Is medical education keeping pace with change?
From complex needs to disruptive technology, young doctors are facing fast-changing demands. We look at how educators can ensure they’re equipped for the challenges they’ll face.
Change in medicine has traditionally been more incremental than sudden. But that pace has been increasing in response to factors like evolving technologies and greater patient expectations. Then came COVID-19.
According to the Medical Deans Australia & New Zealand (‘Medical Deans’), the body representing professional entry-level medical education training and research, the pandemic gave an insight into the kinds of fast and extreme disruption that doctors are likely to face in the future.
Many doctors went from never having used telehealth to using it for most of their consultations – within a matter of months. Then, as the pandemic rolled on, uncertainty and confusion around vaccination brought its own challenges. Meanwhile, as the number of patients presenting with poor mental health rose, so too did levels of stress and burnout among providers.
That raises important questions around whether today’s medical education is meeting these and other challenges.
In Medical Deans’ September 2021 discussion paper Training Tomorrow’s Doctors: all pulling in the right direction, the peak body argues medical education needs to undergo fundamental change to train a workforce that can cope with these kinds of evolving demands. So how can we best prepare our doctors for a satisfying career providing the best possible patient care?
Looking to the future with fresh eyes
While the pandemic created hardships and challenges, it also forced change and created opportunity.
In a letter titled ‘The impact of the COVID‐19 pandemic on medical education’ to the Medical Journal of Australia, educators Adrienne Torda, Gary Velan and Vlado Perkovic from the Office of Medical Education at the University of NSW wrote that COVID-19 forced them to examine all elements of their program.
“This is an opportunity to review the curriculum for future doctors, especially its alignment with the skills and capabilities they will need in their careers,” they wrote.
“Clearly, we need to facilitate the development of teamwork and communication skills, which will prepare students for effective patient care and multidisciplinary, interprofessional practice. Additionally, we have an obligation to support medical students in developing skills in reflection, adaptive problem solving, leadership and lifelong learning, all of which are needed to adapt to a rapidly changing health care environment.”
The academics’ call for a curriculum review with more emphasis on soft skills training reflects a wider demand for generalist skills. For some time, Australia has seen a trend towards medical specialisation: since 2013 the number of registered subspecialists has grown at three times the annual rate of general physicians and surgeons. As a result, according to the Medical Deans discussion paper, we could have a shortfall of more than 9000 GPs by 2030.
“Hospital-based training tends to encourage specialisation and, at the moment, teaching is mainly focused on high-tech hospitals,” says Brian Jolly, Conjoint Professor, Medical Education Unit, at the University of Newcastle’s School of Medicine and Public Health.
“The bigger the hospital, the more internships they have, and many of these are in very specialised areas,” Jolly says. “A broader approach could equip more students with the range of skills they’d need in general practice. For example, we’re advised to visit a GP if we’re suffering from depression or anxiety, but the GP may not have specific training in mental health.”
More focus on areas in need
Around seven million people – about 28 per cent of the Australian population – live in rural and remote areas, according to the Australian Institute of Health and Welfare. They have poorer access to primary health care services than people living in major cities.
The Medical Deans’ discussion paper argues that the current training experience is not providing Australian communities with the doctors they need and is hindering our ability to prepare doctors for their roles in the future.
It gives the example that substantial investment in delivering high-quality, regionally based medical education has seen about one third of medical graduates in Australia express a preference for a career outside a capital city. Yet regional and rural areas continue to grapple with shortages, as this interest at graduation fails to translate into careers in regional areas.
“It isn’t easy to find people to work in these environments,” Jolly says.
“We’ve seen some success in increasing the number of GPs by recruiting more students from rural and remote areas and encouraging them to return to practice there but, despite this and other government initiatives, we’re still very short on numbers. Overseas doctors have been amazingly helpful, but COVID-19 interrupted that pipeline and showed us just how unsustainable that approach can be.”
How better to spread the load?
Technology is continuing to drive disruption – and the need to master emerging technologies and skills can place a heavy burden on both students and practitioners. Cooperation and collaboration across multidisciplinary teams can spread the load, the Medical Deans’ discussion paper argues, but only if everyone in the team is allowed to work at the top of their scope of practice.
“One possible hurdle is that doctors are trained to lead teams – Professionalism and Leadership is one of the Accreditation Standards set out by the Australian Medical Council,” Jolly says.
“As a result, some find it difficult to hand leadership over to another member of the team. These days, other care providers like nurse practitioners, pharmacists and podiatrists are also highly qualified, and in some situations could be better placed to take on the role.”
The Health Professions Accreditation Collaborative Forum works to ensure that health professional graduates are ready for interprofessional collaborative practice.
“More and more patients have multiple conditions that require skills of different healthcare professionals,” Bronwyn Clark, the forum’s chair, stated in a release. “Treatment of such patients requires healthcare professionals to work collaboratively and effectively. Enabling collaborative practice in the real world starts with ensuring health professional students learn about, from and with each other during their training.”
Monitoring areas of study
In his role as a member of an accreditation committee for the Australian Health Practitioner Regulation Agency, Jolly helps to monitor programs of study to ensure that graduates have the knowledge, skills and professional attributes they need to practise safely.
“We see many areas of study that would play a valuable part in medical education,” he says. “For example, cultural safety for Aboriginal and Torres Strait Islander Peoples has been on the agenda for some time. This is an extremely important issue, and one of many areas we’d like to include in the curriculum. The question is, what can we remove to make room for them?”
As the Medical Deans point out, becoming a doctor is already a long and complex process. While adapting to changing circumstances, medical education must also incorporate any changes necessary to protect doctors from burnout and stress by creating a supportive environment for study and work.