Evidence-based medical workforce planning and education: the MSOD project

Overcoming medical workforce shortages and maldistribution remains critical in Australia.1 Numerous government initiatives have targeted these issues.2 Despite recent modest progress in increasing the supply of doctors to underserved regions,3 overall success has been limited.4

After auditing Australia’s rural and regional health workforce, the Australian Government recognised the need for longitudinal data for strategic medical workforce planning.2 The Medical Schools Outcomes Database and Longitudinal Tracking (MSOD) Project of Medical Deans Australia and New Zealand Inc (MDANZ) has been funded from 2004, initially by the Department of Health and Ageing and now by Workforce Australia, to collect data from medical students, tracking them through medical school and into prevocational training. Collection of national data began in 2006.5

As reported in the Journal in 2009, the MSOD Project aims to provide a national dataset that can be used to explain career choices and workforce patterns and inform policy.6 Four years on, to what extent are these uses being achieved?

The MSOD collection is comprehensive, with response rates to voluntary surveys at commencement and exit from medical school being maintained at 95% and 83%, respectively. Surveys are now being administered annually at the end of the first and third postgraduate years with follow-up rates of approximately 70%. The first survey at the fifth postgraduate year will be administered in 2013. Questionnaire responses provide detailed information on demographic background, educational experiences, career intentions and preferred and actual locations of practice for medical students and graduates from all Australian and New Zealand medical schools.5 Since 2005, more than 30 000 questionnaires have been collected. There is no known similar national study of medical students in any other country.

MSOD data inform medical workforce modelling undertaken by Health Workforce Australia1 and Health Workforce New Zealand, which enables analysis of trends in the supply of doctors and the training places required. Data from further administration of MSOD postgraduate questionnaires will contribute to development of national approaches to intern allocation. The data will allow assessment of the success of new initiatives such as the Prevocational General Practice Placements Program and private hospital sector internships.

MSOD data are also used by the Medical Training Review Panel in their annual reports presented to the federal Minister for Health.7 At the MDANZ medical education conference in 2012, Minister for Health Tanya Plibersek said, “The MSOD is an ambitious initiative that has provided invaluable information to stakeholders on government investment in medical education and workforce planning”.8 In particular, publications on rural career intentions and rural medical student placements provide strong support for a policy of continued government investment in rural clinical schools and training posts.9

Evidence related to medical education and workforce has to date been anecdotal. The MSOD dataset has provided the core platform for a number of studies that provide empirical evidence and were conducted by academics and medical students5 and presented at national and international forums.10 Some key findings from these studies are presented in the Box. With greater understanding of factors shaping career choices, it becomes possible to make innovations in medical education and training programs and assess the impact of those changes.

The MSOD Project has achieved international recognition for its scientific quality and capacity to contribute to development of evidence-based health policy. Details of the project were presented at the 14th International Health Collaborative Conference in Quebec.14 Through collaborations with the Australian Primary Health Care Research Institute and the Robert Graham Center in the United States, geospatial analysis and interactive web-based mapping tools are used on MSOD data to reveal the geographical footprint of medical students’ intentions to practise.15 This offers visually engaging outputs to illustrate complex issues, such as maldistribution of intentions to practise, and to help develop relevant funding mechanisms and policies to meet workforce needs.

While it may be early days for MSOD, its value as a prospective cohort study will increase over the next 5 to 10 years. Linkage with the National Health Workforce dataset with appropriate privacy constraints will augment workforce analyses. As workforce shortages within particular medical specialties are identified, linkage will provide the rationale, through consideration of data on students’ early career intentions, to make changes to educational programs and provision of incentives to meet these shortages. Over time, the linked data will also allow evaluation of such initiatives. Linkages with the Australian Rural Clinical Schools Program Survey and the Undergraduate Medical and Health Sciences Admission Test Longitudinal Study are planned. These will assist in analyses of medical school selection processes and further curriculum development.

The MSOD dataset provides mechanisms for evaluating and comparing outcomes of different medical programs (eg, graduate and undergraduate entry; shorter and longer programs) and alignment with national workforce needs.

So what does the future hold? The success of workforce research lies in its contribution to resolving medical workforce shortages and maldistribution. With close engagement between policymakers and researchers, the MSOD Project provides evidence that will continue to underpin innovative approaches to teaching and training, inform appropriate internship and specialty training placements, and contribute to further development of assessment tools and measurement of the quality of clinical training.

The outcomes of these developments should provide the medical workforce required to meet the future needs of Australia and New Zealand.