Zealand Medical Schools Research Articles

A slide into obscurity? The current state of histology education in Australian and Aotearoa New Zealand medical curricula in 2022-2023.

Australia and Aotearoa New Zealand (AANZ) medical schools have been impacted by curricular changes and the introduction of virtual microscopy (VM). No survey has explicitly described the outcome of these events on histology education in AANZ. This study provides a cross-sectional overview of histology education in accredited medical schools across AANZ in 2022-2023. Responses were received from 83% (19/23) of Australian medical schools, and 50% (1/2) of medical schools in Aotearoa New Zealand. VM, either exclusively (42%) or combined with traditional microscopy (37%), emerged as the preferred mode for delivering histology education. Common instructional methods included face-to-face lectures (26%) and synchronous online live lectures (26%). A significant proportion (84%) of educators supplemented resources with virtual microscopy websites. Integration of histology education was prevalent (79%), primarily with pathology (32%) or gross anatomy (26%). On average, medical students in the region spent a maximum of 21 ± 17 h in face-to-face histology laboratories throughout their degree. Histology education was predominantly taught by academics with a PhD degree. This study also examined the similarities and differences in histology education between AANZ and the global landscape. Through this examination, the present study positions AANZ within the broader context of histology education worldwide discusses key factors impacting histology education, and advocates for action to mitigate a looming shortage of pathologists in AANZ. In light of these findings, AANZ medical schools should integrate histology and pathology, establish a core curriculum, and promote flexible teaching modalities.

The Schweitzer effect: The fundamental relationship between experience and medical students’ opinions on professional behaviours

Purpose We examined whether medical students’ opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of ‘experience’ compared to other demographic factors which influence medical students’ opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to ‘experience’ bias? Methods Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations. Results 3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust. Conclusions Our results demonstrate the relationship between experience and medical students’ opinions on professional behaviour- the ‘Schweitzer effect’. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures.

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.

Should New Zealand medical schools use a lottery system to select their students?

Over the years, entry into New Zealand medical programmes has become increasingly difficult and controversial. Many worthy candidates are rejected from medical school despite having a strong academic background and excellent non-academic attributes. Medical schools’ obsession over choosing the most “outstanding” applicants has created great concern over the fairness and predictive ability of current medical school selection procedures, with some scholars pro- posing the use of a lottery admission system to select future medical students. This paper examines the issues related to the current selection system and evaluates the potential feasibility for a lottery to become a more neutral, inclusive, and fairer admission system.

Educators’ consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design

Background Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators’ consideration and application of student motivation in ophthalmology medical education. Material and methods Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. Findings Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists’ confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. Conclusion There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.

Support of parenting in undergraduate medical training in New Zealand

Purpose This research assessed support for parents studying undergraduate medicine at a New Zealand medical school and identified requirements for additional support. Method Support documentation was sourced from Student Affairs and university and medical school websites. The Medical Deans of Australia and New Zealand Medical Students Outcome and Longitudinal tracking Project was retrospectively examined for data specific to medical student parents. Student parents and medical school staff were also surveyed for their knowledge and perceptions around organisation and effectiveness of available support, and suggestions for additional support. Results Parents and expectant parents formed a consistent, likely growing sub-group studying medicine from 2008 to 2020, yet no formal student parent support policy existed until 2019. Prior to this, 67% of student parents and 47% of staff lacked knowledge of available support. Since 2020, calls for greater visibility of parenting policies and flexibility in the curriculum have been operationalised by the medical school. Conclusion Formalising policies and procedures, maximising access to parenting support resources and introducing flexibility in medical curricula can help students balancing families and medical training. This is relevant for sustainability of medicine as a career option for medical students wanting children, especially considering over half of all medical students are female.

Point-of-care ultrasonography-An essential skill for medical graduates?

The recent proliferation of point-of-care ultrasonography (POCUS) in the clinical practice of many medical specialties has exposed persistent barriers to education, training and standardisation. Specialist training curriculums are already overwhelming, having grossly insufficient time available for the specialist trainees and for the small number of available trainers alike to incorporate POCUS into postgraduate education. The logical solution to overcome these barriers could be to incorporate basic POCUS education and training into the undergraduate university curriculums, introducing longitudinal integration with other relevant medical sciences. The Australasian Society of Ultrasound in Medicine already has well-established educational programmes in POCUS with standardised assessment of competency, which could potentially offer the basis for symbiosis with the Australian and New Zealand medical schools.

