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Let’s shake up the debate about medical training

Health workforce maldistribution and shortages, and the oncoming tsunami of medical graduates are generating widespread discussions about the future of health and medical training in the context of moves towards health reform.

Professor Bruce Robinson, dean of medicine at the University of Sydney, has recently suggested that one solution may be to broaden the range of services involved in providing postgraduate medical education. The University of Melbourne’s Emeritus Professor David Penington recently urged the Feds to incorporate university hospitals into health reform.

Now Professor Peter Brooks, who has been a strong advocate of workforce reform and innovation, says it’s time to take the debate a step further.


He writes:

“Recent contributions by Bruce Robinson and David Penington have highlighted some of the issues in relation to medical training and the importance of research and learning  to our health system.

This should be strongly supported but the debate should go further . This is about health professional training – not just the training of doctors. Probably the most important thing that a health professional of today learns is to be able to work as part of a team.

This is how health care is delivered – not by individuals but by teams – and it is almost unethical for any practitioner to hold themselves forth as the ‘sole/independent ‘ health provider  in a given situation.’Team’ learning needs to start early before the ‘siloed ‘ mentality develops – it should be an integral part of any health learning program be it nursing, medicine or allied health professional.

These program teach not only about the role that other health practitioners play in a patient journey but they should also develop a sense of respect for the other professions in the eyes of the learner. Interprofessional education can be taught anywhere but particularly in primary care  and in the rural sector.

Bruce Robinson is correct, we need to move beyond the public teaching hospital  and focus on the primary care and private sectors to provide health learning experiences. These will need to be resourced appropriately with both teaching space and personnel, but this investment will have huge benefits in terms of providing excellent learning opportunities at both an undergraduate and post graduate level.

It is also likely to promote a culture change in the approach of health professionals from ‘illth ‘ to health – learning how to promote health and prevent illness rather than learning entirely on a ‘ sick ‘ population.

The Government has recently established Health Workforce Australia with a significant funding stream for clinical placements and it would be unfortunate if these monies are used to continue the status quo in terms of learning opportunities.

This is exactly the sort of project that might gain from a consortium approach as partly outlined by David Pennington in his plea for University Teaching Hospitals. The model recently established in the UK – Academic Health Centres of Excellence – is a prototype  and could be used to create health learning ‘communities’.

In this model the Government could put out a tender for provision of health education with clear guidelines to the bidders.

Consortia would need to demonstrate that they included public and private health facilities, universities, TAFEs, primary care organizations and general practices, post graduate colleges and professional organization and other health and education industry  partners.

An important addition would be patients who would act as advocates for community learning.

Consortia would also need to demonstrate a governance structure that would deliver the required outcomes.

Contestability often provokes innovation and I would suggest that this type of approach would generate some very interesting ideas to move this whole learning agenda forwards. It is also likely to see the emergence of different models of health education across the country but all of course aspiring to excellence and the registration requirements of the various national registration authorities.

Underpinning all this is a need for all Australians to accept that every clinical interaction they have with a health professional is a learning opportunity and that if we are to continue to train some of the best qualified health professionals on the planet then they (the community) need to accept that teaching role and assist in training the health professionals of the future.”

• Peter Brooks has recently stepped down as Executive Dean Faculty of Health Sciences at the University of Queensland and is Professorial Fellow in the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne

Comments 3

  1. Doctor Whom says:

    The Pennington argument for University Hospitals has been around for some time. In some quarters the response has been less than enthusiastic as it is seen as an attempt by Deans of Medicine to claim a major role in hospital services. In other places concern is about the fact that it is hospital centered.

    Teaching hospitals have struggled with the tentacles of University Medicine Faculties reaching silently into any spare space and budget allocation. The relationship between universities (medical schools in particular but not confined to medicine) and hospitals has been a multi million dollar one often not documented any but the simplest terms.

    Hospital CEOs have been surprised to discover research/teaching units with budgets of some millions that have neither been approved by the university or the hospital but being paid for almost entirely by hospitals. Units of the university occupying space and staff for years with no rent being paid and no written agreements anywhere.

    Some of the more cynical have noted the enthusiasm for university hospitals is coming mainly from universities and would seem to correlate (no controlled studies) with straightened financial times for unis. Those cynical ones note there was no handing out of university endowments offering to build new hospitals when times were flush

    It’s no surprise then that the Pennington University Hospitals proposals haven’t seen a rush to sign up by major health institutions.

    There is the additional problem of the fact that medical training conducted mostly (or entirely) in a hospital is no longer good training for modern healthcare.

    Due to lower length of stay, down to a few hours for many procedures, improved medications and self management, improved primary care and GP skills – the experience available in hospitals just isn’t broad enough. Whole cohorts of people and illnesses just don’t present at hospital anymore. Or if they do they aren’t there long enough for trainees work with.

    Medical, and most other health professional training, has to have a a large component outside hospitals, in the community, in aged care places, in people’s houses, in community health centres, GP prasctices, drug and alcohol clincics, pharmacies, and workplaces.

  2. Doctor Whom says:

    TAFE and on the job training providers will have to be included.

    The trouble is everyone is now a bit wary of medical schools. The efforts to form consortia will have other providers of education and clinical services wanting a bigger say in resource allocation and priorities.

    The new found enthusiasm that university medical schools have for community based primary care services will be tested and monitored by service providers. There is no free ride for anyone.

    The nursing home or residential care unit that is looking after 150 people, with families popping in and out, some with dementia, some with chronic illness, some with cancer, some dying, some needing a script, some needing hospital, some needing attention, some mobile and articulate but frail, some sick of life may just see its priorities some weeks on the needs of the TAFE personal carers course and not on the medical trainees and their A/Prof completing the Team Work module. Thats when the wheels will hit the gravel and corrugations.

  3. Fiona says:

    Allied health professional qualifications attempt to have cross-disciplinary supervision, for example OT and SP students working in schools, with day to day support from a special needs teacher or similar, with discipline-specific supervision less regularly, say weekly, from the Uni’s clinical coordinator. Like all professional training, it gets mixed results, with so many personal factors coming into play with it being a “new” concept to most. I really enjoy working with students from outside my discipline, as we learn from each other, me of the specifics of their roles, them from me as another clinician.

    It will surely become more mainstream across the board…

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air pollution
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consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
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Government 2.0
gun control
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Health in All Policies
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Media Doctor Australia
media-related issues
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National Preventive Health Agency
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Summer reading 2020-2021
Tasmanian election 2021
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The Croakey Archives
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#IHMayDay 2014
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#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16