Medical Schools In Australia Research Articles

Mapping nutrition within medical curricula in Australia and New Zealand: a cross-sectional content analysis

ObjectiveTo systematically map nutrition content in medical curricula across all 23 medical schools in Australia and New Zealand accredited by the Australian Medical Council (AMC).MethodsA cross-sectional content analysis was conducted....

Short communication: Where is women's cardiovascular health taught in Australian and New Zealand medical schools?

Cardiovascular disease is a major cause of mortality in women and is the leading cause of pregnancy-related mortality in Australia. This study aims to discover the extent of teaching regarding women's cardiovascular health in Australian and New Zealand medical schools. All 22 medical schools in Australia and New Zealand were approached for participation in completing this survey. Seven medical schools (32%) completed the survey and demonstrated that within our sample population, findings suggest that while women's cardiovascular health is present in medical curricula, there is a large variability in the rigour and depth as to which it is taught, as well as possible lack of explicit teaching and examination regarding this topic.

Fairness in Assessment: Identifying a Complex Adaptive System.

Assessment design in health professions education is continuously evolving. There is an increasing desire to better embrace human judgement in assessment. Thus, it is essential to understand what makes this judgement fair. This study builds upon existing literature by studying how assessment leaders conceptualise the characteristics of fair judgement. Sixteen assessment leaders from 15 medical schools in Australia and New Zealand participated in online focus groups. Data collection and analysis occurred concurrently and iteratively. We used the constant comparison method to identify themes and build on an existing conceptual model of fair judgement in assessment. Fairness is a multi-dimensional construct with components at environment, system and individual levels. Components influencing fairness include articulated and agreed learning outcomes relating to the needs of society, a culture which allows for learner support, stakeholder agency and learning (environmental level), collection, interpretation and combination of evidence, procedural strategies (system level) and appropriate individual assessments and assessor expertise and agility (individual level). We observed that within the data at fractal, that is an infinite pattern repeating at different scales, could be seen suggesting fair judgement should be considered a complex adaptive system. Within complex adaptive systems, it is primarily the interaction between the entities which influences the outcome it produces, not simply the components themselves. Viewing fairness in assessment through a lens of complexity rather than as a linear, causal model has significant implications for how we design assessment programs and seek to utilise human judgement in assessment.

The hidden labours of designing the Objective Structured Clinical Examination: a Practice Theory study.

Objective Structured Clinical Examinations (OSCEs) have become ubiquitous as a form of assessment in medical education but involve substantial resource demands and considerable local variation. A detailed understanding of the processes by which OSCEs are designed and administered could improve feasibility and sustainability. This exploration of OSCE design is informed by Practice Theory, which suggests assessment design processes are dynamic, social and situated activities. The overall purpose is to provide insights that inform on-the-ground OSCE administration. Fifteen interviews were conducted with OSCE academics and administrators from three medical schools in Australia, the United Kingdom and Canada. Drawing from post-qualitative inquiry, Schatzki's Practice Theory was used both as a sensibility and as an analytic framework. OSCE design was characterised by planning activities, administration activities, negotiation activities and bureaucratic activities; it involves significant and resource-intensive effort in negotiation and coordination. There was considerable local variation but at the same time activities were remarkably consonant across national boundaries. There was a tension between general understandings such as reliability and validity that underpin the OSCE and the improvisational practices associated with design and administration. Our findings highlighted the role of blueprints as a key coordinating artefact but with too many rules and procedures prompting cycles of bureaucracy and complexity. Emphasising coordination rather than standardisation might ease workloads, support adaptation to local environments and prevent an overly reductive approach to this assessment format.

Retaining graduates of non-metropolitan medical schools for practice in the local area: the importance of locally based postgraduate training pathways in Australia and Canada.