Palliative and end of life care in undergraduate medical education: a survey of New Zealand medical schools

BackgroundIn New Zealand, 34% of deaths occur in the hospital setting where junior doctors are at the frontline of patient care. The death rate in New Zealand is expected to double by 2068 due to the aging population, but many studies report that graduates feel unprepared to care for people near the end of life and find this to be one of the most stressful parts of their work. International guidelines recommend that palliative and end of life care should be a mandatory component of undergraduate medical education, yet teaching varies widely and remains optional in many countries. Little is known about how medical students in New Zealand learn about this important area of clinical practice. The purpose of this study was to investigate the organisation, structure and provision of formal teaching, assessment and clinical learning opportunities in palliative and end of life care for undergraduate medical students in New Zealand.MethodsQuantitative descriptive, cross-sectional survey of module conveners in New Zealand medical schools.ResultsPalliative and end of life care is included in undergraduate teaching in all medical schools. However, there are gaps in content, minimal formal assessment and limited contact with specialist palliative care services. Lack of teaching staff and pressure on curriculum time are the main barriers to further curriculum development.ConclusionsThis article reports the findings of the first national survey of formal teaching, assessment and clinical learning opportunities in palliative and end of life care in undergraduate medical education in New Zealand. There has been significant progress towards integrating this content into the curriculum, although further development is needed to address barriers and maximise learning opportunities to ensure graduates are as well prepared as possible.

Pregnancy and parental leave policies at Australian and New Zealand medical schools.

Research into how medical schools support students who are pregnant or with current parental responsibilities has been mostly limited to the US context. To review pregnancy and parental leave policies for students at Australian/New Zealand medical schools. A cross-sectional survey. Data were collected between June and September 2021. Websites of Australian/New Zealand medical schools (n = 23) were searched for freely available information on pregnancy and parental leave policies. Each school was contacted to provide supplementary information on the processes to support students who apply for pregnancy and/or parental leave. Outcome harvesting techniques were used to analyse the key attributes and processes used by medical schools. None of the 23 accredited Australian/New Zealand medical schools had specific pregnancy and/or parental leave policies. Fourteen of the 23 Australian/New Zealand medical schools responded to the request for more information. All confirmed, beyond their University's general student leave policies, they had no additional pregnancy and parental leave policy. Analysis of each school's processes identified the following themes: lack of school specific pregnancy and/or parental leave policies; lack of public statements of support for medical students who are pregnant and/or with current parental responsibilities; and lack of attention to the specific needs of medical students who are pregnant and/or with current parental responsibilities, including those with pregnant partners or are a birth support person. There was a lack of documentation and formalized processes related to the support of this group of students. By creating easily accessible information on pregnancy and parental leave which is nuanced to the challenges of medical school and clinical placements, medical schools and medical education accreditation bodies in Australia/New Zealand can address the needs of medical students who are pregnant and/or with current parental responsibilities and normalize pregnancy and parental status within entry-to-practice medical courses.

Letter to the Editor Regarding “Neuroanatomy Teaching in Australian and New Zealand Medical Schools”

Letter to the Editor Regarding “Neuroanatomy Teaching in Australian and New Zealand Medical Schools”

Neuroanatomy Teaching in Australian and New Zealand Medical Schools

Graduate doctors' knowledge of central and peripheral nervous system anatomy is below an acceptable level. New technologies have been introduced to enhance education in the context of integrated curricula and reduced anatomy teaching hours in medical schools. However, it is unknown how varied this instruction has become between universities. This mixed methods study aimed to describe neuroanatomy teaching in medicine across Australia and New Zealand. An electronic survey was sent to Australian (n= 22) and New Zealand (n= 2) medical schools, endorsed by the Royal Australasian College of Surgeons. Academics were asked to comment on the course, content, instruction, and assessment of neuroanatomy for the 2019 academic year. Ninety-two percent (22/24) of medical schools responded. Neuroanatomy content and instructional methodology was highly variable between institutions. The average time dedicated to teaching neuroanatomy was 46.0 hours (±38.1) with a range of 12-160 hours. Prosections (77%) and models (77%) were used at most universities. Dissection was utilized at 13 of 22 (59%) universities. Incorporation of new technologies was highly variable, the most common being 3-dimensional software (59%) and eBook (55%). Adoption of any virtual reality technologies was low (36%). Seven universities used an established curriculum (29%), whereas most did not (61%). Academics indicated anxiety and motivation were key elements of student engagement. Results demonstrate widespread heterogeneity in the way neuroanatomy is taught to medical students. A standardized curriculum may improve collaboration between universities and facilitate translation of future research in the area into practice.

