Medical education nears saturation

MEDICAL schools are struggling to provide adequate clinical learning experiences to students, due to increasing numbers of students and changing medical practices.

The number of Australian medical students has increased by 65% since 2004, from about 9000 students in 2004 to 15 000 students in 2010. The number of medical graduates is predicted to increase by 120% from 2004 to 2012, according to the Australian Medical Students’ Association (AMSA). (1)

In a letter published in the latest MJA, academics involved in medical education at James Cook University, Townsville, and Bond University on the Gold Coast described the challenge of providing high-quality clinical opportunities for their students. (2)

The authors, led by Associate Professor Tarun Sen Gupta, director of medical education at James Cook University, said the growing numbers of students, the increased use of same-day and early discharge services, as well as the rising proportion of very sick hospital patients, had restricted clinical learning.

“Although increased throughput of patients may theoretically increase teaching capacity, it is likely that high turnover also results in students missing opportunities for holistic learning, such as practising routine history taking and examination skills”, the letter said.

In a survey of inpatient workload at a private and a public teaching hospital in Townsville, the authors found that only about half the patients were well enough for student interactions, and only about half of these were available to students.

Dr Sen Gupta told MJA InSight that students had particularly poor exposure to procedural specialties with high patient turnover, such as cardiology and gastroenterology, although he was confident that, overall, students were receiving quality clinical training.

He said his university already relied heavily on training through the private sector, with one-quarter of 4th-year training conducted in the private sector.

Training in private general practice settings was “getting close to saturation”.

Dr Sen Gupta said possible solutions included improved incentives for the provision of training in general practice and other private settings, increased training in aged care facilities and more use of simulation models.

“We need to look at this Australia-wide — we’ve got lots of students coming through and we’re running out of sites.”

Mr Robert Marshall, president of AMSA, said not enough had been done to prepare for the influx of medical students, despite many organisations having flagged these concerns for several years.

“Medical students graduating now are still of a really high standard, but what is being threatened is the quality”, he said.

However, Professor Justin Beilby, president of Medical Deans Australia and New Zealand, said changes had been made to cope with the increased students, such as the development of rural clinical schools and other new training sites.

Professor Beilby said it was an “exciting” time for medical students because there were so many innovations in training and delivery of curricula.

“The [MJA letter] illustrates that we have to use a broad range of training environments to give students quality training across the breadth of medicine”, he said.

Mr Marshall said the problem with some of the “innovative” training models was that students missed out on vital learning experiences.

He cited the example of replacing exposure to inpatient psychiatry in a large public hospital with learning in a private outpatient psychiatry clinic.

“It’s not the same patients or the same conditions … these trends are really worrying. We are being spread thin across medical education.”

There was also a concern about the tendency towards subspecialisation, such as students spending time with neurosurgeons but not with general surgeons, Mr Marshall said.

– Sophie McNamara

1. Australian Medical Students Association: Policy document
2. MJA 2011; 195: 584-585

Posted 21 November 2011