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International Students Lowering Standards of Australian Medical Education?

UsydGrad

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    I would recommend reading all the proceedings from this conference. The Australian Doctors Fund is leading an effort to reform Australian medical education. They have attracted a growing number of prominent doctors.

    http://www.adf.com.au/archive.php?doc_id=147


    From: Rescuing Medical Education Conference
    Stamford Sydney Airport
    O'Riordan St (cnr Robey St), Mascot
    18 February 2005

    The Politicisation Of Specialist Medical Training - Who Should Set The Standards?
    Professor Donald Sheldon
    Chairman, Council of Procedural Specialists
    Former Chairman, Board of Continuing Professional
    Development and Standards, Royal Australasian College of Surgeons

    CHAIRMAN: I think what needs to be said about Don is that he is a busy, practising surgeon at Royal Prince Alfred Hospital, Sydney. He has registrars, Fellows and residents whom he teaches and with whom he works. He therefore is very much a hands-on surgeon

    PROFESSOR SHELDON: Thank you, and thank you to the ADF for the invitation to speak this afternoon. I jotted down a couple of extra comments I thought I'd make before commencing my talk which is called the politicisation of specialist medical training - who should set the standards?

    Listening to some of the discussions this morning I was reminded of a conference I attended in Chicago a few years ago on behalf of the College of Surgeons - our College of Surgeons. The conference was called "The Credentialing of Medical Practitioners" and it was addressing a number of the issues we discussed today, but even a broader front. This is not just a state or a national issue, it is now an international issue. It was highlighted there that in South America particularly, medical schools are popping up all over the place with very dubious training programmes, and people are coming out with degrees from universities all round the world - moving around the global village and demanding that their qualifications be accepted in other institutions.

    So as well as, I think, today considering the importance of some sort of national integration of standards of undergraduate and post graduate education, we'll have to eventually look internationally as well.

    The other point that popped up this morning, that reminded me of an episode I had a few years ago, when I took a new group of students. They were all Asian students which, in the Prince Alfred intake, is not all that surprising. There's a very large representation of Asian people doing medicine. But this group I had great difficulty coming to terms with. I thought I was a good tutor but no matter how hard I tried I couldn't get any response from them, I couldn't bring them out, I didn't seem to be able to motivate them, and I thought I was losing my touch.

    One of these people was so reticent that I - in desperation - went to the sub-dean and said, look, this individual is not going to make the grade, he's going to need help. I think it's time he was counselled and perhaps redirected into a different career pathway. It was only at that stage that I was informed that the group I had were all fee paying students. They were paying $26,000 a year for their course, and we were still - and still do - giving them their fairly extensive clinical tutorials in an honorary capacity. Not that I begrudge that for a moment, but I think it's important that people are aware of what I think is a strange anomaly and it raises the question of how strongly the universities are going to adhere to local standards if the risk of offending international fee paying students is threatened. So while we're talking about the setting of standards I think it's probably important we keep that sort of information in front of us.

    My remarks today are basically centred around the training of surgeons, since that's my area of expertise, and about which I'm reasonably well informed. I believe, however, these observations apply to other disciplines of medicine.

    The Royal Australasian College of Surgeons was founded in the early 1930's by a group of eminent surgical practitioners in this country and New Zealand. The aim was to ensure that those practitioners who wished to perform surgical operations were adequately trained, had appropriate experience and had passed the proscribed examinations held by the college. They were not motivated by a closed shop mentality, nor was there any attempt to exclude legitimate candidates from sitting for the examinations. The standards demanded were necessarily high and in the public interest, have remained so.

    Our college had no government mandate for its creation, but was subsequently afforded Royal patronage. The Prince of Wales is the current Patron of the college. This is in contra-distinction to the Royal College of Surgeons of England which was established by Royal Charter - a most impressive document outlining the roles and responsibilities of the organisation, and ordained by the King. There are no formal obligations to the State by our college, however. Our college's role was to set the standard, examine the candidates, issue diplomas to the successful, and encourage research and scholarship. At no stage has there been an obligation to train or graduate specific numbers of surgeons or to conform to some contrived workforce requirement. If the candidates do not meet the standard he, or she, fail the test.

