Educating Australia’s future doctors

Educating our future doctors has never before been such a high-stakes activity. The explosion of medical knowledge, new models of health care delivery, workforce imperatives and demands for greater social accountability are changing educational practice at an international level. Over the past decade, Australian medical schools have been at the forefront of many of these changes, as educators seek to consolidate our reputation as a provider of high-quality medical education.

A major priority has been to ensure that the content of medical school programs is relevant and evidence-based. With competing demands on curriculum time, there has been a pressing need to define the core knowledge, skills and attitudes required by medical students to be practice-ready for their junior doctor years. This continues to be a complex and challenging exercise. There has been, for example, robust and at times acrimonious debate about the required depth of bioscience knowledge in entry-to-practice medical programs, in part fuelled by publication of the Australian Medical Education Study.1

Medical schools have also faced the task of extending the core curriculum to reflect changing emphases in health care delivery. Specific expertise is required to sustain new models of practice, such as interprofessional practice, effective management of the diseases of ageing, and chronic condition self-management support. The importance of laying the foundations of this expertise in medical school is increasingly being recognised, particularly within the broader context of the quality and safety movement.2

Considerable energy has also been devoted to optimising the efficiency and efficacy of medical school education.3 New theoretical models of learning, as well as the outcomes of educational research, are being used to define best practice.4 There has been an increasing emphasis on developing pedagogical approaches that help students to effectively appraise information and apply problem-solving frameworks. Substantial progress has also been made in the area of clinical skills acquisition, by applying techniques such as simulation-based learning, hypothesis-driven physical examination and deliberate practice.5

At the same time, the delivery of quality medical school education in Australia has been challenged by economic, logistic and workforce imperatives. One of the main reasons has been the need to overcome the shortage of medical practitioners, particularly in rural areas. This, combined with the expansion of the international student market, has led to a dramatic surge in medical student numbers in Australia, from 1287 in 2004 to a projected 3018 by 2014.6 The increasing demand for places has been accompanied by a growth in the number of medical schools between 2000 and 2008 from 10 to 19, with at least four other universities currently pursuing the right to establish medical programs.

Significant challenges in coordinating clinical placements have arisen as a result of increasing student numbers and changing educational practices. The tertiary teaching hospital is no longer the sole provider of clinical education, and teaching now occurs in a wide variety of locations, including community settings and laboratories for simulation-based learning. Considerable effort has been required to foster consistency of curriculum delivery across these dispersed learning environments. Various bodies, such as the Australian Medical Council and Health Workforce Australia, are working to ensure medical students receive high-quality supervision as well as suitable clinical experience.7

Maintaining a well trained medical education workforce, nevertheless, remains at the heart of educating our future doctors. Several programs, such as Teaching on the run,8 are now offered to help clinical teachers enhance their expertise. Furthermore, a range of postgraduate qualifications is available for those wishing to explore the discipline in more depth or to assume leadership roles in medical education.

A greater emphasis on academic development has contributed to strengthening of relationships with other areas of medical education. The continuum of learning is more clearly articulated than in the past; specifically, the Australian Curriculum Framework for Junior Doctors now provides a pivot between medical school education and vocational training.9 Medical schools are also strengthening their relationships with the wider community, in recognition of their social obligations. This has been exemplified by the development of the Indigenous Health Curriculum Framework,10 and selection procedures that aim to provide equity of access for disadvantaged applicants and shape the medical workforce so that it better serves diverse patient populations.

With these developments has come a greater recognition of the need to evaluate the efficacy and cost-effectiveness of innovation in medical school education. It must be acknowledged that much of the reform in medical education has preceded rigorous inquiry, and the discipline has been rightly criticised for this.11 Accordingly, there has been a greater commitment to undertaking programmatic research and implementing strategies that feed outcomes back into educational policy and practice.

In recognition of the importance of educating our future doctors, the MJA today begins a series of articles exploring the changes taking place in medical school education in Australia. For each article in this Medical Education series, there will be a one-page summary in the MJA’s print edition, and the complete text will be published on the MJA’s website (mja.com.au).

doi: 10.5694/mja11.10968