Curtin University Medical School to be announced tomorrow (1 Viewer)

[Oer]

https://au.news.yahoo.com/thewest/lifestyle/a/27975302/pm-backs-midland-medical-school/

This article was released today - it seems the PM will go to Perth tomorrow to officially announce the funding of a new Western Australia medical school.

It's expected to have its first intake of 60 students in 2017, and ramp that up to 100 local and 10 international students by 2021 (which would also be the year the first students started graduating).

This has been debated for a while, and most medical student and doctor organisations are very unhappy about it, given that we currently don't even have enough internship and postgraduate positions to to accommodate the amount of graduating medical students. AMSA has already condemned the new announcement:

https://www.amsa.org.au/uncategoriz...nts-strongly-oppose-new-medical-school-in-wa/

More similar articles oppositing the new school:

http://www.wamss.org.au/blog/2013/09/17/a-third-medical-school-consider-the-facts/

http://media.amsa.org.au/advocacy/p...25_AMSA_PP_Curtin_Medical_School_proposal.pdf

An info brochure from Curtin University about the planned course structure (5 year undergraduate with the first year focusing on health sciences, UMAT not used for admission):

http://healthsciences.curtin.edu.au/local/docs/med_school_brochure.pdf


What do people think? I'm pretty annoyed that the government would even think about opening a new school without first taking action to solve the internship crisis - more students without improved postgraduate training will only make the problem worse.

 

[bangladesh]

We'll see if the WA government steps it up and increases number of internships. Overall not a smart move imo

 

[Oer]

We'll see if the WA government steps it up and increases number of internships. Overall not a smart move imo

Yep, definitely some action will have to be taken on that front. I wish they'd announce programs to solve the problem BEFORE they announce plans that could exacerbate it.

With any luck they're already planning for the future, but if not then it's definitely an oversight by the government.

On a somewhat unrelated train of thought, the course structure seems pretty unique for Australia, I wonder how people will find it in the future...

 

[4025808]

I'm also pretty annoyed by the move considering the fact that we already have people who aren't able to seek work placement as undergrad med students.

It'll only be good if they increase the number of intern places within WA or Australia as a whole, and not just that, the graduate market too.

 

[bangladesh]

On a somewhat unrelated train of thought, the course structure seems pretty unique for Australia, I wonder how people will find it in the future...

ah not that different. It's quite similar to jmp, monash, uws.

 

[enoilgam]

As with all sectors, the government and industry need to do more to encourage firms to offer more programs for graduates. The government does a lot for apprentices, it's time for them to start doing more for university graduates. This short sighted mentality firms have adopted has already caused a shortage of trained professionals across multiple sectors.

 

[Oer]

ah not that different. It's quite similar to jmp, monash, uws.

The health science first year is what I'm talking about. Sounds like they're gonna make them work together with students from other degrees, which isn't something the other 5-year courses do if I recall.

 

[Oer]

As was expected, the new medical school announced today - guess it's official now, Aus will have a 19th (depending on how you want to count) medical program in a couple of years.

I wonder if/how the university and government will respond to the criticisms that have been going for a while but have gotten much louder today...

 

[brent012]

IMO, as someone who knows very little about the topic, it's not up to the government or universities to restrict placements if there are limited graduate opportunities - just work with industry to improve the situation like Enoil said.

There are plenty of other fields with job shortages that have no caps on enrollment, journalism is one example that comes to mind - there are far more students than there are jobs to go around. I understand that educating a med student would be far more resource intensive than most other courses, but is artificially restricting supply of graduates appropriate just because of that?

 

[Oer]

IMO, as someone who knows very little about the topic, it's not up to the government or universities to restrict placements if there are limited graduate opportunities - just work with industry to improve the situation like Enoil said.

There are plenty of other fields with job shortages that have no caps on enrollment, journalism is one example that comes to mind - there are far more students than there are jobs to go around. I understand that educating a med student would be far more resource intensive than most other courses, but is artificially restricting supply of graduates appropriate just because of that?

You're definitely right that postgraduate saturation isn't an issue specific to medicine - but that doesn't mean it should just be allowed to happen. Ypu pose a great question though, so I'll give my opinion.

The government has imposed caps on numbers for a few reasons. As you said, it's resource intensive - and the government subsidises CSP places quite heavily. For a five-year degree like Curtin's, a student will probably come out with about $50k HECS debt. If you were to pay full fees for that degree (If you're an international student or go to a private university i.e. Bond), you're looking at a figure closer to $350k. Every medical student is costing the government money, so we want them all to be go out to serve the community afterwards.
There's also the issue that medical students need to be trained in teaching hospitals and other clinical environments - and the hospitals can only take in and train so many students. Too many and everyone gets sub-par education.
The other reason there are government restrictions is to get a certain proportion of medical students to come from a rural background - research shows that these students are more likely to work in rural environments later on, where we need more doctors.

