Volume 195 - Issue 10
Challenges with maintaining clinical teaching capacity in regional hospitals
Authors: Tarun Sen Gupta, Richard B Hays, Torres S Woolley, Isaac Seidl and Andrew Johnson
Med J Aust 2011; 195 (10): 584-585. || doi: 10.5694/mja11.10908
Published online: 21 November 2011
Published online: 21 November 2011
To the Editor: In 1999, a new medical school was established at James Cook University in an underserved region with specific needs in rural, remote and Indigenous health.1 Early data suggest graduates are contributing to the local workforce,2 but medical student places have increased further as part of the continued expansion of Australian medical education. As a result, the capacity for medical students to experience high-quality clinical opportunities is under challenge.
We explored teaching capacity through a cross-sectional survey of inpatient workload at a private and a public teaching hospital in Townsville. Both hospitals have been established as major teaching sites for the past decade. Ward audits were conducted for almost 400 inpatients, followed by content analysis of primary and additional diagnoses obtained from hospital records.
We found that in both hospitals, only about half the total number of beds contained patients who were well enough for medical student interactions, and only around half of these patients were available to the students. Overall, the clinical casemix indicated students had reasonable access to patients with a wide range of medical problems. However, the data also showed poor exposure across both hospitals to certain subspecialties, and relatively low exposure in the private hospital to more chronic and complex medical problems.
These findings suggest the potential numbers of meaningful learning opportunities per student may be fewer than expected. Growing student numbers have coincided with expansion in the emergency department, and same-day, early discharge and hospital-in-the-home services. Further, surrounding rural hospitals are being better utilised as step-down facilities for rural residents. These innovations have resulted in a decrease in the average length of stay in the main hospital wards.3,4 Although increased throughput of patients may theoretically increase teaching capacity, it is likely that higher turnover also results in students missing opportunities for holistic learning, such as practising routine history taking and examination skills, and developing a social understanding of a patient’s illness episode. About 300 inpatient beds are currently being added to the public hospital. Based on our findings, this could translate into about 75 additional patients on any given day. However, the number of medical students has now doubled to over 200 per year.
The findings suggest that, at least in one regional area of Australia, hospitals face significant constraints in expanding their clinical teaching. This may have implications for medical schools in other regions. General practices and rural hospitals may also be close to capacity.5 Therefore, we recommend that Australian medical schools plan carefully and strategically to ensure students gain access to sufficient clinical experiences. With support from the Health Workforce Australia initiatives, opportunities to innovate and expand in non-traditional clinical settings may provide a partial solution, but will require evaluation.
Competing interests
No relevant disclosures.
Acknowledgements
We thank Tracy Adams, Manager of Health Information Services at Mater North Queensland Limited, and Alycia Snell, Manager of Clinical Information Services at The Townsville Hospital, for collating the hospital records. The assistance of Dr John Stokes, Director of Intensive Care, Mater Hospital Pimlico, and final-year medical students Malcolm Forbes and Laila Khan was also invaluable in collecting data from the two hospitals.
References
- Hays RB. A new medical school for regional Australia. Med J Aust 2000; 172: 362-363. 0_CHDGJFCG
- Sen Gupta TK, Hays RB, Murray RB. Intern choices for James Cook University graduates [letter]. Med J Aust 2007; 187: 197. 0_i1142878
- Australian Institute of Health and Welfare. Australian hospital statistics 2007–08. Canberra: AIHW, 2009. (AIHW Cat. No. HSE 71; Health Services Series No. 33.) 0_i1142880
- Australian Medical Association. AMA public hospital report card 2010. Canberra: AMA, 2010. http://ama.com.au/node/6211 (accessed Oct 2011).
- Thomson JS, Anderson KJ, Mara PR, Stevenson AD. Supervision — growing and building a sustainable general practice supervisor system. Med J Aust 2011; 194: S101-S104. 0_i1142890