Download Dumbing Down the Medical Profession

Australian Medical Education Is it Good for Our Health?
Helen C Beh
CEO, Australian Orthopaedic Association
The changes



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
Reasons for Change






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 themebased course content
Reasons for Change to GMP

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

University of Sydney Pre GMP

Year 1


Year 2


Anatomy, Histology & Embryology, Behavioural Sciences in Medicine, Medical
Communication, Physiology, Medical Biochemistry
Year 5


Microbiology & Immunology, Anatomy, Human Biology (Cell & Molecular), Biochemistry,
Clinical Statistics, Behavioural Sciences in Medicine, History & Philosophy of Medicine
Year 4


Pharmacology, Human Biology. Biochemistry
Year 3


Biology, Chemistry, Physics, Mathematics
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
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
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
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
Qu ic kTi me™ a nd a
TIFF (LZW)d ec omp res so r
are n ee de d to s ee th is pi ctu re .


University of Queensland
Year 1


Systematic preparation for Clinical Practice
Year 3


Foundations of Medical Practice + Elective
Year 2


Courses
Core Clinical Rotations + Literature Review
Year 4

Core Clinical Rotations + Internship
University of New South Wales

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






Change in Teaching Method


Change from didactic teaching to problembased 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
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
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
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
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
Room for improvement -3

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