Volume 186 · Issue 7 · Supplement

National leadership depends on developing national, evidence-based strategies in medical education

Richard E Ruffin BSc, FRACP, MD · Brendan J Crotty MB BS, MD, FRACP · Louis I Landau MB BS, FRACP, PhD · Barry P McGrath MB BS, MD, FRACP

Internship in the 2 years between university and specialisation or general practice is intended to prepare medical graduates for the practicalities of lifelong professional practice. Changes in both society and new doctors’ expectations mean that anachronistic teaching models need to give way to improved education during internship by doing the following: providing better education and rewards for intern trainers; piloting and evaluating new intern rotations, with support; promoting the value of teaching and training as a means of assuring quality and safety; using the new Australian Curriculum Framework for Junior Doctors to promote diverse learning pathways for interns while establishing an Australian baseplate for internship education; piloting and evaluating the effectiveness of intern education programs with minimal bureaucratic arrangements; advocating hospitals and health departments for improved intern training; and continuing efforts to ensure that the continuum of learning from undergraduate to postgraduate medical education strengthens so as to avoid unnecessary repetition.

Stephen R Leeder MD, PhD, FRACP

The current changes in postgraduate training in the United Kingdom are largely driven by government rather than the profession, and are aimed at producing a medical workforce more quickly and more fit-for-purpose in a rapidly changing National Health Service. Most aspects of the changes are, as yet, untested. Postgraduate training now consists of a 2-year varied Foundation program, followed by selection to a longer training program within a chosen specialty (often with further selection points to different subspecialties after 2 years). Assessment systems are a combination of workplace-based assessments and national examinations of knowledge and skill. The changing, highly managed and partially privatised health service in the UK presents challenges in terms of providing appropriate clinical experience for training. Postgraduate medical education is now regulated by the Postgraduate Medical Education and Training Board, which sets standards for all aspects of training, and approves curricula, programs and assessment systems. The lessons to be learned from the UK are: When education changes, the actual rationale should be clear. It is important to understand the difference between political and professional agendas. Protection of adequate clinical experience is paramount. Competence models can “instrumentalise” medical education (ie, deconstruct integrated professional performance, attempt to micromanage, streamline, objectify and rationalise for purposes of cost or time containment or for managerial imperatives). Standards for medical education should be clear, but not at too specific a level. If trainees’ career structures change, careers advice must also change.

Janet R Grant PhD, FRCGP(Hon), FRCP(Hon)

The Confederation of Postgraduate Medical Education Councils launched the Australian Curriculum Framework for Junior Doctors in October 2006. The curriculum framework: balances the major areas of clinical management, communication and professionalism, and highlights the importance of an integrated approach to prevocational learning and teaching; supports practice-based, opportunistic and continuous learning, and specifies performance and supervision requirements for junior doctors; and has been published in both Internet and printable versions, to make the document accessible and easily usable by junior doctors and supervisors. The implementation of the curriculum framework will be overseen by a steering group that includes representatives from key stakeholder groups, including junior doctors and medical students.

Ian S Graham MB BS, MHP, FRACMA · Andrew J Gleason MB BS(Hons), BSc · Gregory W Keogh MB BS, FRACS · Deborah Paltridge BApplSci(Phyt), MHSc(Ed) · Ian R Rogers MB BS, FACEM · Merrilyn Walton BA, MSW, PhD · Caroline De Paola PhD · Jagdishwar Singh PhD · Barry P McGrath MB BS, MD, FRACP

The junior medical officer (JMO) forum and the combined director of clinical training (DCT) and registrar forum, held as part of the 11th National Prevocational Medical Education Forum in Adelaide in October 2006, discussed issues including the newly launched Australian Curriculum Framework for Junior Doctors; resourcing for JMO training; the role of international medical graduates; and the importance of JMO welfare. The JMO forum resolved that the national curriculum framework be used to ensure adequate training and educational opportunities are provided to JMOs; that accreditation should be performed for all JMO positions; and that JMO welfare should be a priority. The DCT and registrar forum discussed the use of the national curriculum framework to add value to the current training system; improve support of international medical graduates entering the workforce; and improve resources available for training JMOs.

