Introducing a new series on innovations in medical education

Over the past century, the context of medical education has changed significantly, with an explosion of medical discoveries, shorter interactions between patients and their doctors, and a dramatic rise in community expectations. Students are now required to be knowledgeable about medical sciences and learn about prevention, coordinated care, teamwork and communication. Medical education needs to graduate doctors with skills to think critically, communicate and work effectively in interprofessional teams, often in a digital workplace.

The reports on medical errors leading to many hundreds of thousands of deaths every year1 and the Commission on the Education of Health Professionals for the 21st Century in 20102 reinforce the need to transform the delivery of medical education, with a number of organisations — such as the Association of American Medical Colleges (AAMC),3 the Accreditation Council for Graduate Medical Education4 and the Australian Medical Council (AMC) — responding to the calls.

In parallel, concerns about the graduating students’ lack of preparedness for the clinical environment5 have also prompted accreditation bodies, such as the AMC, to develop more relevant graduate outcome statements, leading to some changes in medical school curricula. Learning in specialist training occurs under the auspices of various specialist colleges, accredited by the AMC, and medical registration mandates the need for ongoing professional development. However, the harnessing of this lifelong learning is disorganised and not systematic.

How do we best teach and learn when education continually competes with day-to-day work pressures? The traditional apprenticeship model is no longer considered safe and requires substitutes. Simulated learning experiences can minimise harm to patients, improve clinical skills and provide opportunities for thinking critically, making decisions and communicating in a team setting. Less resource-intense modalities include the use of digital media, such as podcasts, videos with flipped classrooms, mobile devices with applications, and gamification, which may overcome the inability to participate in educational sessions. Technologies such as Twitter6 or online courses7 are increasingly being developed and may be useful for medical students as well as for doctors in training.

The universal gap between the intended outcome of medical education and the performance of medical graduates in a health care setting has become evident over the past few decades.8 Training programs — undergraduate and graduate — are now beginning to focus on the acquisition of competencies in the form of entrustable professional activities, where medical educators make competency-based decisions on the level of supervision required by trainees. The AAMC identified a list of 13 integrated activities that might be expected of all medical school graduates on day one of clinical work without direct supervision.9 Training organisations and colleges in Australia are now starting to take up the concept of entrustable professional activities as a framework for learning.

A distinct change from historical medical education is the recognition of the importance of learning to work effectively within an interprofessional team. The Institute of Medicine recommends that health care students be trained as future interprofessional team members, which will improve patients’ outcomes,10 requiring universities and health facilities to commit to administrative support, faculty training, interprofessional programmatic infrastructure, technology, curriculum mapping and leadership.

In this introductory article, we have included some topics currently discussed among medical educators; however, the list is not complete. This MJA medical education–innovations series will outline some advances and innovations in medical education of interest to generalists, doctors in training and medical students. We are very interested in receiving your feedback about the topics that you think are important.