Leadership curricula and assessment in Australian and New Zealand medical schools

BackgroundThe Australian Medical Council, which accredits Australian medical schools, recommends medical leadership graduate outcomes be taught, assessed and accredited. In Australia and New Zealand (Australasia) there is a significant research gap and no national consensus on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. This study aims to investigate the current curricula, assessment and evaluation of medical leadership in Australasian medical degrees, with particular focus on the roles and responsibilities of medical leadership teachers, frameworks used and competencies taught, methods of delivery, and barriers to teaching leadership.MethodsA self-administered cross-sectional survey was distributed to senior academics and/or heads or Deans of Australasian medical schools. Data for closed questions and ordinal data of each Likert scale response were described via frequency analysis. Content analysis was undertaken on free text responses and coded manually.ResultsSixteen of the 22 eligible (73%) medical degrees completed the full survey and 100% of those indicate that leadership is taught in their degree. In most degrees (11, 69%) leadership is taught as a common theme integrated throughout the curricula across several subjects. There is a variety of leadership competencies taught, with strengths being communication (100%), evidence based practice (100%), critical reflective practice (94%), self-management (81%), ethical decision making (81%), critical thinking and decision making (81%). Major gaps in teaching were financial management (20%), strategic planning (31%) and workforce planning (31%). The teaching methods used to deliver medical leadership within the curricula are diverse, with many degrees providing opportunities for leadership teaching for students outside the curricula. Most degrees (10, 59%) assess the leadership education, with one-third (6, 35%) evaluating it.ConclusionsMedical leadership competencies are taught in most degrees, but key leadership competencies are not being taught and there appears to be no continuous quality improvement process for leadership education. There is much more we can do as medical educators, academics and leaders to shape professional development of academics to teach medical leadership, and to agree on required leadership skills set for our students so they can proactively shape the future of the health care system.

Twelve things we have learned from medical students during the Pandemic.

This article was migrated. The article was marked as recommended. While the COVID-19 pandemic has disrupted every aspect of modern life, including medical education, the response has been remarkable. Ingenuity and innovation have flourished in the face of adversity. An international community of practice has blossomed in response to the challenges posed by COVID-19. Communication and sharing of information have been a hallmark of this community. In Australasia, the Medical Education Collaborative Committee hosted a series of meetings and webinars which enabled educators from all Australian and New Zealand medical schools to share experiences, solutions and resources. This group is auspiced by the Medical Deans Australia and New Zealand, which is the peak body representing professional entry-level medical education, training and research. One of these webinars focused on the student experience, featuring a panel of Australasian medical students drawn from a range of medical schools. The discussion during this session was wide reaching, including topics such as communication, co-designing curriculum changes, the importance of compassion, innovative practice, and meaningful student participation in placements. The ideas drawn from the panel discussion augmented by rich audience participation form the basis of the twelve tips presented in this paper. While derived from the experience in Australia and New Zealand, the authors believe these lessons are likely to be relevant in other jurisdictions.

Medical ethics education in Australian and New Zealand (ANZ) medical schools: a mixed methods study to review how medical ethics is taught in ANZ medical programs

The objective of this study was to review the design and delivery of medical ethics (ME) education within medical programs across Australia and New Zealand (ANZ), how current teaching has been informed by the proposed core curriculum published in 2001 by the ATEAM (Braunack-Mayer et al. 2001) and how it could look moving forward. We conducted a mixed methods study using an online questionnaire consisting of 51 items. This included both binary and open-ended questions to categorise and explore similarities and differences in medical ethics curricula in medical programs accredited by the Australian Medical Council (AMC) across ANZ. Participants were asked about curriculum design format, duration, goals, assessments, content areas of their own ME curriculum. Convenors from 18 universities responded (78%). The main commonality was that ME curricula were integrated both longitudinally and laterally with other content. There was also commonality in content areas addressed. The goals, format, educators, and assessments of the ME curricula were highly variable. Most respondents described a curriculum which prioritised knowledge and skill development related to ME. Although the core goals of including knowledge, skills, and attitudinal development in ME curricula are still present, there is no uniformity in terms of format, delivery, or assessment across medical programs in ANZ. This is an area for collaborative development.

Leadership development in New Zealand and Australian medical schools: needs analysis

BackgroundLeadership is a core competency of doctors. However, specific learning outcomes for leadership are often not well defined in medical school curricula. This article uses New Zealand (NZ) and Australian...

