Prevocational medical training and the Australian Curriculum Framework for Junior Doctors: a junior doctor perspective

Andrew J Gleason, J Oliver Daly and Ruth E Blackham
Med J Aust 2007; 186 (3): 114-116. || doi: 10.5694/j.1326-5377.2007.tb00831.x
Published online: 5 February 2007
The current situation

There is a common misconception that a medical graduate steps into a hospital and instantly becomes a doctor. In reality, the process of becoming a doctor is gradual, beginning at the undergraduate level, where one learns the principles of sound clinical practice, and continuing through the supervised hands-on experience of prevocational and vocational training. This process involves the acquisition of skills, knowledge, reasoning and experience, and is a vital foundation for later unsupervised practice. Although clinical experience during training is essential, it must be supplemented by on-the-job teaching from senior clinicians and structured education programs.

There are no published data documenting the amount of teaching available to prevocational doctors in Australia, so we make generalisations based on our experience. On a daily basis, doctors in training spend minimal time at work involved in dedicated education and training activities. As a vital cog in the day-to-day operation of the public health system, much of their time is occupied by repetitive administrative tasks. In many hospitals, the only structured education interns and residents receive is 1 hour of formal teaching a week. This teaching is of variable quality and relevance and, because of service demands, junior doctors are frequently too busy to attend these sessions. When they are able to attend, interruptions to answer pager calls often make effective learning virtually impossible (although some hospitals now have pager-free teaching time). Valuable teaching from consultants and registrars also takes place, but this is sporadic and impromptu. Teachers are left with the difficult task of determining what should be taught and how this should be done.1 The systems that do exist for delivering education are inefficient, under-resourced, under pressure and unsustainable.2 Ultimately, prevocational doctors have little time for learning, and little formal teaching is provided.

To illustrate these issues, a recent national survey, commissioned by the Australian Government Department of Health and Ageing, showed that 64% of prevocational doctors felt generally prepared for their job, 31% felt adequately prepared for clinical emergencies and 45% felt prepared for performing procedures.3 Only 20% reported exposure to clinical skills training and 56% felt that they had adequate contact with consultants. More than 80% of these trainees wanted more formal instruction from their registrars and consultants, and increased exposure to high-fidelity simulation and to professional college tutorials.

Although a high workload makes learning difficult, increasing numbers of junior doctors will not alleviate this problem unless adequate resources are provided for training. A survey of medical students and interns in WA showed that 80% of respondents predicted a negative effect of the increased medical student numbers on teaching, and 77% predicted a negative effect on training positions for junior doctors.4 A very strong emphasis on training is necessary to cope with increasing numbers of medical graduates. In keeping with this, the Productivity Commission has identified the inadequacy of funding for clinical training, and a failure to consider the clinical training implications of increases in the number of undergraduate university places.5

The state of prevocational medical education in Australia stands in stark contrast to that in the United Kingdom, where an overhaul of training for junior doctors has recently taken place. The resulting Foundation Programme is well organised and has pledged funding of £73 million.6,7

The Australian Curriculum Framework for Junior Doctors

With the development of prevocational curricula overseas, there has been a move towards curriculum development in Australia. This has led to the production of a draft Australian Curriculum Framework for Junior Doctors (Box 1), based heavily on existing curricula developed by the Postgraduate Medical Education Councils of NSW, SA and WA, the Committee of Deans of Australian Medical Schools, the Australian Council for Safety and Quality in Health Care, and curricula from the UK and Canada.7,9-14 The Framework, produced under the auspices of the Confederation of Postgraduate Medical Education Councils, will be available for viewing and feedback at The first substantive version of the Framework was launched at the 11th National Prevocational Medical Education Forum in Adelaide on 29 October 2006.

The Framework recognises many of the training needs of prevocational doctors, and has created a unique opportunity to improve the quality of medical training in Australia. The long-term outcome depends on how conscientiously and effectively it is implemented and resourced. Some brief suggestions regarding implementation appear in the preamble of the current version of the Framework, and it is expected that implementation will vary with local practice. A steering committee will be formed to discuss implementation in more detail, but it is important that we, as junior doctors, express our views beforehand.

The Framework is designed to support the process of turning medical graduates into generalist doctors. For this objective to be met, a number of areas must be addressed (Box 2).

The use of the Framework must not become a chore for the junior doctor to complete in his or her free time. The demands of working as a junior doctor are too great to have this additional burden. Training of junior doctors should be seen as a key result area for every Australian hospital. As such, the hospital and individual departments should take responsibility for the education and competency of junior doctors. Hospitals and governing bodies have a duty of care to the Australian populace that requires they ensure doctors are trained as well as possible. Not adequately meeting these needs has far-reaching implications for the general community for years to come.


Australia has the economic and intellectual resources necessary to train the best doctors in the world, and we believe that this should become a reality. The education of junior doctors as generalists before entry into vocational training is integral to the development of highly skilled medical practitioners. Ensuring that this process is as effective as possible will require debate and centralised organisation. Although ostensibly daunting, this is by no means a far-fetched task — it merely requires a modicum of funding and some creative changes to our training system and culture. The Australian Curriculum Framework for Junior Doctors has the potential to add to this process, provided it is well resourced and implemented in an effective manner with substantial input from junior doctors (Box 3). At stake is the standard of health care provided to the community. For this to be protected, an ongoing investment in prevocational medical education is required.

2 Issues to address in adopting the Australian Curriculum Framework for Junior Doctors

General aspects

The process of implementation

Practical aspects of implementation

The assessment process

  • Andrew J Gleason1
  • J Oliver Daly2
  • Ruth E Blackham3

  • 1 The Alfred Hospital, Melbourne, VIC.
  • 2 The Royal Women’s Hospital, Melbourne, VIC.
  • 3 Sir Charles Gairdner Hospital, Perth, WA.



We thank the following for their invaluable opinions and contributions: Marion Mateos and Anand Rajan (Co-Chairs, Junior Medical Officer Forum, NSW Institute of Medical Education and Training), Matthew Peters (Chair, Resident Medical Officer Committee, Postgraduate Medical Council of Queensland), Anna Lowe (Representative, Resident Medical Officer Committee, Postgraduate Medical Council of Queensland), and Michael Edmonds (Chair, Junior Medical Officer Forum, Postgraduate Medical Council of SA).

Competing interests:

Andrew Gleason received funding from the NSW Institute of Medical Education and Technology to attend meetings of the Writing Group of the Australian Curriculum Framework for Junior Doctors.

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