — should contribute financially in some way.

On the educational front, Phelan is disappointed that we did not provide evidence that university education will enhance the educational experience of trainees. However, undertaking educational studies that meet the standards required of reductionist experiments has proven to be difficult, and we have to make do with a more ecological approach.

We have no doubt that our Macquarie University scholars will derive lasting benefit from working in an environment in which learning is one of the primary goals of their existence, rather than an add-on, after-hours, activity. Learning arises not from watching, but from doing. Modern concepts of neurobiology and learning suggest that learning results in structural changes in the brain, and these will be enhanced for the learner by full participation in all processes of care. We shall ensure that learning is maximised by an appropriate balance between scholars’ clinical experience and the educational opportunities that their clinical experience will provide.

The Canadian contracting model, which Phelan mentions, is not dissimilar to the arrangement that will flow from the Memorandum of Understanding between Macquarie University and the Royal Australasian College of Surgeons and the Neurosurgical Society of Australasia, in that College trainees will substitute experience at Macquarie University for time spent in public hospitals in the College’s Surgical Education and Training Program.

In Australia, we do not share the Canadians’ advantage of having only two postgraduate colleges. Given the current fragmented state of postgraduate medical education in Australia, we believe that it is better to experiment with and to evaluate new models than slavishly to copy what appears to work in a different setting. One of the flavours of the decade is competition, and we believe that competing models should be set up and should be rigorously evaluated from both educational and financial viewpoints.

If history shows that the Macquarie lighthouse has illuminated the way to improved health for the Australian people, we shall be well satisfied.