Medical educator pool shrinks

A SHORTAGE of senior medical educators and growing demand for their expertise has prompted leading Australian educators to call for a more defined career pathway for medical education.

In an editorial in the latest MJA the authors said the lack of defined career pathways, a failure to formally recognise medical education as a specialty, and the emphasis many universities placed on research at the expense of teaching had resulted in an erratic supply of medical educators. (1)

Lead author Professor Wendy Hu, professor of medical education at the University of Western Sydney, told MJA InSight the impetus to write the editorial came last year when six universities in NSW and the ACT were seeking heads of medical education at the same time, “with no new people in the pipeline”.

Coauthor Professor Jill Thistlethwaite, professor of medical education at the University of Queensland, told MJA InSight there was a growing demand for senior medical educators in Australia and internationally, and a shrinking pool of senior educators. “We need to think about nurturing the next generation.”

Professor Hu described the current path to being a medical educator as “patchy and piecemeal”. She said stiff competition for limited medical education research grants, a dearth of departments of medical education and no defined vocational end point could dissuade younger clinicians from pursuing education as a career path.

The authors outlined an approach to further develop the discipline by targeting medical students, medical graduates and medical education specialists. For medical education specialists, they recommended specialty recognition; an Australasian academy of medical educators, and more resources for medical education research.

Professor Simon Willcock, chair of the Confederation of Postgraduate Medical Education Councils, said he agreed with the editorialists’ position, but had concerns about the suggestion that medical education be recognised as a specialty.

“One of the mistakes we’ve made in medicine is to build lots of specialty silos. This creates a very expensive and, at times, disintegrated system where people have lots of expertise but it isn’t broadly shared across the system”, he said.

Professor Willcock agreed that universities had disinvested in medical education. He said education and training was often viewed as the poor cousin to “anything associated with research”, which attracted funding.

However, he said medical education had now reached a fork in the road. “We need to decide whether we develop a specialty of medical education where people go down a narrower and narrower path and become the gurus, or whether expertise in medical education can be integrated as part of a more generalist scope of professional practice that might include clinical work, administration work, leadership, education and training and research”, Professor Willcock said.

It was also essential that medical education and training was aligned with current community and workforce need, he said. “One of the problems [when] people become very expert in a narrow area, particularly if they move away from clinical practice, is that they ... often lose the focus or alignment with what we are educating and training for. I don’t think people should give up clinical practice to be purely an educator.”

Professors Hu and Thistlethwaite agreed that maintaining a connection to clinical practice was essential.

Professor Thistlethwaite said an Australian academy of medical education would be complementary to specialist colleges. “It would certainly not be your only college — most of us would stick with our disciplinary colleges”, she said, adding that the academy would also include non-medical educators.

Professor Hu said it was also important to acknowledge medical education as a professional obligation for all doctors.

“Medical education is something that everybody should do to some extent, and we understand that pursuing medical education as a career will appeal to a smaller number of people. That’s why we have argued for a whole range of strategies”, she said. “But we don’t yet have a comprehensive analysis of medical education workforce needs so we can make sound recommendations about what is needed to deliver quality medical education.”

Dr Will Milford, chair of the AMA’s Council of Doctors in Training, said medical educators and supervisors had been forgotten in the past decade of rapid expansion of medical schools and medical training.

“They are the ones that bear the biggest brunt of trying to support and educate and train medical students, interns and prevocational doctors”, he said.

He said a nationally consistent scheme of professional credit and qualifications for medical educators would provide appropriate recognition and, in turn, attract more doctors to medical education.

- Nicole MacKee

1. MJA 2013; 198: 8-9

Posted 21 January 2013

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