    It is also important to realise that virtually all the teaching is performed pro bono and gratis by the Fellows of the College. Practising surgeons train their junior colleagues in their hospitals, and tutors and examiners give freely of their time to ensure the maintenance of these standards.

    It therefore came as somewhat of a surprise that the ACCC saw fit to accuse the college of running a monopoly that breached anti competitive legislation, and was potentially vulnerable to fines of $10 million per breach. Many of us saw this as a misdirected activity, and believe that the college should surely be exempt under the public interest exclusions that exist under the act. It seemed anomalous that the government health insurance monopoly, Medicare, was deemed to be in the public interest, whilst an institution committed to the welfare of surgical patients in a not-for-profit model could be deemed in breach by the ACCC.

    To avoid prosecution the college has had to modify its procedures and comply with on-going controls and regulations imposed by this government instrumentality. Needless to say, there now exists specific selection criteria into training programmes, and state demands for the number of trainees that the college must accept, so that perceived man power supplies are met, are current.

    Surgical training involves the acquisition of large amounts of knowledge plus the technical skills to perform complex surgical manoeuvres. This takes time. It also takes a suitable number of patients on whom trainee surgeons can operate, under the supervision of their mentors. There has to be hands-on training opportunities for the candidate to become experienced and competent. The college correctly requires that each candidate maintain a log book of his or her operations before that individual can be deemed safe to operate independently in the community. It would be irresponsible of the college to graduate candidates whose surgical experience was one appendix and two ingrown toenails, to take an extreme example.

    Conflict has arisen whereby the states are demanding the college train more surgeons to fill workforce requirements. There have been allegations that the college training programme is the cause of hospital surgical waiting lists, by not providing enough surgeons. However, everyone knows that the waiting list problem is due to the inadequate theatre availability, and access to hospital beds for the existing workforce, who could do the work quite readily with the manpower we have in place, if the facilities were provided

    The political machinations to blame the College of Surgeons for the failure of the health service are blatantly dishonest and misleading. The motivations of the State, in the broadest sense, to control medical practice and training are complex. You could spend a day on those issues alone.

    The current arrangement we have in Australia really is a failed attempt to introduce a British National Health model in this country. In Britain, the Specialist Training Authority, or STA, is a government instrument that determines how many specialists are required. The Treasury allocates the estimated finance, and the colleges are then instructed to process the necessary workforce. This is a model I think we do not want to see in this country. We now see that Britons are having to go to Europe to contracted hospitals because the NHS cannot service the demand. Our system is headed down the same pathway unless there is a change of philosophy and policy.

    Cont. but too long to post!
     

    pitman

    Grasshopper
    15+ Year Member
    May 23, 2003
    1,651
    176
    Queensland via Boston
      ...raises the question of how strongly the universities are going to adhere to local standards if the risk of offending international fee paying students is threatened

      Interesting anecdote. Is there a risk to offending int'l full-fee paying students? Here's a different anecdote: at UQ, of 7 fails last year in our class of over 300 (~275 domestic), 3 were $ from Brunei. I don't think the school gave two hoots whether any int'ls were "offended". Oh, then again, some have argued that Oz schools intentionally fail int'ls b.c. of racism, or to get their $36k for longer. This is nonsense. You can't have it both ways.

      Depending on what the allusions are in the above ("standards"? "offending"?), the same argument could be made about domestic full-fee paying students somehow corrupting the system. The argument is wholly non-unique, and unsubstantiated, based on the hypothetical and the cliche, "money corrupts".

      Yes, if YOUR school takes weak students, then it should certainly fail them where appropriate, whoever they are, just as mine does. As JobsFan said...so what?

      -pitman
       

      Purifyer

      Dr. Funk
      7+ Year Member
      15+ Year Member
      Nov 30, 2001
      389
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        PM me if you want some more tissues USMedgrad, or USYDgrad, or whatever. One of the benefits of Australian health care is that counselling services are partially funded by government subsidy. If only you could have taken advantage of this fact while you were there :(
         
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