Medical student views about changes to internships in South Australia

To the Editor: The South Australian Institute of Medical Education and Training (SA IMET) recently conducted a review of internships in South Australia and proposed three potential changes.1 First, new prevocational training networks would rotate individual interns between more than one major teaching hospital. Under the existing system, most interns remain exclusively at one location, although there is an established southern network incorporating the Flinders Medical Centre, and some other interns undertake one rotation at a rural hospital or general practice. Second, 2-year graduate contracts would replace 1-year contracts. Third, applicants would be allocated internships on “merit” rather than through optimised preferences based on the priority groups used by SA IMET, which give priority to SA graduates and Australian citizens.2

The Adelaide Medical Students’ Society and Flinders Medical Students’ Society surveyed students about the proposed changes.3 There were 824 respondents, representing 57% of the 1447 medical students in SA. Most students opposed the proposals: 63% (459 of 725) preferred single-hospital over network-based internships; 75% (523 of 695) preferred 1-year over 2-year contracts; and 66% (451 of 679) preferred optimised preferences over merit-based allocation. Our submission to the SA IMET Council, which includes methodology and datasets, is online.3

The SA IMET Council has approved the implementation of prevocational training networks for the ostensible reason that they will enhance equity in intern exposure to different hospitals.4

It remains unclear if new networks will be introduced and, if they will, how and when this will occur.5 This ongoing uncertainty is a cause of consternation for students considering applying for internship in SA next year, as they are unsure which format their internships will take.

There are significant disparities in the desirability of internship placements at different hospitals in SA. Combined with optimised preference allocation, these disparities generate stark discrepancies in intern demographics.3 In 2010, the proportion of non-permanent Australian resident interns at the Royal Adelaide Hospital was 8%, while at the Queen Elizabeth Hospital, it was 85%.1 Such discrepancies are replicated across the state.

Although new prevocational training networks may help the government in homogenising intern demographics, they will not satisfactorily address equity, because interns will likely do four rotations at a primary site and one at a secondary site. An alternative approach to achieving both objectives would be to reduce the underlying reasons for the disparities in desirability of internship at different hospitals. These reasons could be elucidated through assessing student opinion, which remains unexamined on these issues.

Finally, prevocational training networks may result in a duplication of allocation processes. Applicants may first undergo a central optimised preference allocation conducted by SA IMET. Each network may then utilise a separate secondary process of their preference for allocation to primary and secondary sites. The uncertainty inherent in this duplicated system would be deeply unpopular with applicants, and may render SA less attractive as a location to apply for internship.