Medical education in Australia

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

Various models of medical education exist in Australia. Undergraduate-entry program typically last 5–6 years, and permit entry from secondary school matriculation. Applicants are usually assessed by a combination of high school leaving certificate performance, UMAT (Undergraduate Medicine and Health Sciences Admission Test) score and interview. Graduate medical programs typically last 4 years, and require the entrant to have attained a previous bachelor degree qualification at a certain level of achievement in addition to aptitude tests and interviews. The most common selection test used is the GAMSAT (Graduate Australian Medical Schools Admission Test).

In early years, theoretical domains of study predominate, with increasing clinical focus during the program. However, early clinical exposure — in which students commence clinical skills from very early in the course, concurrently with theoretical study — is a component of many degrees, most notably the graduate medical programs. In recent years medical school learning and teaching in Australia has taken on a new direction. At most universities there has been a move away from the more traditional methods of teaching with a shift towards the Problem Based Learning (PBL) pedagogy including the use of Objective Structured Clinical Examinations (OSCEs).

Depending on the program undertaken, students graduate as Bachelor of Medicine / Bachelor of Surgery (MBBS), (BMBS), or an equivalent Bachelor of Medicine (BMed), in addition to any other degrees attained during study.

Recently, there is a review of the Australian Qualifications Framework which proceeds the masters degree(extended) to allow the use of "Doctor of ......" for the degree's title. Many Australian universities are under the process of superseding their bachelor-level degree (MBBS) by master-level degree (MD) to meet the criteria of Bologna process.

The University of Melbourne in Australia introduced the North American MD degree in 2011 for graduates of the Bachelor of Biomedicine and Bachelor of Science New Generation degrees. The university is the first in Australia to leave the Bachelor of Medicine and Bachelor of Surgery (MBBS) and offer the Doctor of Medicine (MD) as a first professional degree in medicine rather than as a research degree. The first cohort of MD students from the university will graduate in 2014, one year after the last graduating cohort of MBBS students. The University of Melbourne renamed its previous research MD degree to Doctor of Medical Science (DMedSc), which will distinguish the new MD graduates from the doctors who obtain the research degree.

The University of Western Australia from 2014 will begin a similar 4 year post graduate course with graduates qualifying with an MD (professional doctorate) rather than the MBBS (bachelor's degree) as it stood up until 2011.

The University of Queensland is planning on also introducing the MD to replace the current Bachelor of Medicine and Bachelor of Surgery from 2015.

Griffith University will introduce the MD to replace the MBBS from 2014. The Medical Board of Australia will recognise graduates of this award from the end of 2014.

Flinders University is offering the Bachelor of Clinical Sciences which provides students with tailored preparation for the Doctor of Medicine (master's degree "extended") .

The University of New South Wales is proposing to change from their old style MBBS degree to the joint-degree BMed/MD (Bachelor of Medical Studies/ Doctor of Medicine). This program will start at the end of 2013.

The University of Sydney will award the graduate-level MD degree (master's degree "extended") instead of undergraduate MBBS from 2014.

The University of Newcastle and University of New England are considering to renew their (Joint Medical Program) Bachelor of Medicine(BMed) at the level 7 bachelor's degree to level 9 master's degree "extended" according to Australian Qualifications Framework which is the Doctor of Medicine(MD) from 2015.

The University of Adelaide is currently under the process of developing a new curriculum from traditional MBBS (level 7) to MD or Doctor of Medicine (level 9) which will be ready at the end of 2015.

In the Australian capital city, the Australian National University is proposing to change its medical program from the current Australian Qualifications Framework (AQF) Level 7 program resulting in the award of the MBBS degree to the AQF Level 9 Extended program resulting in the award of the MChD or Medicinae ac Chirurgiae Doctoranda (Latin for Doctor of Medicine and Surgery) degree. This change has not yet been finalised and will not be until the outcome of the current Australian Medical Council reaccreditation process for the ANU Medical School is known towards the end of this year. However, students coming into the program in 2014 should note that if the new program is accredited, they will graduate with the MChD. If the new program is accredited, students currently enrolled in the MBBS program will be offered a choice as to which award they graduate with. Again, subject to the outcomes of accreditation for the MChD award, the MBBS award will cease to be offered at the ANU from 2018.

Student life is well-catered for at medical schools in Australia, with medical students generally running one of the most active societies on campus. There is also a national medical students society, AMSA (Australian Medical Students' Society), responsible for student advocacy on a national level. AMSA also runs the AMSA Convention.

See also: Medical Schools in Australia

Internship

In 2012, the intern training system in Australia has come under severe criticism for refusing to provide internships to locally trained medical school graduates on the basis of their citizenship. Over 150 graduating full fee paying medical students were facing deportation as State and Territory governments had not guaranteed internship positions and funding for this group of students. This is despite a severe shortage of doctors in Australia, and a practice of importing large numbers of trained physicians from abroad.

Some States amended their employment arrangements through expansion of internship positions within the private hospital sector. The Department of Health and Ageing provided funding to support the employment of full fee paying students as well as funding to assist in the required accreditation of these additional positions. This arrangement was reached in late 2012. Despite the significant efforts made by private hospitals and accrediting bodies to secure additional positions, the majority of the affected graduates found employment elsewhere. Despite this, the growth of internship training opportunities within the private sector along with the innovative collaborative arrangements established between private providers and public sector providers, remains a significant achievement of the 2012 "internship crisis". A significant factor cited in analysis of the 2012 "internship crisis" was the paucity of reliable projections for graduate numbers and the impact this had on the employment of medical graduates. It remains to be seen whether this lack of data can be resolved in future years so that appropriate planning can take place between medical schools and intern employers.

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 . 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.

Historically the intern year was the only postgraduate training required to obtain a Provider Number. However, since 1996 the Commonwealth Government no longer issues Provider Numbers to doctors who have not completed postgraduate training (with some notable exceptions). A Provider Number is required to bill Medicare

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

Upon successful conclusion of the intern year, doctors qualify for full registration in the Medical Board of their State or Territory, and are licensed to engage in independent medical practice. However, because Provider Numbers are not issued to doctors who have not completed postgraduate studies, nearly all doctors continue their training as Resident Medical Officers (RMOs) in hospitals, which typically lasts two years.

Some states (e.g. New South Wales) also require junior doctors to undertake a second generalist year, which is their first RMO year. Other states permit streaming from the first RMO year.

Specialist training

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

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

Urban and rural medical education

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. Transferring the curricula has not been an easy task, but there are reports of success.

See also

• Medical Schools in Australia
• Category:Schools of medicine in Australia
• Category:Teaching hospitals in Australia