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Medical education

Health services administration Letters 10 December 2018 Free

The Australian Health Practitioner Regulation Agency does not require doctors to practise under the name that they are registered under

To the Editor: Within our clinical practice, we sought to establish the qualifications of a medical practitioner. In doing so, we discovered that medical practitioners are not required to practise under the name that they are listed under on the Australian Health Practitioner Regulation Agency (AHPRA) Register of Practitioners. A practitioner may register under one name, then practise under another. We see this as problematic for patients and inconsistent with the function of the register. AHPRA states that the register “has accurate, up to date information about the registration status of all registered health practitioners in Australia. It is an important way the National Registration and Accreditation Scheme helps keep the public safe”.1 The national register lists all practitioners registered with AHPRA and any conditions on their registration. Patients may access this information if they feel unable to make enquiries directly of a practitioner, or if they wish to view particulars before seeing the practitioner. AHPRA states that “if a practitioner's name does not appear on the register, they are not registered to practise in Australia”. The stated exemption to this statement is that “in a very small number of cases, the details of a registered health practitioner may not appear on the register because of personal safety issues”.1 It is under Part 10 of the Health Practitioner Regulation National Law Act 2009 that each national Board is empowered to maintain the register of all health practitioners currently registered by that Board.2 We note the current consultation paper by the COAG Health Council,3 in preparation for a second tranche of amendments to the National Law, which includes the proposal that the National Law be amended to “enable a practitioner to nominate one or more aliases or additional names to be recorded on the public register, with the register searchable using the alias”.3 We believe this relatively simple measure is consistent with the rights of the practitioner to use a favoured name and of the patient to confirm a practitioner's registration. We therefore support this change.

Katinka Morton · Grant Lester

Letter to the Editor2
Health services administration Letters 10 December 2018 Free

The Australian Health Practitioner Regulation Agency does not require doctors to practise under the name that they are registered under

In reply: The national online register of practitioners is a vital part of Australia's system of regulating health practitioners to assure patient safety. It makes accessible to the public and employers the names of all health practitioners who are registered to practise. It also provides important information about limits or restrictions placed on the way a registered practitioner is allowed to practise. The national online register must remain an authoritative source of trusted information on health practitioners, so consumers can rely on it for accurate and up to date information to inform their health care decision making. Through our work, we have become aware that some health practitioners practise their profession using an alias rather than their legally recognised name published on the register. The Australian Health Practitioner Regulation Agency (AHPRA) has asked governments to consider an amendment to the Health Practitioner Regulation National Law Act 2009 to enable a practitioner to nominate one or more aliases to be recorded on the public register. We are pleased that this proposal is now the subject of public consultation. AHPRA believes that recording additional names or aliases on the register would help inform and protect the public, by making it easier to identify a practitioner who may not be practising under their legal name. There are some operational and practical issues to consider. A clear definition of an alias is required so health practitioners can readily understand their obligations to inform AHPRA and the national Boards of the use of these names. Consideration would need to be given to the requirements for practitioners to provide up to date information on the use of aliases in their practice, and whether any verification of this is necessary. The validity of the register could be compromised by information that is unverified or out of date. Finally, there may be risks from unintended consequences, including whether publishing aliases could be used for commercial gain or benefits not related to public information and protection, which is the focus of the National Law. AHPRA awaits the outcomes of the current public consultation process with interest.

Martin Fletcher

Letter to the Editor1
Medical education Letters 1 October 2018 Free

Why patients should be part of medical training from day one

To the Editor:The Reflection article by Bravery1 reminded us of the disability rights movement slogan “Nothing about us without us” and prompted us to reflect on the ways in which expert patients, carers, health and patient advocates, and community members contribute to medical student teaching at the School of Medicine at the University of Notre Dame Australia, Fremantle. Their partnership is crucial to the School being able to meet the standards — (2.1.4) “the medical education provider relates its teaching, service and research activities to the health care needs of the communities it serves,” and (4.6) “learning and teaching methods in the clinical environment promote the concepts of patient centred care and collaborative engagement” — of the Australian Medical Council’s Standards for Assessment and Accreditation of Primary Medical Programs.2 From the School’s inception in 2005, academic staff and community members have worked collaboratively, in the spirit of reciprocity, to teach students. First-year students engage with teenage mothers, expert patients and their families, older people in community-based physical activity classes, and patients in general practice settings, and they live with a family in the Wheatbelt region in Western Australia to learn first-hand about the social determinants of health and the health needs and priorities of Australians in rural settings — a program undertaken in collaboration with the medical students from Curtin University.3 By the end of the pre-clinical years, students have been taught by sex workers, people of diverse sexualities, and children with cancer via panel discussions and in clinical skills sessions, and they have shadowed a patient to witness their lived journey in a community radiology clinic. A one-week Kimberley placement provides insight into health issues in remote areas by living and working in community settings such as Indigenous communities, pastoral stations, art galleries and sporting organisations. These opportunities pave the way for collaboration between the School and other professions and industries — two-way interprofessional learning in real-world settings. As stated by Bravery,1 the impact on students is palpable. They appreciate the opportunity to understand people’s personal perspectives4,5 and apply this understanding to their medical practice — “the [rural or remote placement] guides my work now … It comes back to me; it helps me understand rural people’s lives”.6