One of the biggest reasons this is an issue though, is that in most other degrees, once you get degree you are qualified to use that degree in the workforce. In medicine that is not the case - you MUST complete your internship to be able to registered and work as a doctor. And we already have Australian-trained doctors missing put on internships - more students won't improve that situation unless we can first create more training positions for them.

Really it's just important have a well balanced healthcare system, and people are worried that this will push things in the wrong direction.

 

[enoilgam]

IMO, as someone who knows very little about the topic, it's not up to the government or universities to restrict placements if there are limited graduate opportunities - just work with industry to improve the situation like Enoil said.

There are plenty of other fields with job shortages that have no caps on enrollment, journalism is one example that comes to mind - there are far more students than there are jobs to go around. I understand that educating a med student would be far more resource intensive than most other courses, but is artificially restricting supply of graduates appropriate just because of that?

The problem isnt really a lack of jobs, it's a lack of opportunities for graduates. A lot of fields have a demand for experienced professionals, but businesses are reluctant to invest in training graduates because of the costs. I mean, look at engineering - businesses are cutting graduate programs for engineers and then looking overseas for experienced professionals due to a lack of domestic supply.

As someone who has experienced the graduate market, it's stupidly circular. Every "entry level" role requires experience, but hardly anyone is willing to offer that experience. That is the number one problem with graduate recruitment in this country. Without a willingness to provide needed industry relevant training to graduates, shortages in skilled professionals will continue to grow.

 

[patpatpat]

There are two differences between medicine and other degrees that make comparisons meaningless:

i) the government investment during university years is significantly higher than virtually any other degree. A law student may pay $8k pa towards their degree (deferred through HECS) and the additional funding from the government isn't much more. A medicine student pays the same, but the additional federal government funding to universities per student is about $15-20k pa, and the state health systems contribute even more through provision of clinical rotations, resources, tutors (who are often rostered off clinical duties) etc. As a significant majority of the cost of the degree is paid for by the government rather than the student, there is an incentive to ensure that the number of graduates is equal to the needs of the community. Having an excess number is producing a huge waste.

ii) medicine is (to the best of my knowledge) the only field where the government monopolises the ability of a practitioner to gain registration. It isn't simply a question of experience, a doctor cannot practice without completing an intern year. In other degrees which have similar requirements (pharmacy, law) there are opportunities available in the private sector as well as the public sector, and in the case of law it is possible to gain registration through further study without even working. Given the government has so much control over the number of intern places and the future of each graduate's career, it also has a responsibility to ensure that there aren't an excessive number of students.

As for encouraging "firms" to increase the number of roles, this has been happening. Problem is the rotations which are being created are useless. Some of my colleagues are doing community health rotations for 10-13 weeks where they may do clinical work for an hour, administrative work for a couple of hours and spend the rest of the time waiting for something to happen. I know that someone will come along as say "stop whining, jobs are being created" but consider this - in a decade this generation of junior doctors will be the ones looking after you and your loved ones, and they may have spent a significant proportion of their formative years studying or doing nothing rather than gaining meaningful practical exposure.

 

[Kiraken]

this is a horrendously stupid idea tbh

 

[Medman]

I escaped my clinical placements early. I am still a doctor somehow.

 

[Schmeag]

Individually, I don't think this will affect you greatly unless you are an international student.

If you perform okay in your studies, you'll likely get a job--that holds for permanent residents. I really feel for the Australian-trained international students who are forced to return home because they have temporary visas and are preferenced lower than Australian permanent residents. I understand why this occurs, but it applying for medical internships in other countries is no walk in the park either. Otherwise, the internships in the medical field seem significantly easier to come by than internships in other professions. Anecdotally, I know of colleagues who failed exams in medical school that scored outer metropolitan internships straight out of university. While I agree that there is a bottleneck for clinical medicine, a medical degree does not limit one to its clinical aspects and there are other career pathways one can pursue.

At a regional level, opening new rural schools seem to make sense unless someone has the statistics to say otherwise. The metropolitan doctor overload and the rural doctor shortage continues and Australian trained doctors continue to prefer working in metropolitan area despite rural incentives. Perhaps opening universities in rural areas will improve that rural doctor retention at the cost to overall quality in postgraduate training, as is CSU's thinking.

