1. The Graduate Medical Program Dr. Chris Roberts and Prof Ann Sefton The Office of Teaching and Learning in Medicine

2. Medical Education in Australia 15 Medical Schools nationwide –7 Undergraduate programs –8 Graduate programs Workforce shortage in Australia –Increase of 5 new med schools since 2001 –Shift towards graduate medicine over 10 yrs

3. Academic –50% non-med sciences Ethnicity –15% North American international students, 10% Asian-descent Gender –60% female The students

4. Student Funding Local Students: –HECS-funded ($ 5,000 - $ 7,500 p.a) –Local full-fee paying ($ 30,000 p.a.) –Rural-bonded places ( p.a.) International Students: –Full-fee paying ($ 30,000 p.a.)

5. Where will you go? For 1 st year vocational training i.e. 2012 33% General Practice 14% Adult medicine 13% Adult surgery 8% Anaesthetics 8% Psychiatrists 6% Emergency Medicine

6. What sort of Doctor ? Lets talk about professionalism The Minister’s story

7. What sort of Teachers? Lets talk about role modelling

8. What sort of student? An example of a senior student taking a history

9. What is our course so good? Because our graduates are competent at clinical skills Good science knowledge Self confident Good team workers A bit argumentative

10. Patient How should I talk to this patient? Why do they think they’re ill? Why is the patient ill? Is the illness part of a pattern? How do I know my advice is the best? What affects and guides our relationship? Communication skills Patients’ perceptions Basic and Clinical Sciences Epidemiology and Public Health Evidence-based medicine Professional Development

11. 114 clinical problems Basic science and clinical medicine integrated Science is clinically led

12. Generic Graduate Skills Patient and Doctor Theme Personal/Professional Development Theme Basic and clinical sciences Theme Community and Dr Theme MBBS specific outcome objectives Clinical Competencies Basic and Medical Sciences

13. Curriculum Themes Patient-Doctor (PDt) Clinical skills, diagnostic method, bedside manner Basic & Clinical Sciences (BCS) Basic sciences, medical sciences Personal/Professional Development (PPD) Medical ethics, medico-legal, doctor’s health Community & Doctor (CDr) Public health, EBM, statistics, health economics

14. Year 1 2 3 4 Horizontal Integration

15. Year 1 2 3 4 Vertical Integration Clinical Competencies

16. Year 1 2 3 4 Vertical Integration Clinical Basic Competencies Sciences

17. Year 1 2 3 4 Clinical Basic PPD Competencies Sciences Vertical Integration

18. Year 1 2 3 4 Clinical Basic PPD Population Health Competencies Sciences (CDr)

19. Basic Sciences Clinical Competencies

20. Curriculum outline

21. A typical week?

22. PBL tutorial 1 formulate problem identify learning PBL tutorial 3 management plan PBL tutorial 2 plan inquiry - patient data diagnostic decision

23. Pre-clinical Years 1 & 2 Lecture-based, on campus –12+hours of lectures per week: 8 BCS, 2 CDr/PPD –1 hospital-based day: PDr clinical and procedural skills tutorials 67 PBL clinical cases –One case per week, 3 tutorials per case, 10 students per group –Original patient data, patient reports,and radiological images –PBL discussion focus on Mechanism of Disease Basic and clinical sciences History and Physical Exam Differential Diagnoses

24. problem trigger Patient information Differential Diagnosis PBL Tutorial Session 1 PBL Tutorial Session 2 PBL Tutorial Session 3 Self-guided Learning Goals

25. problem trigger Patient Interview Self-guided Learning Goals patient results PBL Tutorial Session 2 PBL Tutorial Session 1 PBL Tutorial Session 3 Provisional Diagnosis Patient information Differential Diagnosis Self-guided Learning Goals

26. problem trigger diagnostic decision * research questions * feedback on the problem patient results PBL Tutorial Session 3 PBL Tutorial Session 1 PBL Tutorial Session 2 Patient information Differential Diagnosis Patient Interview Provisional Diagnosis Self-guided Learning Goals Self-guided Learning Goals

27. How content is integrated into a complex case presentation eg “Mr Sarich’s chest pain” across learning elements: 1 case trigger 6 clinical results 7 learning topics 6 lectures 6 theme sessions 1 patient data sheet 10 formative assessment questions other online resources Example of PBL in Cardiology: “Mr Sarich’s chest pain”

31. Clinical Years 3 & 4 Hospital-based teaching and learning –2-days of lectures and tutorials per week 2 PBL tutorials, one self-directed tutorial, 8 students per group –3 days of clinical ward experience 8 Integrated Clinical Attachments (ICA) in Year 3 4 Clinical Rotations (CRC) in Year 4 Join medical/surgical team on ward rounds, 1-3 students per dept. Attend departmental lectures as scheduled for junior doctors PBL tutorial discussion focus on Management –Investigations –Treatment options –Follow-Up and Prognosis

32. 1.A short case scenario 2.A series of clinical reasoning steps (see below) 3.Each step begins with a prompt question(s) 4.A text entry for student response: An expert response, which may include links to further learning, appears after the student has submitted their own response History Problem Formulation Examination Refinement of DD Investigations Working Diagnosis EBM Management Prognosis Discussion Points Reference Material

33. Problem solving using a specific clinical discipline approach

34. Perspectives of PBL Process Advantages Mature-aged students with life experience make better doctors Students develop a comprehensive clinical reasoning process Learning in a clinical context Collaborative learning and communication skills Disadvantages Generic clinical problem solving rather than case-specific reasoning All problems not equal in developing problem solving skills Knowledge developed may be biased towards one case type Resource intensive

36. And Finally We make no apologies for changing the course as we go, we are always trying to make it better!!

37. References University of Sydney Medical Program http://www.medfac.usyd.edu.au/showcase/index.php http://www.gmp.usyd.edu.au University of Sydney Faculty of Medicine http://www.medfac.usyd.edu.au Medical Society (MedSoc) http://www.medsoc.usyd.edu.au Office of Teaching and Learning in Medicine http://www.otlm.med.usyd.edu.au/