The objective of this study was to identify commonalities between one regionally based medical school in Australia and one in Canada regarding the association between postgraduate training location and a doctor's practice location once fully qualified in a medical specialty. Data were obtained using a cross-sectional survey of graduates of the James Cook University (JCU) medical school, Queensland, Australia, who had completed advanced training to become a specialist (a 'Fellow') in that field (response rate = 60%, 197 of 326). Medical education, postgraduate training and practice data were obtained for 400 of 409 (98%) fully licensed doctors who completed undergraduate medical education or postgraduate training or both at the Northern Ontario School of Medicine (NOSM), Ontario, Canada. Binary logistic regression used postgraduate training location to predict practice in the school's service region (northern Australia or northern Ontario). Separate analyses were conducted for medical discipline groupings of general/family practitioner, general specialist and subspecialist (JCU only). For JCU graduates, significant associations were found between training in a northern Australian hospital at least once during postgraduate training and current (2018) northern Australian practice for all three discipline subgroups: family practitioner (p<0.001; prevalence odds ratio (POR)=30.0; 95% confidence interval (CI): 6.7-135.0), general specialist (p=0.002; POR=30.3; 95%CI: 3.3-273.4) and subspecialist (p=0.027; POR=6.5; 95%CI: 1.2-34.0). Overall, 38% (56/149) of JCU graduates who had completed a Fellowship were currently practising in northern Australia. For NOSM-trained doctors, a significant positive effect of training location on practice location was detected for family practice doctors but not for general specialist doctors. Family practitioners who completed their undergraduate medical education at NOSM and their postgraduate training in northern Ontario had a statistically significant (p<0.001) POR of 36.6 (95%CI: 16.9-79.2) of practising in northern Ontario (115/125) versus other regions, whereas those who completed only their postgraduate training in northern Ontario (46/85) had a statistically significant (p<0.001) POR of 3.7 (95%CI: 2.1-6.8) relative to doctors who only completed their undergraduate medical education at NOSM (28/117). Overall, 30% (22/73) of NOSM's general speciality graduates currently practise in northern Ontario. The findings support increasing medical graduate training numbers in rural underserved regions, specifically locating full specialty training programs in regional and rural centres in a 'flipped training' model, whereby specialty trainees are based in rural or regional clinical settings with some rotations to the cities. In these circumstances, the doctors would see their regional or rural centre as 'home base' with the city rotations as necessary to complete their training requirements while preparing to practise near where they train.

Australian medical student expectations of work-life balance as a doctor.

This article was migrated. The article was marked as recommended. Objectives: To explore the perceptions of medical students on achieving good work-life balance after graduation, and their opinions on parenting having an impact on their future careers. Methods: Cross-sectional cohort study of an online survey was distributed to students from all medical schools in Australia through the General Practice Students Network. Main outcome measures: Medical student perceptions on the effects of their future careers on the ability to maintain work-life balance and whether future parenting would impact their careers. Both quantitative and qualitative responses were collected. Results:The majority of survey respondents believed their careers would have a moderate or significant impact on the ability to achieve work-life balance. Thematic analysis revealed medical students perceived medical careers as lacking flexibility, being time-consuming, and potentially detrimental to health. Surveyed students indicated both parenting goals and specialty choice needed to be considered when planning their career. Conclusions: Australian medical students expressed significant concerns about their ability to juggle parenting and achieve work-life balance within the realities of a medical career.

Does a socially-accountable curriculum transform health professional students into competent, work-ready graduates? A cross-sectional study of three medical schools across three countries

Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan.Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/or supervision of first year medical graduates from three SAHPE medical schools.Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group).Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies (‘communication skills’, ‘teamwork’, ‘professionalism’, ‘work-readiness’, ‘commitment to practise in rural communities’, ‘commitment to practise with underserved ethnic and cultural populations’), as well as ‘overall performance’ and ‘overall clinical skills’.Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs.

Why we need to teach leadership skills to medical students: a call to action

Health system reform models since the early 1990s have recommended leadership training for medical students, graduates and health workers. Clinicians often have leadership roles thrust on them early in their...