This has not been short-term issue. Medical students have been made to be aware that jobs may not exist after graduating for many years now. Everyone calls for the government to increase training positions, but this ends up diluting training numbers and could reduce training quality; it takes time to generate capacity for postgraduate training positions and a lot this is due to our small population and large geographical landscape. There are only so many Level 1 trauma centres a state can have before the supply of patients becomes inadequate to justify maintenance costs of equipment/drugs, deteriorating clinical skills, dilution of teaching and academia.

Let's not lambast the government for working with a difficult situation. That AMSA article is quite old and while it identifies many problems, it doesn't serve up many concrete recommendations. For all the critics, I would ask "How could we increase training positions and are we aiming for access to healthcare for all, or are we aiming for absolute quality in healthcare... or perhaps it's a balance?"

 

[patpatpat]

Individually, I don't think this will affect you greatly unless you are an international student.

It will: less SRMO jobs, greater competition for registrar jobs, less clinical experience and opportunities, greater market saturation as a consultant. The whole outcry over international students not being guaranteed internships is just the tip of the iceberg. Moves to address this and opening a new medical school will adversely affect training and employment for domestic graduates.

While I agree that there is a bottleneck for clinical medicine, a medical degree does not limit one to its clinical aspects and there are other career pathways one can pursue.

Except a medical degree is very clinically focussed. The first two years are essentially a science degree without the practical aspects (not at all preparing someone for a career as a scientist), and the latter two years are almost entirely clinical. There is no teaching of business skills etc. Given the investment by both the student and the community, it is a waste to have a graduate with a degree not practicing medicine.

This has not been short-term issue. Medical students have been made to be aware that jobs may not exist after graduating for many years now.

For international students that is true; domestic students have been told that they are guaranteed an internship on graduation, and little has been discussed about problems higher up the latter.

Let's not lambast the government for working with a difficult situation. That AMSA article is quite old and while it identifies many problems, it doesn't serve up many concrete recommendations. For all the critics, I would ask "How could we increase training positions and are we aiming for access to healthcare for all, or are we aiming for absolute quality in healthcare... or perhaps it's a balance?"

I feel strongly that this decision is a political one rather than being evidence based. It is clear that the federal government hasn't engaged with the major stakeholders, and hasn't produced any evidence to support its stance. It hasn't, for instance, guaranteed funding for new internships to support the graduates from Curtin. It hasn't provided evidence that rurally trained doctors stay in the rural/regional areas, nor has it put in place any incentives to ensure this happens (for instance, mandating that at least half of the Curtin students spend their first two years practicing in a rural/regional area).

Ultimately there has been a shortage at a consultant level (both GP and specialist) for a while. In the past this has been addressed by importing doctors from overseas. In many ways the shortfall has already been addressed by the significant increase in numbers in 2005-06, but the graduates from then are still filtering through training. Given another 5-10 years the shortage will be significantly (if not entirely) reduced, and this includes doctors being forced into rural/regional areas because they cannot find employment in the city.

Opening a new school to address a "shortage" which is already being corrected is classic of the stupidity from this government. It's akin to baking a cake - the oven temperate is set to 180C as the instructions say, 10 minutes later the oven is only 100C, so the baker overreacts and turns it up to 250C and the cake gets burnt. Except what will be burnt is the future medical graduates and the funding they receive.

 

[Schmeag]

It will: less SRMO jobs, greater competition for registrar jobs, less clinical experience and opportunities, greater market saturation as a consultant.

All of what you have listed that affect medical graduates already exist. However, much like other professions, rather than guaranteeing all medical students a place regardless of ability, there is now the workplace performance element that provides incentive for those who want to proper clinical experience. Medical students and doctors have it quite well off in terms of job security and despite the whole furore regarding the medical student tsunami, in my experience, this continues to remain relatively so.

The individual has plenty of jobs open to them. Many seek to locum for money to buy a house, travel for a year or as a stop-gap measure in between other jobs--this seems to be a bad way to get experience/training. My experience is that junior medical staff are always in short supply. ED registrars always seem to be lacking, with plenty of IMGs (many UK trained) to take up the slack. There are certain professions where doctors have simply refused to gravitate to, just as there are plenty of locations that doctors have refused to gravitate to. Again, the IMGs fill in that void. The jobs are there, but doctors have other ideas.

The whole outcry over international students not being guaranteed internships is just the tip of the iceberg. Moves to address this and opening a new medical school will adversely affect training and employment for domestic graduates.

To clarify, I am not advocating for Australian-trained international students be guaranteed internships. Rather, I was expressing the feeling that it must really suck to be them.

