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http://www.theaustralian.news.com.au/story/0,20867,19257939-23289,00.html
Medical training may be moving away from its intentions
OPINION
Stewart Bryant
May 27, 2006
IT is hard to imagine an apprentice mechanic undertaking a training program where the study of a car engine is an \"elective\" subject. Why then are medical students exposed to training programs where anatomy - the basic roadmap of the human body - can be an elective subject?
There has been much debate recently about the direction of medical training in Australia. That some medical schools even consider anatomy to be optional is a sharp indicator of where many believe medical training needs to be re-focused.
Those most critical claim that we are creating a generation of doctors whose focus on interpersonal skills training will mean that they are entering the profession with the ability to counsel a dying patient but without a true understanding of the diagnosis and treatment options.
Unfortunately, pathology is also too often relegated within the curriculum of medical schools. This is remarkable when one considers that medicine is pathology.
Every detected cancer in Australia is diagnosed or confirmed by a pathologist. Pathologists also diagnose infectious diseases such as golden staph, avian flu and HIV.
They diagnose and monitor diabetes, heart failure and arthritis. The list goes on - in fact 70 per cent of all medical diagnoses involve pathology tests. It is a major problem if doctors don\'t know enough pathology. They may not understand the disease process well enough to be certain of the diagnosis, the appropriate treatment and the possible future course of the illness. They don\'t know what tests to order. They don\'t know how to interpret and apply the results of tests. In short, their patients are at risk.
The Royal College of Pathologists of Australasia (RCPA) has developed a core curriculum in pathology and provided this to all universities in Australia and New Zealand. There are pathologists passionate about improving pathology teaching in medical courses and some universities are starting to take notice. Others have a long way to go.
However, the lack of academic specialist medical staff, in particular pathologists, in most Australian universities is of serious concern. Given headlines like \"Doctors fail basic anatomy\" (The Weekend Australian, 6-7 May 2006), one wonders, in reality, if universities have the medical manpower to do the training.
One reason for this is that pathology is in crisis - not just in Australia, but around the world. The shortage of skilled pathologists has never been as severe as it is now. Today in Australia, there are only 1300 practising pathologists, well short of what we require. Many are past retirement age but because there is no one to replace them they keep working. A recent review in NSW revealed that 20 per cent of the practising pathologists were over 60, and many over 65. So why has pathology - the very basis of all medicine - been allowed to drift into such a sorry state, one for which the broader community will pay a price sooner rather than later?
There have been reports that the problems with specialist shortages relate to the specialist medical colleges\' training programs. Ill-informed claims have had a good airing in the media lately, claiming that the current medical specialist programs are more expensive than they need to be, and disadvantage patients. One solution proposed is that universities, instead of colleges, train doctors to become specialists. Given that the training of medical specialists by colleges such as the RCPA is done on a pro-bono basis by college fellows, this argument is as silly as it is inaccurate.
Universities will not provide services on a pro-bono basis, so it is hard to envisage how a change to university-based specialist training could save money.
It is equally difficult to see how patients are in any way \"disadvantaged\" by the current training system when trainee specialists are providing the bulk of the medical workforce in Australian hospitals and laboratories.
It has been suggested that student trainees could be fast-tracked, an argument made by Robert Wells on this page earlier this year (Weekend Health, 25 March). The RCPA has for many years accepted doctors for pathology training after their internship (most other colleges require two years\' postgraduate work), despite the fact this is not always optimal.
Further, retrospective accreditation of other appropriate training that is relevant to pathology is also offered.
Finally, there seems to be a perception that universities will be better able to provide training. In fact, it may be that opportunities exist to explore some areas where training models could be developed with universities. Indeed, the RCPA has already had preliminary discussions with a university specifically to look at this.
The RCPA puts any \'blame\' for the shortage of pathologists directly on all governments\' doorstep, through a lack of funding for training positions for pathologists.
Currently there are more young doctors wanting to do pathology training than training positions. There are many laboratories ready, willing and able to train doctors to be pathologists, but there is no money provided by government to employ trainees. In fact from 1992-2002, 70 pathology training positions - or 25 per cent - were cut from the Australian system.
The Australian Medical Workforce Advisory Committee recommended that there be an extra 100 pathology training positions created per year for at least five years. It is now the third year since that report and there should be no fewer than 300 new positions in place. There are only 39 nationally.
The problem is as simple as it is tragic. It is also a key indicator of just how little some sections of government really know about the critically important role pathology plays in the health of the community.