It’s important, but not important enough: eHealth as a curriculum priority in medical education in Australia

Information and communications technology has become central to the way in which health services are provided. Technology-enabled services in healthcare are often described as eHealth, or more recently, digital health. Practitioners may require new knowledge, skills and competencies to make best use of eHealth, and while universities may be a logical place to provide such education and training, a study in 2012 found that the workforce was not being adequately educated to achieve competence to work with eHealth. We revisited eHealth education and training in Australian universities with a focus on medical schools; we aimed to explore the progress of eHealth in the Australian medical curriculum. We conducted a national interview study and interpretative phenomenological analysis with participants from all 19 medical schools in Australia; two themes emerged: (i) consensus on the importance of eHealth to current and future clinical practice; (ii) there are other priorities, and no strong drivers for change. Systemic problems inhibit the inclusion of eHealth in medical education: the curriculum is described as ‘crowded’ and with competing demands, and because accrediting bodies do not expect eHealth competence in medical graduates, there is no external pressure for its inclusion. Unless and until accrediting bodies recognise and expect competence in eHealth, it is unlikely that it will enter the curriculum; consequently the future workforce will remain unprepared.

A snapshot of current Objective Structured Clinical Examination (OSCE) practice at Australian medical schools

Objective: The objective of this collaborative study was to compare current practices of conducting high-stake, exit-level Objective Structured Clinical Examinations (OSCEs) at all Australian medical schools. We aimed to document similarities and differences between schools, and compare existing practice against available gold standard, evidence-based practice. We also aimed to identify areas where gold standards do not currently exist, and could be developed in the future.Methods: A 72-item semi-structured questionnaire was sent to all 19 Australian medical schools with graduating students.Results: A total of 18/19 schools responded. Of these, 16/18 schools had summative exit-level OSCEs representing content from multiple medical specialties. The total number of OSCE stations varied from 8 to 16, with total OSCE testing time ranging from 70 to 160 min. All schools blueprinted their OSCE to their curriculum, and trained simulated patients and examiners. There was variation in the format of marking rubric used.Conclusions: This study has provided insight into the current OSCE practices of the majority of medical schools in Australia. Whilst the comparative data reveal a wide variation in OSCE practices between schools, many recommended “gold standard” OSCE practices are implemented. The collective awareness of our similarities and differences provides us with a baseline platform, as well as an impetus for iterative quality improvement. Such discourse also serves to develop new gold standards in practice where none have previously existed.

Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally.

IntroductionPain management is a major health care challenge in terms of the significant prevalence of pain and the negative consequences of poor management. Consequently, there have been international calls to improve pain medicine education for medical students. This systematic review examines the literature on pain medicine education at medical schools internationally, with a particular interest in studies that make reference to: a defined pain medicine curriculum, specific pain medicine learning objectives, dedicated pain education modules, core pain topics, medical specialties that teach pain medicine, elective study opportunities, hours allocated to teaching pain medicine during the curriculum, the status of pain medicine in the curriculum (compulsory or optional), as well as teaching, learning, and assessment methods.MethodsA systematic review was undertaken of relevant studies on pain medicine education for medical students published between January 1987 and May 2018 using PubMed, Medline, Excerpta Medica database (EMBASE), Education Resources Information Center (ERIC), and Google Scholar, and Best Evidence Medical Education (BEME) data bases.ResultsFourteen studies met the inclusion criteria. Evaluation of pain medicine curricula has been undertaken at 383 medical schools in Australia, New Zealand, the United States of America (USA), Canada, the United Kingdom (UK), and Europe. Pain medicine was mostly incorporated into medical courses such as anaesthesia or pharmacology, rather than presented as a dedicated pain medicine module. Ninety-six percent of medical schools in the UK and USA, and nearly 80% of medical schools in Europe had no compulsory dedicated teaching in pain medicine. On average, the median number of hours of pain content in the entire curriculum was 20 in Canada (2009), 20 in Australia and New Zealand (2018), 13 in the UK (2011), 12 in Europe (2012/2013), and 11 in the USA (2009). Neurophysiology and pharmacology pain topics were given priority by medical schools in all countries. Lectures, seminars, and case-based instruction were the teaching methods most commonly employed. When it was undertaken, medical schools mostly assessed student competency in pain medicine using written examinations rather than clinical assessments.ConclusionsThis systematic review has revealed that pain medicine education at medical schools internationally does not adequately respond to societal needs in terms of the prevalence and public health impact of inadequately managed pain.Electronic supplementary materialThe online version of this article (10.1007/s40122-018-0103-z) contains supplementary material, which is available to authorized users.

