Sue Ieraci: MB BS: a degree or a licence

EVERY year teaching hospitals around Australia have to deal with some medical interns who cannot manage the clinical environment.

Often it was clear before these graduates entered the hospital system that they couldn’t manage.

Some have overwhelming anxiety or other mental illness. Some have academic skills but do not have good problem-solving skills — or simple commonsense.

Some have passed exams but have not invested enough time in hands-on clinical training to be “work-ready” when they start employment as a clinical doctor.

Whether the problem with these interns is impairment or lack of aptitude, the result is a group of people with a medical degree who are unable to effectively practise medicine.

The only answer seems to be to hold them in the hospital system in highly supervised positions for prolonged periods.

This not only presents a burden to the clinical service where they are employed, but sometimes can delay the recognition that — in reality — not every medical student is suited to clinical medicine.

This problem raises some important questions.

Does an MB BS make you a graduate with a medical degree, or a doctor?

If a medical degree qualifies you to enter an internship, what responsibility does the university where that student graduated have to certify fitness to practise?

Should it be possible to obtain a medical degree if you don’t have the skills or aptitude to practise?

The vast majority of new graduates enter medical practice as hospital interns with a degree of trepidation, but without undue mishap.

As medical education becomes more hands-on and as hospital orientation procedures improve, the transition from student to practitioner is becoming smoother.

But these changes don’t resolve the problem of students who are not meant to be doctors in practice.

It’s time universities started to seriously consider answers to these questions for the sake of the profession, the medical students who can’t cope and the community as a whole.

Dr Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She also runs the health system consultancy SI-napse.

Posted 25 October 2010