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 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 the degrees of Bachelor of Medicine and Bachelor of Surgery (MBBS) to its graduates whilst reserving the title of Doctor of Medicine (MD) for their research training degree, analogous to the PhD, or for their honorary doctorates. A notable exception is the Bachelor of Medicine (BMed) joint program of the University of Newcastle and the University of New England. Although the majority of Australian MBBS degrees have been graduate programs since the 1990s, under the previous Australian Qualifications Framework (AQF) they remained categorised as Level 7 Bachelor degrees together with other undergraduate programs.

The latest version of the AQF includes the new category of Level 9 Master's degrees (Extended) which permits the use of the term 'Doctor' in the styling of the degree title of relevant professional programs. As a result, various Australian medical schools have replaced their MBBS degrees with the MD to resolve the previous anomalous nomenclature. With the introduction of the Master's level MD, universities have also renamed their previous medical research doctorates. The University of Melbourne was the first to introduce the MD in 2011 as a basic medical degree, and has renamed its research degree to Doctor of Medical Science (DMedSc).[2]

Current Australian medical schools and their basic qualifying medical degrees are listed below:[3]

University Current Degree(s) Duration Entry Previous Degree(s)
University of Adelaide MBBS 6 years Undergraduate N/A
Australian National University MChD 4 years Graduate MBBS
Bond University MBBS 4.6 years Undergraduate N/A
Deakin University BMBS 4 years Graduate N/A
Flinders University MD 4 years Graduate BMBS
Griffith University MD 4 years Graduate MBBS
James Cook University MBBS 6 years Undergraduate N/A
University of Melbourne MD 4 years Graduate BMedSc/MBBS
Monash University MBBS 5 years Undergraduate N/A
Monash University MBBS 4 years Graduate N/A
University of Newcastle BMed 5 years Undergraduate N/A
University of New England BMed 5 years Undergraduate N/A
University of New South Wales BMed/MD 6 years Undergraduate MBBS
University of Notre Dame Australia MBBS 4 years Graduate N/A
University of Queensland MD 4 years Graduate MBBS
University of Sydney MD 4 years Graduate MBBS
University of Tasmania MBBS 5 years Undergraduate N/A
University of Western Australia MD 4 years Graduate MBBS
University of Western Sydney MBBS 5 years Undergraduate N/A
University of Wollongong MBBS 4 years Graduate N/A

Prevocational training

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.[4] For graduates of Australian and New Zealand Medical Schools, PGY1 is called internship, and they are called interns or Junior Medical Officers (JMOs).[4] PGY2 is also known as Resident Medical Officer Year 1 (RMO1).[4]

Internship

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 National Standard for General Registration took effect on 1 January 2014 and made this training structure of compulsory and non-compulsory rotations consistent across Australia.[5] 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 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.

Residency

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. In general, most doctors spend two to three years practicing as a Resident Medical Officer (RMO) in a hospital before commencing specialist training. Others may choose to continue practicing as an RMO for a longer period before deciding on the field in which they would like to specialise. Some may continue working as an RMO for the entirety of their medical careers, often because they enjoy the diversity that residency offers.[6]

Specialist training

Specialist training programs are governed by Medical Colleges, such as the Royal Australasian College of Surgeons. These colleges also oversee and maintain professional standards for their areas of specialty, and as such the requirements of specialist training programs vary between colleges. Most specialty training programs take between three and six years to complete. Doctors who have commenced specialist training through a Medical College are referred to as Registrars, although in some colleges doctors continue to be referred to as RMOs until later in the program.

Those successful in completing the requirements of their college program become Fellows of that college. They are then referred to as Specialists. Specialists typically work in specialist private practice or as a Consultant in a hospital, or sometimes both.

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 Australian Medical Colleges require their members to undertake continuing medical education. The requirements of each college vary. Some colleges, such as the Royal Australian College of General Practitioners, offer online courses that contribute to the continuing clinical and professional development of its fellows.

Urban and rural medical education

The shortage of doctors in rural areas is an ongoing problem, and to encourage medical doctors to remain in 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.[7] Transferring the curricula has not been an easy task, but there are reports of success.[8]

Online education for General Practitioners

With almost a third of Australian GPs practicing in rural areas, the use of online education has increased significantly 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

References

  1. ↑ "Information booklet 2014". Australian Council for Educational Research. Retrieved 28 September 2014.
  2. ↑ "Doctor of Medicine (MD)". University of Melbourne. 15 January 2014. Retrieved 5 July 2014.
  3. ↑ "Medical School Accreditation Program and Status Report". Australian Medical Council. Retrieved 31 May 2014.
  4. ↑ 4.0 4.1 4.2 IMG Orientation Handbook, 2nd Edition. By Medical Workforce Unit, Central Coast Local Health Network, Northern Sydney Local Health Network. January 2011
  5. ↑ "Registration Standards". Medical Board of Australia. Retrieved 3 June 2014.
  6. ↑ "What happens when you finish your medical degree?". Australian Indigenous Doctors' Association. Retrieved 7 March 2015.
  7. ↑ 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
  8. ↑ 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).