Australian Medical Education - Is it Good for Our Health? Helen C Beh CEO, Australian Orthopaedic Association Helen C Beh CEO, Australian Orthopaedic Association

The changes Selection Process Course Structure and Content Teaching Methods Selection Process Course Structure and Content Teaching Methods

Changes to selection From virtually unrestricted entry to: Entry on basis of HSC performance Entry on basis of performance on multiple selection tools HSC Performance Graduate status Interview GAMSAT Score From virtually unrestricted entry to: Entry on basis of HSC performance Entry on basis of performance on multiple selection tools HSC Performance Graduate status Interview GAMSAT Score

Reasons for Change Restriction on number of medical places Students entering medicine with: Wrong motivation Poor communication skills Poor social skills Poor medical skills Restriction on number of medical places Students entering medicine with: Wrong motivation Poor communication skills Poor social skills Poor medical skills

Changes to Course Content and Structure Change from undergraduate to graduate course in some Universities Change from focus on pure science medical science to focus on medical practice Change from subject-based to theme- based course content Change from undergraduate to graduate course in some Universities Change from focus on pure science medical science to focus on medical practice Change from subject-based to theme- based course content

Reasons for Change to GMP GMPs aimed at Greater student maturity Wider student life experience GMPs aimed at Greater student maturity Wider student life experience

Reasons for Course Content Changes Greater integration of medical science and medical practice Greater focus on medicine as a community concern Greater focus on patient-doctor interaction Greater integration of medical science and medical practice Greater focus on medicine as a community concern Greater focus on patient-doctor interaction

University of Sydney Pre GMP Year 1 Biology, Chemistry, Physics, Mathematics Year 2 Pharmacology, Human Biology. Biochemistry Year 3 Microbiology & Immunology, Anatomy, Human Biology (Cell & Molecular), Biochemistry, Clinical Statistics, Behavioural Sciences in Medicine, History & Philosophy of Medicine Year 4 Anatomy, Histology & Embryology, Behavioural Sciences in Medicine, Medical Communication, Physiology, Medical Biochemistry Year 5 Infectious Diseases & Pharmacology, Medical Communication, Clinical Diagnosis, Immunology, Pathology, Clinical Physiology, Neuroscience, Clinical Epidemiology Year 6 Infectious Diseases, Pathology, Pharmacology,Public Health, Medicine, Surgery Year 1 Biology, Chemistry, Physics, Mathematics Year 2 Pharmacology, Human Biology. Biochemistry Year 3 Microbiology & Immunology, Anatomy, Human Biology (Cell & Molecular), Biochemistry, Clinical Statistics, Behavioural Sciences in Medicine, History & Philosophy of Medicine Year 4 Anatomy, Histology & Embryology, Behavioural Sciences in Medicine, Medical Communication, Physiology, Medical Biochemistry Year 5 Infectious Diseases & Pharmacology, Medical Communication, Clinical Diagnosis, Immunology, Pathology, Clinical Physiology, Neuroscience, Clinical Epidemiology Year 6 Infectious Diseases, Pathology, Pharmacology,Public Health, Medicine, Surgery

University of Sydney Years 1-3 Basic and Clinical Sciences Patient & Doctor Patient and Community Personal and Professional Development Year 4 Child & Adolescent Health Perinatal & Women’s Health Community Practice Psychological Medicine - Drugs & Alcohol Option Years 1-3 Basic and Clinical Sciences Patient & Doctor Patient and Community Personal and Professional Development Year 4 Child & Adolescent Health Perinatal & Women’s Health Community Practice Psychological Medicine - Drugs & Alcohol Option

Course Description: Learning in the University of Sydney Medical Program is integrated across disciplines and between years. Learning is based on clinical problems presented in tutorial settings. Principal areas of study: Throughout its four years, the program is organised around four major themes rather than around specific subjects or disciplines. The emphasis is on progressive development across all four themes in the knowledge, skills and behaviour appropriate for a graduate. The themes form the basis both for the design of the curriculum, and for the assessment of student learning. The themes are; basic and clinical science; community and doctor; patient and doctor; personal and professional development

