Medical education in Australia

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Medical education in Australia is concerned with both the basic training of medical practitioners and with the post-graduate training of medical specialists.

Medical school[edit]

Various models of medical education exist in Australia. Undergraduate programs typically last 5–6 years, and by-definition, admit secondary school matriculants. Applicants are usually assessed by a combination of high school leaving certificate performance, Undergraduate Medicine and Health Sciences Admission Test (UMAT) score and an interview. Graduate medical programs typically last 4 years, and applicants are assessed on the results of their previous academic degree in addition to aptitude tests and interviews. The most commonly used selection test is the Graduate Australian Medical School Admissions Test (GAMSAT).[1]

During the pre-clinical years, theoretical domains of study predominate most Australian medical programs. However, early clinical exposure — in which students commence clinical skills training early in the course, concurrently with theoretical study — is a component of many programs, particularly graduate medical programs. In recent years, medical school teaching and learning in Australia has taken on a new direction in line with international trends. At most universities there has been a shift from traditional methods of teaching to the Problem Based Learning (PBL) pedagogy including the use of Objective Structured Clinical Examinations (OSCEs).

Historically Australian medical schools have followed the British tradition by conferring MBBS degrees to medicine graduates. The notable exception is the Bachelor of Medicine (BMed) joint program of the University of Newcastle and the University of New England. Australian MBBS degrees can be either undergraduate-entry (i.e. after high school) programs of 5 or 6 years duration, or graduate-entry programs of 4 years duration.

Recently, some universities have begun to rename the MBBS to Doctor of Medicine (MD). This new MD is not to be confused with the traditional MD in the Australian medical education hierarchy, which is a terminal research degree akin to a Doctor of Philosophy (PhD). These programs are required to conform to the Australian Qualifications Framework Level 9 (Extended Masters) requirements, particularly in relation to research publication.[2] The University of Melbourne was the first to rename their MBBS to MD,[3] with University of New South Wales[4] and Griffith University[5] following suit, and University of Queensland expected to follow.[6]

Currently accredited basic medical qualifying degrees are listed below (as at 31 May 2014):[7]

University Degree Duration Entry level Notes
University of Adelaide MBBS 6 years Undergraduate
Australian National University MChD 4 years Graduate
Bond University MBBS 4.6 years Undergraduate
Deakin University MBBS 4 years Graduate
Flinders University MD 4 years Graduate Name changed from BMBS to MD from 2013.
Griffith University MD 4 years Graduate Name changed from MBBS to MD from 2014.
James Cook University MBBS 6 years Undergraduate
University of Melbourne MD 4 years Graduate Name changed from MBBS to MD from 2013.
Monash University MBBS 5 years Undergraduate Runs both undergraduate and graduate programs.
Monash University MBBS 4 years Graduate Runs both undergraduate and graduate programs.
University of Newcastle BMed 5 years Undergraduate Joint program with University of New England.
University of New England BMed 5 years Undergraduate Joint program with University of Newcastle.
University of New South Wales MD 6 years Undergraduate Name changed from MBBS to MD from 2013. Runs both undergraduate and graduate programs.
University of New South Wales MD 4 years Graduate New program from 2013. Runs both undergraduate and graduate programs.
University of Notre Dame Australia MBBS 4 years Graduate
University of Queensland MD 4 years Graduate New program changing from MBBS to MD in 2015.
University of Sydney MD 4 years Graduate
University of Tasmania MBBS 5 years Undergraduate
University of Western Australia MD 4 years Graduate Presently transitioning from an undergraduate/graduate MBBS to a graduate MD[8]
University of Western Sydney MBBS 5 years Undergraduate
University of Wollongong MBBS 4 years Graduate

Prevocational training[edit]

Prevocational training refers to the first two years of training that medical graduates undertake after leaving university. These are commonly referred to as PGY1 and PGY2 (where PGY stands for "postgraduate year"). For international medical graduates, entry into prevocational training requires AMC certification.[9] For graduates of Australian and New Zealand Medical Schools, PGY1 is called internship, and they are called interns or Junior Medical Officers (JMOs).[9] PGY2 is also known as Resident Medical Officer Year 1 (RMO1).[9]

Internship[edit]

All States and Territories require medical graduates to successfully complete at least one year of supervised practice, generally known as an internship. Internship is undertaken in hospital, general practice and community training positions accredited for this purpose. Interns in Australia are required to complete compulsory rotations in Emergency Medicine, General Medicine and General Surgery, with the remaining internship time spent in non compulsory rotations across a diverse range of medical disciplines. The advent of the National Standard for General Registration, due to take effect on 1 January 2014 will see this training structure of compulsory and non compulsory rotations consistent across Australia.[10] Rotations differ across training sites in terms of clinical content and patient load in accordance with the health services delivered at each site. In some states, a general practice term is offered for the compulsory Emergency Medicine, given the availability of undifferentiated patient morbidity and acuity at such sites. Interns are closely supervised during each rotation and routinely assessed. Successful completion of Internship results in the granting of general registration as a medical practitioner.