Michael J R Edmonds BMedSci(Hons), MB BS · David S Everett FRACP

When prevocational medical trainees become registrars, they have increasing responsibilities for ensuring safe, effective, and timely delivery of health care, while simultaneously performing a number of managerial and leadership roles. Registrars do not currently receive training for their roles as front-line managers, despite this being an identified need by trainees and the health care workers with whom they interact. The national program for the Professional Development of Registrars is a soundly based, well developed and successful generic program that could be applied in a wide variety of postgraduate arenas.

Andrew A Block MB BS, BMedSci, FRACP · Jagdishwar Singh PhD · Anne M Kanaris PhD · Barry P McGrath MB BS, MD, FRACP

There will be a massive increase in the number of medical school graduates over the next 5–10 years — there were 1287 Australian resident graduates in 2004, and there will be more than 3000 by the middle of the next decade. A workshop held during the 11th National Prevocational Medical Education Forum explored ways to provide the additional prevocational training posts that will be required. Four possible sites for additional training posts were discussed: expansion of public hospital training posts; general practice; private hospitals; and other sites, including private rooms and community placements. Current accreditation procedures will need to be amended to accommodate more interns. There will be limited access to prevocational training posts for non-resident (full-fee-paying) graduates and international medical graduates. There is an urgent need for postgraduate medical councils, state health departments, the federal government, and medical boards to work together to identify, develop and accredit new training posts.

Brendan J Crotty MB BS, FRACP, MD · Terry Brown MB ChB, FFAEM, FACEM

Changes in health care systems in Australia have had an unanticipated impact on the traditional scope of education and training opportunities for junior medical officers (JMOs) in public hospitals. It has become apparent that the context of JMO training must expand and evolve. The value of general practice and community-based term rotations for JMOs is well established in the literature. South Australia has successfully implemented JMO training in rural and urban general practice settings, and in areas of workforce need in metropolitan community health centres. Western Australia is piloting new models of JMO education and training in outer metropolitan and rural areas, with the intention of expanding its education sites in 2008. Community and general practice terms are in keeping with key objectives of the Australian Curriculum Framework for Junior Doctors, showing that a new era of cooperative venture between universities, postgraduate medical councils, regional training providers and health networks, and specialist training colleges is achievable.

Karen Grace MSocSci · Colleen J Bradford MB BS, FRACGP

Designers of accreditation processes must choose whether the process will be based on “principles” or “rules”, how judgements are made, and the extent to which the process is intended to be formative (ie, beyond a summative accreditation decision). Principles-based quality improvement models should be considered as a basis for accreditation processes. Principles-based approaches are: applicable to the accreditation contexts of health care and health education; systemic in focus; consistent with “quality” being an integrated business activity rather than an “add-on”; likely to encourage self-directed improvement behaviour; suited to peer-review processes in professional settings; and typically well received by participants.

Lindsay H Heywood PhD, MBA, FAICD

The new curriculum framework for doctors in postgraduate years 1 and 2 is a step towards seamless medical education. The framework will need additional components to make “the curriculum” deliverable. Assessment is an essential element of most curricula, and assessment systems should be carefully planned. Diligent observation and rating in the workplace may provide a suitable approach. In the future, Australia must also thoroughly engage with the debate on continuing validation of competence.

Brian C Jolly BSc, MA, PhD

A comprehensive but succinct orientation is vital for junior doctors as they rotate through jobs during the early postgraduate years. The orientation process will become increasingly relevant in Australia with the change of work patterns to shorter hours and rotating shift rosters. Although orientation is often thought to be suboptimal, there is limited research published on this important process. Feedback from junior doctors suggests that formalised orientation programs at the start of term are highly valued. Junior doctors themselves should be involved in the development and delivery of the orientation program. Junior doctors appreciate the participation of senior staff in the orientation program, but much of it can be overseen by registrars, nursing staff and allied health staff. Use of a standardised proforma with peer-to-peer delivery can facilitate a smooth orientation.

Seonaid Mulroy BSc(Hons), MB BS(Hons) · Ian R Rogers MB BS, FACEM · Neela Janakiramanan MB BS(Hons) · Michelle Rodrigues MB BS(Hons)