University of Melbourne Semesters 1-5 (Years 1 - 3) Body Systems: Basic Sciences in Medicine Human Mind & Behaviour in Health & Illness: Health & Society Introduction to Clinical Medicine Semesters 6 & 7 (Years 3-4) Choice of an option from: aboriginal health, adolescent health, medical ethics and the law, laboratory research, international health, women’s health Semesters 1-5 (Years 1 - 3) Body Systems: Basic Sciences in Medicine Human Mind & Behaviour in Health & Illness: Health & Society Introduction to Clinical Medicine Semesters 6 & 7 (Years 3-4) Choice of an option from: aboriginal health, adolescent health, medical ethics and the law, laboratory research, international health, women’s health

Courses University of Queensland Year 1 Foundations of Medical Practice + Elective Year 2 Systematic preparation for Clinical Practice Year 3 Core Clinical Rotations + Literature Review Year 4 Core Clinical Rotations + Internship University of Queensland Year 1 Foundations of Medical Practice + Elective Year 2 Systematic preparation for Clinical Practice Year 3 Core Clinical Rotations + Literature Review Year 4 Core Clinical Rotations + Internship

Phase 1 Foundations Society and Health Beginnings, Growth & Development Health Maintenance Ageing and Endings Phase 2 Society and Health Beginnings growth and Development Health Maintenance Ageing and Endings Independent Learning Project Phase 3 Clinical Modules Phase 1 Foundations Society and Health Beginnings, Growth & Development Health Maintenance Ageing and Endings Phase 2 Society and Health Beginnings growth and Development Health Maintenance Ageing and Endings Independent Learning Project Phase 3 Clinical Modules University of New South Wales

Change in Teaching Method Change from didactic teaching to problem- based learning Change from lecture based teaching to tutorial based teaching Change from didactic teaching to problem- based learning Change from lecture based teaching to tutorial based teaching

Reasons for Changes to Teaching Techniques Shift in education philosophy from teaching as a passive process to learning as an active process Evidence on effectiveness of problem-based learning PBL became fashionable as an educational tool Shift in education philosophy from teaching as a passive process to learning as an active process Evidence on effectiveness of problem-based learning PBL became fashionable as an educational tool

Summary of Changes Selection change to target those with motivation, aptitude and interactive skills Course change to cut back science units to increase focus on medical practice Change in course delivery from didactic teaching to PBL to improve learning Change in level of entry to increase maturity and experience Selection change to target those with motivation, aptitude and interactive skills Course change to cut back science units to increase focus on medical practice Change in course delivery from didactic teaching to PBL to improve learning Change in level of entry to increase maturity and experience

New System Graduates Have the changes worked? Better communication skills Change in social skills? Change in clinical skills? Poorer clinical skills at AST level Greater confidence Lower career commitment Have the changes worked? Better communication skills Change in social skills? Change in clinical skills? Poorer clinical skills at AST level Greater confidence Lower career commitment

Room for improvement - 1 Pendulum has swung too far away from sciences Balance between science, social science needs adjustment Argument that former level of scientific knowledge not necessary is invalid Doctors are researchers and they can never have too much evidence Emphasis on social sciences may be misplaced because of the role of personality in human interaction Pendulum has swung too far away from sciences Balance between science, social science needs adjustment Argument that former level of scientific knowledge not necessary is invalid Doctors are researchers and they can never have too much evidence Emphasis on social sciences may be misplaced because of the role of personality in human interaction

Room for improvement -2 Effectiveness of training in communication and social skills poorly established Selection procedures need improvement to target those with the social and communication skills required for medical practice Effectiveness of training in communication and social skills poorly established Selection procedures need improvement to target those with the social and communication skills required for medical practice

Room for improvement -3 Better balance of theory and practice in medical sciences Better balance of didactic and PBL teaching Better balance of theory and practice in medical sciences Better balance of didactic and PBL teaching

What the AOA is doing Current: Orthopaedic Principles and Basic Science Exam as part of AST programme Examined in Anatomy, Pharmacology, Bacteriology, Pathology, Biomechanics Future: UG Committee working on national standard for curriculum in musculo-skeletal medicine which includes an increase in didactic teaching and practical sessions in anatomy, biochemistry and physiology Current: Orthopaedic Principles and Basic Science Exam as part of AST programme Examined in Anatomy, Pharmacology, Bacteriology, Pathology, Biomechanics Future: UG Committee working on national standard for curriculum in musculo-skeletal medicine which includes an increase in didactic teaching and practical sessions in anatomy, biochemistry and physiology