Pain medicine content, teaching and assessment in medical school curricula in Australia and New Zealand

BackgroundThe objective of pain medicine education is to provide medical students with opportunities to develop their knowledge, skills and professional attitudes that will lead to their becoming safe, capable, and compassionate medical practitioners who are able to meet the healthcare needs of persons in pain. This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand.MethodAll 23 medical schools in Australia and New Zealand in 2016 were included in this study. A structured curriculum audit tool was used to obtain information on pain medicine curricula including content, delivery, teaching and assessment methods.ResultsNineteen medical schools (83%) completed the curriculum audit. Neurophysiology, clinical assessment, analgesia use and multidimensional aspects of pain medicine were covered by most medical schools. Specific learning objectives for pain medicine were not identified by 42% of medical schools. One medical school offered a dedicated pain medicine module delivered over 1 week. Pain medicine teaching was delivered at all schools by a number of different departments throughout the curriculum. Interprofessional learning (IPL) in the context of pain medicine education was not specified by any of the medical schools. The mean time allocated for pain medicine teaching over the entire medical course was just under 20 h. The objective structured clinical examination (OSCE) was used by 32% of schools to assess knowledge and skills in pain medicine. 16% of schools were unsure of whether any assessment of pain medicine education took place.ConclusionThis descriptive study provides important baseline information for pain medicine education at medical schools in Australia and New Zealand. Medical schools do not have well-documented or comprehensive pain curricula that are delivered and assessed using pedagogically-sound approaches considering the complexity of the topic, the prevalence and public health burden of pain.

Standard setting in Australian medical schools

BackgroundStandard setting of assessment is critical in quality assurance of medical programs. The aims of this study were to identify and compare the impact of methods used to establish the passing standard by the 13 medical schools who participated in the 2014 Australian Medical Schools Assessment Collaboration (AMSAC).MethodsA survey was conducted to identify the standard setting procedures used by participating schools. Schools standard setting data was collated for the 49 multiple choice items used for benchmarking by AMSAC in 2014. Analyses were conducted for nine schools by their method of standard setting and key characteristics of 28 panel members from four schools.ResultsSubstantial differences were identified between AMSAC schools that participated in the study, in both the standard setting methods and how particular techniques were implemented. The correlation between the item standard settings data by school ranged from − 0.116 to 0.632. A trend was identified for panel members to underestimate the difficulty level of hard items and overestimate the difficulty level of easy items for all methods. The median derived cut-score standard across schools was 55% for the 49 benchmarking questions. Although, no significant differences were found according to panel member standard setting experience or clinicians versus scientists, panel members with a high curriculum engagement generally had significantly lower expectations of borderline candidates (p = 0.044).ConclusionThis study used a robust assessment framework to demonstrate that several standard setting techniques are used by Australian medical schools, which in some cases use different techniques for different stages of their program. The implementation of the most common method, the Modified Angoff standard setting approach was found to vary markedly. The method of standard setting used had an impact on the distribution of expected minimally competent student performance by item and overall, with the passing standard varying by up to 10%. This difference can be attributed to the method of standard setting because the ASMSAC items have been shown over time to have consistent performance levels reflecting similar cohort ability. There is a need for more consistency in the method of standard setting used by medical schools in Australia.

The efficacy of medical student selection tools in Australia and New Zealand.

