ACADEMY OF CLINICAL EDUCATORS UNIVERSITY OF NEWCASTLE Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective Ian Frank AM Chief Executive Officer
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective INTRODUCTION • AMC major role development of standard for medical education since establishment (1985) • 30 years at AMC – 27 as Chief Executive • Previously 12 years University of Adelaide – 6 as Assistant Registrar (Medicine) – Faculty Executive Officer • Career bookended by Doherty Report (1988) and Woods Accreditation Services Review (2017)
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective DISCLAIMER Views, reflections and opinions expressed are mine and not necessarily the official position of the Australian Medical Council
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective PRESENTATION • Changing Context of Medical Education – Then and Now • Doherty Report 1988 • Milestones in Medical Education – Graduate Entry Challenge – Medical Workforce and New Schools – Off-shore medical courses – Advent of the M.D. Degree • Accreditation of Specialist Training • Medical Education under NRAS • Woods-Carver accreditation system review • Future Challenges for Medical Education
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective 1988 • 10 Medical Schools • All direct entry (matriculation) • All Bachelor Degree programs • All Commonwealth funded positions • Duration: 7 x 6 year /3 x 5 year • Course structure: 8 x pre-clin science/clinical 2 x integrated courses • Approximately 1200 graduates per year
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective 1988 2017 • • 10 Medical Schools 21 Medical Schools -39 Programs(+ 2 NZ) • • All direct entry (matriculation) 14 direct entry – 25 graduate entry • • All Bachelor Degree programs 18 Bachelor/18 Masters/3 Combined • • All Commonwealth funded positions Mixture of Govt. funded and full fee • • Duration: 7 x 6 year /3 x 5 year Duration: – • Bachelor 9 x 4yr/1 x 4.5yr/5 x 5yr/3 x 6yr Course structure: – Masters 1 x 3yr/13 x 4yr/2 x 5yr/2 x 6yr 8 x pre-clin science/clinical – Combined 1 x 4yr/2 x 5yr 2 x integrated courses • Course structure: • Approximately 1200 graduates per - All integrated programs year - Variety of clinical settings • Approximately 3400 graduates per year
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective BACKGROUND TO AMC / PRE-HISTORY • Decades prior to 1970’s no significant changes in medical education in Australia • 1973 Karmel Report finds medical education inward looking not responding to community needs – concerns with student selection • Two new schools established – Flinders (1972) and Newcastle (1978) • Commonwealth funds community medicine and clinical pharmacology • Narrow settings for clinical training (1980’s SA experience – reluctance to move out of major teaching hospitals) • Decision to establish the AMC – an accreditation not registration decision – GMC withdraws from overseas accreditation when UK joins EU
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective DOHERTY REPORT 1988 • Commissioned by Minister Blewett 1987 – reported in 1988 • Recommendation not implemented BUT major impact on medical education • Multi-disciplinary team – chair by Professor Ralph Doherty – PVC Health Science UQLD • Wide ranging recommendations for undergraduate, pre-vocational and specialist training, including: – Regular curriculum review – Self-directed learning – Community involvement – Expanded settings for clinical training – Innovation in student selection • Defined knowledge, skills and attitudes to prepare student for life-long learning • Controversy over 2 year internship proposal – only one State supported (NSW)
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective SPECIFIC EXAMPLES OF DOHERTY RECOMMENDATIONS • Innovation in medical education 5(i) The Medical Schools be encouraged to develop innovative programs, including development of curricular material and staff development, to foster an inquisitive and self-directed approach to learning • Assessment and medical education 5(vii) Assessments be designed to reinforce educational objectives ….. • Team-based training 6(xi) Strategies to develop team approaches to patient care with other health care professionals be identified and such approaches become a core component of the training program. The trainee should understand how such health professionals work in hospitals, community settings and private practice
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective INITIAL AMC ACCREDITAION PROCESS • First accreditation UQLD March 1988 led by Professor John Hamilton • GMC Accreditation Guidelines used - Doherty Report outcomes not available • Key principles of AMC approach to accreditation: – Quality improvement not just quality assurance – Diversity of medical education critical – Universities and Medical Schools must retain academic independence • Critical component AMC accreditation process: – self assessment by Medical School prior to accreditation – accreditation becomes external validation of self assessment – Medical School has ownership of process
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective INITIAL AMC ACCREDITATION PROCESS • U QLD not unqualified accreditation – conditions imposed to address concerns identified by AMC team • Major concern for Council and the President – who was Director General of QLD Health at the time: I came to the conclusion that if the council didn’t maintain standards it had set at the start for national accreditation, then we could forget the whole thing. I felt that we had to establish the standards and implement those standards without flinching from the difficulties we encountered into this foray into the unknown. (Dr. Peter Livingston AO Foundation President 1985 -1988)
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective MILESTONES IN MEDICAL EDUCATION – AMC PERSPECTIVE Graduate Entry Challenge • New AMC accreditation guidelines 1992 (Larkins 1991-95) incorporate Doherty findings • Consortium 3 Medical Schools – Flinders / Sydney / Queensland propose graduate entry into integrated curricula – based on problem-based learning • Major challenge for AMC – new curricula and programs not fully developed – required multiple reviews by AMC before full accreditation gained. • Accreditation outcomes: – Flinders accredited 1995 (commenced 1996) -Sydney accredited 1996 (commenced 1997) – Queensland – accreditation team found University not ready for graduate entry program – following extensive consultation accredited to commence 1997 – further AMC review until full program implemented. • Challenged AMC to respond to new developments and major curriculum re-structuring. • Graduate Entry Proposals – sees greater collaboration between the schools on curriculum development and student selection (GMSAT)
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective MILESTONES IN MEDICAL EDUCATION – AMC PERSPECTIVE Medical Workforce and New Medical Schools • 1997 AMC considers proposal for new Medical School at James Cook University – first new school in 25 years – complex accreditation – new course commenced 2000 • 2000 Government debates medical workforce: – Failing recruitment to rural and remote areas – Indigenous health issues – 2002 report of Australian Medical Workforce Advisory Committee – projected deficit in Australian trained practitioners
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective MILESTONES IN MEDICAL EDUCATION – AMC PERSPECTIVE Medical Workforce and New Medical Schools • Commonwealth relaxes restrictions on numbers – proposals for new schools increase: – The Australian National University 2003 – Griffith University 2004 – Bond University (first private university) 2004 – Wollongong University 2006 – University of Western Sydney2006 – University of Notre Dame Australia • Fremantle School 2004 • Sydney School 2007 – Deakin University 2007 • Rapid expansion new course presented challenges to AMC – need to change processes to accommodate phased implementation of new programs.
Doherty to NRAS: A 30-year Review of Medical Education from an AMC Perspective MILESTONES IN MEDICAL EDUCATION – AMC PERSPECTIVE Off-shore Medical Courses • Early proposals for AMC to accredit off-shore courses by Australian Universities rejected • Medical Deans vocal in opposition- concern automatic registration of graduates if off-shore courses accredited • Post-2000 major advances in medical education globally – global standards for basic medical education developed by World Federation for Medical Education (WFME) adopted by AMC
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