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Changes in medical education to help physicians meet future health care needs

Judith N Hudson, Kathryn M Weston and Elizabeth A Farmer
Med J Aust 2017; 206 (9): 378-379. || doi: 10.5694/mja16.00790

Generalist training may be a solution for responding to future population health needs

Health care needs are changing due to the rapidly ageing population and the increasing number of patients with long term conditions and comorbidities.1 This has occurred at a time of continuing maldistribution of the medical workforce in Australia and increased specialisation and subspecialisation within the medical profession and the medical education system. As the next generation of doctors will need to serve an older population and those with more than one condition, a more useful focus would be “much less on narrow disease silos and … more on the breadth of possible permutations of co-morbidity”.1 Long periods of training and increasing subspecialism may also lead to difficulty in changing the scope of practice in times of surplus or reluctance to move to geographic areas with medical workforce shortages.2 For example, despite increasing numbers of medical graduates in Australia, there are existing shortages in generalist specialties, such as general practice, general medicine and psychiatry, and many rural communities still have reduced access to medical care compared with urban populations.2 Do current models and degree of specialisation encountered in medical training optimally prepare physicians to serve the needs of all patients?

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  • Judith N Hudson1,2,3
  • Kathryn M Weston3
  • Elizabeth A Farmer3

  • 1 University of Adelaide, Adelaide, SA
  • 2 University of Newcastle, Newcastle, NSW
  • 3 University of Wollongong, Wollongong, NSW


Competing interests:

No relevant disclosures.

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access_time 04:29, 15 May 2017
Joachim Sturmberg

It is encouraging to see that the ideas pioneered at the Greater Murray Clinical School in Wagga Wagga have been rediscovered [1-3]. The real key to succeeding towards a "person-centered health professional workforce" is the exposure students receive to the "human experiential nature of 'dis-ease' " which more often than not occurs in the absence of identifiable disease [4, 5]. Health professional education should focus on health, current educational models expose students more or less exclusively to 'non-health'. Health is a 'personal adaptive state', most people are healthy most of the time regardless of their "identifiable diseases" [6]. It is more than high time to acknowledge the multifaceted nature of medical knowledge [7] and for a shift in focus of health professional education, however, it will not come unless teachers and practitioners expand their mindsets.

References
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2. Sturmberg JP, Reid S, Khadra MH. A Longitudinal, Patient-Centred, Integrated Curriculum: Facilitating Community-Based Education in a Rural Clinical School. Educ Health (Abingdon). 2002;15(3):294-304.
3. Sturmberg JP, Reid AL, Thacker JL, Chamberlain C. A community based, patient-centred, longitudinal medical curriculum. Rural and Remote Health (online). 2003;3(no. 210): http://rrh.deakin.edu.au/articles/subviewnew.asp?ArticleID=210; last accessed 29/07/2006.
4. Sturmberg JP. The personal nature of health. J Eval Clin Pract. 2009;15(4):766-9.
5. Sturmberg JP. Health: A Personal Complex-Adaptive State. In: Sturmberg JP, Martin CM, editors. Handbook of Systems and Complexity in Health. New York: Springer; 2013. p. 231-42.
6. White K, Williams F, Greenberg B. The Ecology of Medical Care. N Engl J Med. 1961;265(18):885-92.
7. Sturmberg JP, Martin CM. Knowing - in Medicine. J Eval Clin Pract. 2008;14(5):767-70.

Competing Interests: No relevant disclosures

Assoc Prof Joachim Sturmberg
Newcastle University

access_time 04:19, 19 May 2017
Larry A. Green

I appreciate this commentary! People in all our countries are waiting for a re-balancing of medical practice such that generalism and specialism co-exist with their respective ideas, ways of decision-making, and implementation. The educational system, as in Wollongong, needs much bolder action world-wide.

Competing Interests: No relevant disclosures

Dr Larry A. Green
University of Colorado

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