To estimate the efficacy of selection tools employed by medical schools for predicting the binary outcomes of completing or not completing medical training and passing or failing a key examination; to investigate the potential usefulness of selection algorithms that do not allow low scores on one tool to be compensated by higher scores on other tools. Data from four consecutive cohorts of students (3378 students, enrolled 2007-2010) in five undergraduate medical schools in Australia and New Zealand were analysed. Predictor variables were student scores on selection tools: prior academic achievement, Undergraduate Medicine and Health Sciences Admission Test (UMAT), and selection interview. Outcome variables were graduation from the program in a timely fashion, or passing the final clinical skills assessment at the first attempt. Optimal selection cut-scores determined by discriminant function analysis for each selection tool at each school; efficacy of different selection algorithms for predicting student outcomes. For both outcomes, the cut-scores for prior academic achievement had the greatest predictive value, with medium to very large effect sizes (0.44-1.22) at all five schools. UMAT scores and selection interviews had smaller effect sizes (0.00-0.60). Meeting one or more cut-scores was associated with a significantly greater likelihood of timely graduation in some schools but not in others. An optimal cut-score can be estimated for a selection tool used for predicting an important program outcome. A "sufficient evidence" selection algorithm, founded on a non-compensatory model, is feasible, and may be useful for some schools.

Research: Why aren’t more medical students doing it?

Background: Many medical schools in Australia and Internationally struggle to engage medical students along a research pathway. Aims: The aim of this study was to identify medical student’s confidence, attitudes and perceived obstacles to participating in research during medical school. Methods: A cross-sectional survey was carried out of undergraduate medical students in years 1–5 attending the University of Tasmania. Results: Of the 237 students who responded to the survey (response rate of 41.9 per cent) the majority (70.3 per cent) agreed that research was a useful experience and expressed a desire to be involved in research (60.1 per cent). Women were generally less confident than men in their ability to conduct research while research experience was significantly associated with an increase in confidence in conducting research. Frequently endorsed reasons by students for not undertaking an Honours year were a desire to not delay graduation by a year for financial (79 per cent) and employment reasons (71 per cent) and social concerns regarding integrating with a different year group (69 per cent). Additional concerns included a lack of time and motivation. Conclusion: The difficulties inherent for students in undertaking research including low confidence, lack of time, financial constraints and pressure to get out into the workforce should help to inform medical educators in developing solutions to encourage student participation in research.

Research knowledge and skills in primary medical training – a cross-sectional audit

This article was migrated. The article was marked as recommended. Background: Internationally, medical education has either adopted, or is moving toward, a Masters level qualification at completion. This reflects the higher-level learning outcomes and potentially facilitation of thinking and decision-making required of medical graduates. In Australia, the main difference between bachelor and masters programs appears to be the level of research skills training. This study explores the characteristics of research training in medical schools and alignment with higher education qualification frameworks. Methods: A cross-sectional audit was conducted of 22 medical schools in Australia and New Zealand, seeking information on: degree type, entry requirement, research knowledge and skills taught, teaching format, and barriers to offering students research experiences. Results: Information about 15 medical programs was obtained, with Australian Qualifications Framework or New Zealand Qualifications Framework Level 7, 8 or 9E outcomes. All included a variety of teaching methods on biomedical ethics, principles of evidence-based practice, and search strategies for medical evidence, critical appraisal of the literature and disease surveillance/epidemiology. Small projects were available in all programs, although voluntary in Level 7/8 programs and mandatory in Level 9E programs. Conclusions: There appear to be few differences in research training and learning outcomes from Level 7 and Level 9E programs, although Level 9E programs have a more systematic approach and assurance that all graduates can achieve the higher outcomes. Barriers to successful implementation relate to finding curriculum space and sufficient research training capacity for all medical students.

Novel Approaches To Undergraduate Oncology Education.