Except a medical degree is very clinically focussed. The first two years are essentially a science degree without the practical aspects (not at all preparing someone for a career as a scientist), and the latter two years are almost entirely clinical. There is no teaching of business skills etc. Given the investment by both the student and the community, it is a waste to have a graduate with a degree not practicing medicine.

This is true. However, for the individual, the buck does not stop with getting an internship--the bottleneck has other exit points. I am not arguing that there AMSA et al do not have a point at a state level.

For international students that is true; domestic students have been told that they are guaranteed an internship on graduation, and little has been discussed about problems higher up the latter.

In my experience, that is not correct. I was made well aware by my faculty of medicine that the likelihood that internship places might not necessarily be guaranteed, and this was some time ago.

I feel strongly that this decision is a political one rather than being evidence based. It is clear that the federal government hasn't engaged with the major stakeholders, and hasn't produced any evidence to support its stance.

There does seem to have been a lack of consultation, given the way AMSA has reacted. Do you mind linking me/PMing me the numbers on the predicted rural workforce that you have been mentioning?

Also, I would like to know what AMSA's suggestions would be to increase training positions (beyond the dilution of experience by dividing an RMO job into two). How would this actually happen?

 

[Schmeag]

On a side note:

I know that someone will come along as say "stop whining, jobs are being created" but consider this - in a decade this generation of junior doctors will be the ones looking after you and your loved ones, and they may have spent a significant proportion of their formative years studying or doing nothing rather than gaining meaningful practical exposure.

Can I also just add that I think this is an exaggeration. How much is "significant", what is "doing nothing" and what is "meaningful practical exposure"? In some ways, I feel that for whatever reason, my experience in this regard is different to yours. Your statement brings to my mind a doctor spending 1-2yrs sitting in an empty room. You can learn from so many things in a rotation. For example, writing discharge summaries may seem a bore, but it makes you critically think how to succinctly communicate a patient's history and to know which details to highlight for each condition--this becomes important when you are assessing and then communicating findings yourself. A large part of your training is in being proactive and self-reflective of your experiences. In ten years, those consultants you refer to will include yourself as well as all the other doctors and medical students on this forum. The colleges just give you hoops to jump through so you can get some letters at the end of your name, but you are the one in charge of your own learning.

EDIT
An example I will provide is the Anaesthetist. These guys are supposed to be masters of the airway, but very few would be able to to say that they perform a cricothyroidotomy on a regular basis. Does this mean that they are poorly-trained? No! There is simply a lack of cases (thankfully) that would warrant this--ie there are too many anaesthetists compared to number of cricothyroidotomies performed per year. Instead, these anaesthetists update their skills through simulations and workshops.
/EDIT

Some of my colleagues are doing community health rotations for 10-13 weeks where they may do clinical work for an hour, administrative work for a couple of hours and spend the rest of the time waiting for something to happen.

You need to tell me where this job is at. I've heard of cruisy rotations (ie 8-5 clinic jobs with a couple half days), but this takes the cake.

 

[patpatpat]

The individual has plenty of jobs open to them. Many seek to locum for money to buy a house, travel for a year or as a stop-gap measure in between other jobs--this seems to be a bad way to get experience/training. My experience is that junior medical staff are always in short supply. ED registrars always seem to be lacking, with plenty of IMGs (many UK trained) to take up the slack. There are certain professions where doctors have simply refused to gravitate to, just as there are plenty of locations that doctors have refused to gravitate to. Again, the IMGs fill in that void. The jobs are there, but doctors have other ideas.

That's correct, but overall working conditions for doctors are going to worsen as more are forced to take jobs in less desirable locations, in areas they aren't interested in, for less pay. This certainly isn't a reason why the number of medical students should be restricted, but the current generation of doctors (and later year students) are not immune from the effects of the tsunami. It is not just international students who will be affected.

There does seem to have been a lack of consultation, given the way AMSA has reacted. Do you mind linking me/PMing me the numbers on the predicted rural workforce that you have been mentioning?

I'll have a look for it. Someone posted up one of the official report on MSO/PagingDr estimating that taking into account the ageing population, the level of medical student intake in 2006 was sufficient to meet needs. If the government now has estimates which suggest otherwise, it can easily release them to appease the medical community and the broader population. That it isn't doing so strongly suggests this is a politically driven decision, rather than one based on needs.

Also, I would like to know what AMSA's suggestions would be to increase training positions (beyond the dilution of experience by dividing an RMO job into two). How would this actually happen?[/QUOTE]

Can I also just add that I think this is an exaggeration. How much is "significant", what is "doing nothing" and what is "meaningful practical exposure"? In some ways, I feel that for whatever reason, my experience in this regard is different to yours. Your statement brings to my mind a doctor spending 1-2yrs sitting in an empty room. You can learn from so many things in a rotation.