Dr Stewart Bryant is president of the Royal College of Pathologists of Australasia
Medical training may be moving away from its intentions
OPINION
Stewart Bryant
May 27, 2006
IT is hard to imagine an apprentice mechanic undertaking a training program where the study of a car engine is an \"elective\" subject. Why then are medical students exposed to training programs where anatomy - the basic roadmap of the human body - can be an elective subject?
There has been much debate recently about the direction of medical training in Australia. That some medical schools even consider anatomy to be optional is a sharp indicator of where many believe medical training needs to be re-focused.
Those most critical claim that we are creating a generation of doctors whose focus on interpersonal skills training will mean that they are entering the profession with the ability to counsel a dying patient but without a true understanding of the diagnosis and treatment options.
Unfortunately, pathology is also too often relegated within the curriculum of medical schools. This is remarkable when one considers that medicine is pathology.
Every detected cancer in Australia is diagnosed or confirmed by a pathologist. Pathologists also diagnose infectious diseases such as golden staph, avian flu and HIV.
They diagnose and monitor diabetes, heart failure and arthritis. The list goes on - in fact 70 per cent of all medical diagnoses involve pathology tests. It is a major problem if doctors don\'t know enough pathology. They may not understand the disease process well enough to be certain of the diagnosis, the appropriate treatment and the possible future course of the illness. They don\'t know what tests to order. They don\'t know how to interpret and apply the results of tests. In short, their patients are at risk.
The Royal College of Pathologists of Australasia (RCPA) has developed a core curriculum in pathology and provided this to all universities in Australia and New Zealand. There are pathologists passionate about improving pathology teaching in medical courses and some universities are starting to take notice. Others have a long way to go.
However, the lack of academic specialist medical staff, in particular pathologists, in most Australian universities is of serious concern. Given headlines like \"Doctors fail basic anatomy\" (The Weekend Australian, 6-7 May 2006), one wonders, in reality, if universities have the medical manpower to do the training.
One reason for this is that pathology is in crisis - not just in Australia, but around the world. The shortage of skilled pathologists has never been as severe as it is now. Today in Australia, there are only 1300 practising pathologists, well short of what we require. Many are past retirement age but because there is no one to replace them they keep working. A recent review in NSW revealed that 20 per cent of the practising pathologists were over 60, and many over 65. So why has pathology - the very basis of all medicine - been allowed to drift into such a sorry state, one for which the broader community will pay a price sooner rather than later?
There have been reports that the problems with specialist shortages relate to the specialist medical colleges\' training programs. Ill-informed claims have had a good airing in the media lately, claiming that the current medical specialist programs are more expensive than they need to be, and disadvantage patients. One solution proposed is that universities, instead of colleges, train doctors to become specialists. Given that the training of medical specialists by colleges such as the RCPA is done on a pro-bono basis by college fellows, this argument is as silly as it is inaccurate.
Universities will not provide services on a pro-bono basis, so it is hard to envisage how a change to university-based specialist training could save money.
It is equally difficult to see how patients are in any way \"disadvantaged\" by the current training system when trainee specialists are providing the bulk of the medical workforce in Australian hospitals and laboratories.
It has been suggested that student trainees could be fast-tracked, an argument made by Robert Wells on this page earlier this year (Weekend Health, 25 March). The RCPA has for many years accepted doctors for pathology training after their internship (most other colleges require two years\' postgraduate work), despite the fact this is not always optimal.
Further, retrospective accreditation of other appropriate training that is relevant to pathology is also offered.
Finally, there seems to be a perception that universities will be better able to provide training. In fact, it may be that opportunities exist to explore some areas where training models could be developed with universities. Indeed, the RCPA has already had preliminary discussions with a university specifically to look at this.
The RCPA puts any \'blame\' for the shortage of pathologists directly on all governments\' doorstep, through a lack of funding for training positions for pathologists.
Currently there are more young doctors wanting to do pathology training than training positions. There are many laboratories ready, willing and able to train doctors to be pathologists, but there is no money provided by government to employ trainees. In fact from 1992-2002, 70 pathology training positions - or 25 per cent - were cut from the Australian system.
The Australian Medical Workforce Advisory Committee recommended that there be an extra 100 pathology training positions created per year for at least five years. It is now the third year since that report and there should be no fewer than 300 new positions in place. There are only 39 nationally.
The problem is as simple as it is tragic. It is also a key indicator of just how little some sections of government really know about the critically important role pathology plays in the health of the community.
Dr Stewart Bryant is president of the Royal College of Pathologists of Australasia