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Intern system needs upgrade, not overhaul

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Calls to dump the current medical intern training system and replace it with a two-year prevocational program or absorb it in the final year of medical school are ill-considered and unnecessary, the AMA has told a Government inquiry.

In a submission to the Council of Australian Governments’ Health Council National Review of Medical Intern Training, the AMA argued that although aspects of the current intern system could be improved, any changes should be incremental and underpinned by evidence.

AMA President Professor Brian Owler and AMA Council of Doctors in Training Chair Dr Danika Thiemt told the review there was nothing to show that a wholesale overhaul of existing arrangements was warranted.

“It is hard for us to agree that the current internship model is flawed when there is so much variety and flexibility across Australia, and when the calibre of doctors in training emerging are world-class and are regarded as such,” they said. “That is not to say there is no room for improvement, but we do not believe this has to take the shape of frame-breaking change, and any change should be informed by a strong evidence base.”

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The COAG review is being conducted amid expectations a growing number of medical graduates will miss out on an internship place this year as Federal and State governments squabble over funding and responsibility.

A national audit found that there was a shortfall of 366 intern places this year, and Australian Medical Students’ Association President James Lawler said anecdotal reports indicated there would not be enough places in 2016.

“This is a bittersweet time for medical students around the country, with excitement at their internship offers conflicting with the fact that they are now competing for training places in a system that is already overwhelmed,” Mr Lawler said.

The review has been asked to examine four options, ranging from leaving the system as-is, to increasing intern term periods, establishing a two-year UK-style prevocational training program or drawing internship-like duties back into the final year of medical school.

In their submission, Professor Owler and Dr Thiemt argued strongly against the latter two options.

“The AMA believes there is no evidence to support radical changes to the structure of the internship along the lines suggested in [these] options,” they wrote. “These options are unrealistic, would require a significant investment of resources, including cost and additional supervisor input, and may result in unintended negative consequences. In any case, it is unlikely that cash-strapped jurisdictions would be in any position to fund them.”

The AMA leaders said the UK-style model might be superficially attractive, but there was no evidence that it would deliver any improvement on current arrangements, while the type of learning gained through university education was “very different” from that provided in a workplace, where interns are required to make decisions about care, albeit under supervision.

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“There is no evidence to show that the current model of internship in Australia is ‘broken’, or that radical changes to its structure are required,” Professor Owler said. “The current model of intern training in Australia has served the community well. Instead of sweeping changes, we need to build on what works.”

But he said the review had highlighted a lack of data surrounding the quality and effectiveness of the intern year in preparing junior doctors for independent practice, and the AMA has proposed that remedying this be a priority.

“The AMA believes the review must propose new systems to provide better information on the quality of medical intern training, the transition from medical school to intern training, and in the remaining prevocational and vocational training years,” the AMA President said.

The AMA has recommended there be a national survey of medical training, similar to the survey that the General Medical Council undertakes in the United Kingdom.

Adrian Rollins

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