I would say that someone spending more than a couple of their first 10 rotations on a poor term (community health, rehabilitation, niche specialties such as infectious diseases) is spending a significant proportion of their time not learning the basic medical skills required of a doctor. While they may do some clinical work and may have a decent amount of time to study, they are not getting the hands-on exposure needed to be a good doctor.

For comparison, a decade or two ago interns on a surgical term would be responsible for seeing a patient with appendicitis in ED, clerking them to the ward, being the primary surgeon (supervised by the registrar) and then being in charge of the patient's post-operative care. The registrars would supervise them to make sure that nothing went wrong, and would handle the more complex cases. These days an intern may see a patient a couple of times on a ward round, write up their antibiotics as instructed by the registrar and write a discharge summary. Who has gotten the better clinical exposure, and is more prepared to manage patients at a higher level?

That's not an argument in favour of going back to the old system, but seeing and doing things educates someone a lot more than reading and writing about something. And with the opportunities to gain meaningful clinical exposure being further diluted with an increasing number of doctors, future generations will be served by doctors with less exposure and less experience at managing their care.

A large part of your training is in being proactive and self-reflective of your experiences. In ten years, those consultants you refer to will include yourself as well as all the other doctors and medical students on this forum. The colleges just give you hoops to jump through so you can get some letters at the end of your name, but you are the one in charge of your own learning.

Exactly, but how many interns or residents go out of their way on the wards after they have finished work to find patients with a good history and clinical signs. BPT's may routinely do long cases, but the future generation of GP's isn't. It is much better to have an extra medical or surgical term than a throwaway term created solely for the purpose of making a job.

 

[Schmeag]

That's correct, but overall working conditions for doctors are going to worsen as more are forced to take jobs in less desirable locations, in areas they aren't interested in, for less pay. This certainly isn't a reason why the number of medical students should be restricted, but the current generation of doctors (and later year students) are not immune from the effects of the tsunami. It is not just international students who will be affected.

Working conditions for doctors, have gotten and will continue to become significantly better. Not getting into the specialty one desires or working in a location one prefers is not an indication of deteriorating working conditions. Doctors want the best of both worlds--they want to be paid well and they want to work decent and safe hours under safe conditions with adequate supervision. However, they also want the best experience, training and knowledge to boot.

As you say, in the olden times experience and training would have been excellent. This was also an age with long working hours, paternalistic doctor-patient relationships and difficult access to care in rural and remote areas. Now we live in a time of consumerism, patient autonomy, patient safety and ethical practice. Working hours have been significantly reduced and more doctors have been required to fill in the vacant hours. Increased supervision and oversight has increased patient safety, but has reduced clinical exposure. I recognise that you were not advocating for a return to the older medical era, but I caution that increased clinical exposure doesn't come for free (they say remote medicine is great for clinical exposure due to lack of supervision, but it has many downsides for a lot of doctors--lifestyle, working hours, accountability...etc.). In other countries right now, interns are performing caesarian sections straight out of medical school. They also might be unpaid, might be given less than a week of annual leave, might still be subject to an unsupportive consultant hierarchy, and might work double shifts for almost all of a week.

No doctor should blame the system for making them a bad doctor. In any case, a good doctor is not necessarily the one with the right rotations and clinical experience. A good doctor must reflect, recognise and adapt to their limitations. Years ago, doctors would have been forced to learn through a trial by fire. Given the choice, some would prefer lifestyle, better working hours, or better money through locuming over such tribulations. This is neither good nor bad. It simply is. I highly doubt that the system will transition back to that age of medicine, thus we must move forward and adapt.

I would say that someone spending more than a couple of their first 10 rotations on a poor term (community health, rehabilitation, niche specialties such as infectious diseases) is spending a significant proportion of their time not learning the basic medical skills required of a doctor. While they may do some clinical work and may have a decent amount of time to study, they are not getting the hands-on exposure needed to be a good doctor.

Judgement on rotation quality is dependent on the eye of the beholder. I believe rehabilitation and infectious diseases are great rotations and provide excellent clinical experience. For the aspiring GP, rehabilitation should provide an idea of the service provided and its limitations and whether/when a patient is appropriate for referral; it might also be useful in managing chronic pain. ID is an excellent rotation for diagnosing and managing chronic conditions such as HiV; it might also be useful in travel medicine. Not everyone will love infectious diseases, but not everyone will love general surgery either. The last thing a general medicine wannabee will want is to have to perform a lot of appendicectomies.