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Time for another medical revolution

Martin B Van Der Weyden
Med J Aust 2008; 188 (8): 433.
Published online: 21 April 2008

If there is one constant in medicine, it is change. Medical education has not escaped this phenomenon, with recent initiatives including early exposure to real-world clinical experiences, a shift from pedagogical teaching to self-learning, and an emphasis on problem-based learning and effective communication. The ultimate aim is to produce an individual who is grounded in patient care and medical knowledge, committed to lifelong learning, and an exemplar of communication. Feeding this stream of graduates is an array of undergraduate and graduate medical schools with a variety of curricula.

However, despite these reforms, one aspect of medical education in Australia has remained unchanged, namely the time taken to graduate doctors: 5–6 years for undergraduate-entry schools and 4 years for graduate-entry medical schools. Interestingly, at least two medical schools in Canada have opted for 3-year courses. Has 1 year less made a significant difference? Anecdotal evidence would suggest not. Performances immediately after graduation or after specialist training appear not to be influenced by whether the students graduated from a 3-year or a 4-year program.

This raises the question of why under-graduate and, for that matter, postgraduate medical training in Australia is governed by apparently immutable and rigid timeframes. The next revolution in medical education is to determine whether commitment to these timeframes is warranted.

The time has come for health and education ministers to question whether adherence to 4–6-year courses, given their high social and professional costs, is justified. Medical students should ask whether this prolonged preparation time actually makes them better and wiser doctors. And professional Colleges should be asked to justify the arbitrary time currently required for specialisation.

It's time for another medical revolution, to promote the collection of rigorous evidence and the encouragement of flexibility and individuality in the education of our future doctors.

  • Martin B Van Der Weyden


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