Aside from experience gained through working, formal educational opportunities are required to be provided by intern training providers along with a range of wellbeing and advocacy infrastructure specifically tailored to interns. Accreditation of intern training programs and positions is conducted by each State's postgraduate medical council or equivalent, under the approval and authority of the Medical Board of Australia. The majority of postgraduate medical education councils/equivalent are part of the State health department, though structural models vary widely. A minority are independent of the State health department. Accreditation frameworks have been nationalised since the successful adoption in 2009 of the Prevocational Medical Accreditation Framework. This important milestone, along with the Australian Curriculum Framework for Junior Doctors, represented a significant watershed moment in nationally consistent intern education and accreditation. Since then, the Medical Board of Australia have appointed the Australian Medical Council to review and further nationalise intern training and training. This latest generation of nationalisation is expected to take effect in 2014 in tandem with the National Standard for General Registration.

Residency[edit]

Upon successful conclusion of the intern year, doctors qualify for full registration with the Medical Board, and are licensed to engage in independent medical practice.

Specialist training[edit]

Specialist training varies considerably from specialist college to college. In some specialist college training programs a trainee may continue as an RMO in their early training, whilst in most others trainees begin at registrar level.

At the same time as working in hospitals or other healthcare environments, registrars also prepare for examinations for admission into specialist medical colleges, such as the Royal Australian College of General Practitioners, the Royal Australasian College of Surgeons, etc.

Those successful in completing the requirements of their college program become fellows of that college. They are now specialists in the case of most areas of medicine (and typically work in specialist private practice and/or as a consultant in a hospital).

There have been recent calls for harmonisation of the accreditation of medical specialist college training programs. This is consistent with the nationalisation underway within the prevocational phase of the medical training continuum. It remains to be seen if harmonisation reaches the vocational phase of the medical training pipeline.

The recent growth in medical schools and medical graduate numbers has resulted in an increased number of prevocational and resident doctors who seek entry to vocational training programs as part of their professional development. Entry requirements and demand varies widely from medical colleges and historically there is consistent over-subscription to more "popular" specialisations (such as orthopaedic surgery) and an under-subscription to other specialisations. This mal-distribution of medical specialities has been under increasing study by national medical workforce bodies.

Continuing medical education[edit]

All professional colleges require their members to undertake continuing medical education; the requirements of each college vary.

Urban and rural medical education[edit]

The shortage of doctors in rural areas is an on-going problem, and, to encourage medical doctors to remain in the rural areas after qualification, the Australian Commonwealth Department of Health and Ageing has set aside considerable funding to establish rural clinical schools in every Australian State.[11] Transferring the curricula has not been an easy task, but there are reports of success.[12]

Online Education for General Practitioners[edit]

With almost 30% of Australian General Practitioners (GPs) being 'rural' the use of education access online has exploded in recent years. A key online provider is ThinkGP which is the largest single provider of online education to GPs in Australia.

Established in 2005 by a GP Dr John Crimmins the site has become an excellent litmus test for the uptake of online learning for Australian GPs. The uptake of online education by GPs is currently being studied by Monash University who feel this should influence the standards of education delivery to GPs in the future.

See also[edit]

References[edit]

  1. ^ "Information booklet 2014". Australian Council for Educational Research. Retrieved 28 September 2014. 
  2. ^ "Additional areas for consideration for accredited education providers proposing implementation of a Masters Degree (Extended) level primary medical degree". Australian Medical Council. Retrieved 5 July 2014. 
  3. ^ "Doctor of Medicine (MD)". University of Melbourne. 15 January 2014. Retrieved 5 July 2014. 
  4. ^ "UNSW makes MD official". The Australian. Retrieved 3 July 2014. 
  5. ^ "Community Newsletter May 2013". Griffith University. Retrieved 5 July 2014. 
  6. ^ "Doctor of Medicine degree (MD) at UQ". University of Queensland. 17 February 2014. Retrieved 4 July 2014. 
  7. ^ "Medical School Accreditation Program and Status Report". Australian Medical Council. Retrieved 31 May 2014. 
  8. ^ "UWA Faculty of Medicine". Retrieved 5 July 2014. 
  9. ^ a b c IMG Orientation Handbook, 2nd Edition. By Medical Workforce Unit, Central Coast Local Health Network, Northern Sydney Local Health Network. January 2011
  10. ^ "Registration Standards". Medical Board of Australia. Retrieved 3 June 2014. 
  11. ^ Maley M, Denz-Penhey H, Lockyer-Stevens V, Murdoch JC: Tuning medical education for rural-ready practice: designing and resourcing optimally. Medical Teacher; 2006;28(4):345–350
  12. ^ Denz-Penhey, Harriet; Murdoch, J Campbell (2010). "Organising a clinical curriculum in rural settings: implementing quality control". The Internet Journal of Medical Education 1 (1).