With the increasing incidence of cancer and related survival, junior doctors are more commonly involved the management of oncology patients. A comprehensive oncology curriculum has been developed and adopted across medi-cal schools in Australia. However, it was not designed to inform how medical students should be taught, and whether curriculum content translates to knowledge and competency can depend on its implementation. We have conducted a literature review of PubMed, Embase and Cochrane databases to identify and summarise the evidence for novel approaches to delivering the undergraduate oncology curriculum. Numerous effective approaches have been developed across areas of prevention, clinical examination through simulation, the multidisciplinary team, psycho-oncology, palliative care and even research. There is growing focus on a holistic and multidisciplinary approach to cancer education although direct clinical exposure and interactions with cancer patients is still crucial. Medical schools may also have an under-recognised role in promoting positive health behaviour if their graduates are to convey these preventative measures to their patients. Application of such methods relies upon clinicians and medical educators to consider the practicability and relevance of specific implementation in their local context.

Physical Activity Training in Australian Medical Education

PURPOSE: Previous research has demonstrated that Australian physicians do not feel comfortable communicating with their patients about participating in regular physical activity (PA). This shortcoming may be due to a lack of training during medical school. The purpose of this study was to determine the quality and quantity of PA training in Australian medical schools to better guide programs on how they can modify their curricula in order to improve the physician-patient interaction regarding daily PA. METHODS: The websites of all 19 accredited Australian medical schools were explored to determine the amount of PA training listed as a part of their curricula. Program leaders at each school were contacted, via email or telephone, to introduce the study and request an appointment to conduct the survey. When necessary, the option of completing an online version of the survey was offered. The survey asked program leaders to describe the amount, content, form, and timing of their PA training. RESULTS: No Australian medical school websites reported including PA training in their curricula. Seventeen (89%) completed either the phone interview or the online survey. Fifteen schools (88%) reported providing PA training with 8 (53%) providing instruction on the 2014 Australia’s Physical Activity Guidelines. Nine of the 15 (60%) schools stated that their students received training on properly referring their patients who needed exercise, PA or physical therapy to an accredited professional. However, only 6 of these 15 (40%) schools reported that they felt their curriculum included a sufficient level of training to prepare students for counseling their patients on exercise/physical activity programs. The most common barriers that medical schools experienced in offering PA training was a lack of time to fit more material into their curricula. CONCLUSIONS: The majority of medical schools in Australia reported including PA training in their curricula, even though this training was not mentioned on their websites. While PA training is being included in Australian medical school curricula, there appears to be a need for greater emphasis on instruction regarding the national PA guidelines, how physicians can refer their patients to PA specialists, and ensuring that future physicians are adequately prepared to provide PA counseling.

In memoriam: Richard T. Johnson, 1931–2015

In memoriam: <scp>R</scp>ichard <scp>T</scp>. <scp>J</scp>ohnson, 1931–2015

Innovation in Indigenous Health and Medical Education: The Leaders in Indigenous Medical Education (LIME) Network as a Community of Practice

Problem: The Leaders in Indigenous Medical Education (LIME) Network aims to improve the quality and effectiveness of Indigenous health in medical education as well as best practice in the recruitment, retention, and graduation of Indigenous medical students. Intervention: In this article we explore the utility of Etienne Wenger's “communities of practice” (CoP) concept in providing a theoretical framework to better understand the LIME Network as a form of social infrastructure to further knowledge and innovation in this important area of health care education reform. Context: The Network operates across all medical schools in Australia and New Zealand. Outcome: Utilizing a model of evaluation of communities of practice developed by Fung-Kee-Fung et al., we seek to analyze the outcomes of the LIME Network as a CoP and assess its approach and contribution to improving the implementation of Indigenous health in the medical curriculum and the graduation of Indigenous medical students. Lessons Learned: By reflecting on the Network through a community of practice lens, this article highlights the synthesis between the LIME Network and Wenger's theory and provides a framework with which to measure Network outputs. It also posits an opportunity to better capture the impact of Network activities into the future to ensure that it remains a relevant and sustainable entity.