Anatomy teaching stuck in time? A 10-year follow-up of anatomy education in Australian and New Zealand medical schools

ObjectivesTo detail how human anatomy is currently being taught and assessed in Australian and New Zealand medical schools.MethodsMedical schools in Australia and New Zealand were invited to respon...

Keeping them interested: a national study of factors that change medical student interest in working rurally.

In most countries it remains a challenge to sustain the rural medical workforce. Based on evidence that medical students with rural backgrounds are more likely than their urban peers to enter rural practice, medical schools may have rural entry pathways. It is less well established what happens to career intentions during medical school. This study assessed how rural intentions persist or change during medical school and sought factors associated with either persistence or change in rural intention. Students who participate in the Medical Schools Outcomes Database and Longitudinal Tracking project complete surveys at entry to and exit from medical school. They are asked about demographics, career intentions and influencing factors. This study used data from students at both of New Zealand's medical schools from 2006 to 2016. Participants were placed into one of four groups: rural intention at entry and rural intention at exit (R-R), urban at entry and rural at exit (U-R), rural at entry and urban at exit (R-U) or urban at entry and urban at exit (U-U). 'Rural' was defined as an area with a population of 100 000 or fewer. Differences among the groups in demographics and influencing factors were analysed. Overall, 4368 students completed an entry survey (response rate 85.9%), and 2243 students completed an exit survey (response rate 66.4%). A third intended to work in a rural area; of these, 49% had a rural background and 51% an urban background. From the linked entry and exit data (n=1114), there were 239 (21.4%), 188 (16.8%), 135 (12.1%) and 552 (49.5%) students in the R-R, U-R, R-U and U-U groups respectively (p<0.001). Most students had a stable geographical career intention. Of those who changed, more moved towards a rural intention than away from it. Medical students with a persistent rural pattern had characteristics of a rural background (70%), being female (68%), New Zealand European (76%) or having involvement with a rural club for at least 1 year (45%). These students were also more likely to express a GP career intention as their first choice (25%). There were small differences in age, but otherwise no particular demographic factors were associated with students who changed intention. Similarly there were only small differences in perceived career influencing factors among groups. This large national study shows a stability of career location intention for the majority of students. It confirms earlier findings of the importance of rural background in rural career preference, but shows that women may have a higher propensity for a persisting rural interest. Apart from providing quality experience in rural areas for all students, and facilitating rural clubs, the study did not reveal any other strategies that might be used by medical schools to either increase or prevent the loss of rural interest.

The status of radiation oncology teaching in Australian and New Zealand medical schools.

Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession. An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval. Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5years; however, most have no intention of changing radiation oncology teaching. Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development.

Ethics Education in New Zealand Medical Schools.

This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand's medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the "professionalism" and "professional development" in medical curricula.

'It was serendipity': a qualitative study of academic careers in medical education.

Despite a demand for educational expertise in medical universities, little is known of the roles of medical educators and the sustainability of academic careers in medical education. We examined the experiences and career paths of medical educators from diverse professional backgrounds seeking to establish, maintain and strengthen their careers in medical schools. Semi-structured interviews were conducted with 44 lead and early-career medical educators from all 21 Australian and New Zealand medical schools. Questions explored career beginnings, rewards and challenges. Transcripts underwent systematic coding and independent thematic analysis. Final themes were confirmed by iterative review and member checking. Analysis was informed by Bourdieu's concepts of field (a social space for hierarchical interactions), habitus (individual dispositions which influence social interactions) and capital (economic, symbolic, social and cultural forms of power). Participants provided diverse accounts of what constitutes the practice of medical education. Serendipitous career entry and little commonality of professional backgrounds and responsibilities suggest an ambiguous habitus with ill-defined career pathways. Within the field of medicine as enacted in medical schools, educators have invisible yet essential roles, experiencing tension between service expectations, a lesser form of capital, and demands for more highly valued forms of scholarship. Participants reported increasing expectations to produce research and obtain postgraduate qualifications to enter and maintain their careers. Unable to draw upon cultural capital accrued from clinical work, non-clinician educators faced additional challenges. To strengthen their position, educators consciously built social capital through essential service relationships, capitalising on times when education takes precedence, such as curriculum renewal and accreditation. Bourdieu's theory provides insight into medical educator career paths and the positioning of medical education within medical schools. Medical educators have an indistinct practice, and limited cultural capital in the form of research outputs. In order to maintain and strengthen their careers, educators must create alternative sources of capital, through fostering collaborative alliances.