Donna B Mak · Jelena Maticevic · Brian D Power

Medical education Letters 20 August 2018 Free

The efficacy of medical student selection tools in Australia and New Zealand

To the Editor: In their recent article, Shulruf and colleagues1 concluded that prior academic achievement constituted the most effective means of predicting timely graduation. This outcome measure overlooks a more important graduate attribute: professionalism — the values and skills that the profession and society expects of doctors. This attribute is identifiable at admission, and it is possible to test for and select for this.2 When considering the desired outcome of satisfactory performance at junior medical officer level, the authors state that the “outcome of subsequent workplace performance, while important, is moderated by influences beyond the undergraduate environment”.1 This statement contradicts extensive literature suggesting otherwise. An erosion of vicarious empathy during medical education programs is well documented and is evident across other health care professions.3 Medical school education fails to consistently foster the development of advanced moral reasoning in medical students, with particular problems developing during the period of clinical immersion, when the influence of the “hidden curriculum” becomes evident to students.3 The above have been linked to the experience of burnout in students, which can manifest as professionalism lapses in both pre-clinical and clinical rotations.4 Papadakis and colleagues5 suggested that disciplinary action by a medical board was strongly associated with prior unprofessional behaviour in medical school. Most complaints against doctors are due to conduct, not competence. Many organisations have developed guidelines to ensure medical students adhere to professional standards. Academic and intellectual qualities alone cannot predict the ideal candidate for admission to medical school, and facets of professionalism such as moral orientation, resilience and self-control are acknowledged to contribute to one’s efficacy as a doctor. Furthermore, prioritising timely completion may promote students not seeking help, perpetuating poor performance in an effort to ensure timely completion. This perpetuates a workplace culture where people do not feel able to seek help, with significant repercussions as seen in the recent suicides of young doctors. Timely completion may indeed be predicted by prior academic success; however, attitudinal and behavioural factors are highly relevant at selection and throughout subsequent careers. An overemphasis on prior academic achievements may de-emphasise student characteristics associated with the development of professionalism.

Mark H Arnold · Jennifer Smith-Merry · Andrew S Lane

Health services administration Letters 2 July 2018 Free

Selecting medical students: we need to assess more than academic excellence

To the Editor: Reading the article on the task of selecting candidates for medical school,1 I recalled my own trajectory into the profession. I was interviewed by a surgeon, who was the sole interviewer, our interaction being one of genteel conversation. My peers at the time had a similar interchange with the university officials. Uniformly, we have all proceeded to remain in medicine. Our careers have lasted. One has to wonder whether a selection process that is more time consuming is actually better than the above straightforward approach. Considering personality type, there will be a wide spread of introverts and extroverts. Academically adept and generally bright, the hopefuls can perform on the day to leap over any clever tests for entrance. Moreover, the profession has niches for all of them. The introvert can quietly tend towards microbiology, while the extrovert might heartily choose to be a surgeon. Like politics, the profession needs representatives from different areas of society. We should not aim to standardise too much. There will be nations today where entry into medicine is still standardised with reference to social status. If we recruit only the well-to-do youngsters, we will not have the level of understanding that can be brought into the profession from those of humbler backgrounds. Someone from a lower economic stratum will understand the community to which they wish to return after qualifying as a doctor. I have first-hand experience of observing such a course of career in my peers. It cannot be forgotten that the aspirants keen to join medicine are very young people whose personalities have yet to ripen through living. If they can pass tough exams, then they have an admirable trait as embryonic personalities. They can focus and work with diligence. They also hold an ambition to become doctors. If they can apply themselves and do not have any overt oddities of personality, they should be given a chance to become doctors. This has been a time-tested method in medical schools — in a world that needs more doctors than ever — and I fail to be convinced that finer filters on the path into medicine will be worthwhile.

Jagdeep Singh Gandhi

Letter to the Editor1

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