Issue 16 / 30 April 2012

THE campaign for a new medical school at Curtin University in WA highlights the soft evidence underpinning such proposals.

The US has 137 medical schools serving a population of 312 million (one school per 2.3 million population); the UK has 35 medical schools serving 59 million people (one per 1.7 million) and in Australia there are 21 such institutions for a population of 22 million (one per 1.04 million).

It is also interesting to note that more than half the current Australian medical schools have been founded during the past 10 years, with predictions that the so-called tsunami of graduates seeking internships is set to peak in 2012–2014.

This makes it even more surprising to see Curtin University proposals to establish yet another medical school.

Among the many reasons cited in support of this initiative is the perception that there is a shortage of doctors, particularly in rural and remote communities. Leaders of the health faculty at Curtin University argue that the pressure exerted by the appropriate selection and graduation of more doctors in the system will drive their movement into rural and remote districts to meet this perceived need.

And yet the evidence for this conclusion is not clear, irrespective of the seeming sophistication and conviction with which the cause has been prosecuted.

The debate surrounding the Curtin proposal has been largely conducted in WA, where it is opposed by both the medical profession at large and the AMA.

More recently, the debate has entered the national consciousness through the Australian Medical Students’ Association.

The students highlight their very real concerns about the capacity of the current training programs within the medical postgraduate sector to accommodate not only increasing student numbers, but also recent graduates. So far the federal government is funding the extra training places, but for how long?

It is crucial that the student voice be heard and their disquiet addressed.

At the same time, the Medical Deans of Australia and New Zealand voiced their reservations. President Professor Justin Beilby said in a media release: “There has been a significant increase in the number of medical students in recent years, and it is essential we do not increase that number until we have a proper, detailed workforce plan”.

All this friction is not without precedent. Past proposals to establish new medical schools in Australia have usually caused a ruckus. This has invariably reflected the lack of readily accessible evidence informing and underpinning such proposals from a national perspective.

Significantly, such bids are usually prosecuted by individuals and universities in pursuit of the prestige which inevitably comes with the foundation of a new medical school. There is also considerable secondary gain in attracting increased federal funding.

Certainly, no one would deny the centrality of funding in any debate about university education. When considering the current suboptimal financial support of universities, particularly medical faculties, we may be better served by simply enhancing the capacity of our current 21 medical schools through increasing their shoestring budgets. It should not be beyond their collective wisdom to devise a system which is flexible enough to accommodate fluctuations in student numbers geared to changing needs.

It is time to bring some semblance of evidentiary rigour to the process of developing a national policy for meeting projected workforce requirements.

We also need an independent and informed body to address all proposals for new medical schools and oversee their establishment.

After all, we would be loath to repeat the British experience and graduate too many medical practitioners, who subsequently struggle to find clinical places to complete their training.

Such a cavalier approach to our next generation of doctors is to be avoided at all costs.

Dr Martin Van Der Weyden is Emeritus Editor of the MJA.

Posted 30 April 2012

12 thoughts on “Martin Van Der Weyden: School evidence needed

  1. Anonymous says:

    One other issue that underpins Curtin University’s zeal for a new medical school that has not been highlighted is the nature of training of medical students are to receive i.e. with emphases on integrative medicine as is the case in many German medical schools for example. None of the schools in Australia, US or NZ do this either. Whether Curtin University has leaders to make a serious commitment to the goal of integrative medicine and to cater to the remote and regional communities particularly Australian Aboriginal and culturally diverse populations, including reservation of places for students of Aboriginal origin (talking only about these matters in meetings or in media is different from taking action), is a serious question that needs addressing urgently before approval of a new medical school at Curtin or any other university.

  2. Rob Loblay says:

    If Curtin University is really planning to emphasize ‘integrative medicine’ in its proposed medical school curriculum, this is a big worry. As many would know, ‘integrative medicine’ is code for all manner of dodgy CAM practices. Anyone with a passing knowledge of what goes on in German medicine will understand why none of the medical schools in Australia, US or NZ have chosen to go down this path – thus far!

  3. Matthias Maiwald says:

    The issue that Dr Van Der Weyden has alluded to in his last two sentences deserves further mention. An oversupply of medical graduates makes the medical profession vulnerable to undue influence and workplace pressure. I graduated in a system where we had an oversupply of medical graduates in the early 1990s, which led to low wages, short-term contracts (with the constant threat of non-renewal) and long work hours. By the early 2000s, the pendulum had begun to swing in the other direction, people did not want to do these jobs any more, and it became difficult to fill some positions. I would say that the 1990s situation is not a good one for the medical profession to be in.

  4. Anonymous says:

    I would really like Rob Loblay to offer an opinion on the relevance of nutritional medicine in the training of medical students and general medicine practitioners in the US, Australia and NZ. Nutritional medicine is a part of the integrative medicine in my way of understanding.

  5. Rob Loblay says:

    Anonymous asks about the relevance of training in ‘nutritional medicine’. If by that he/she means training in use of megavitamins & various other nutritional supplements in prevention & treatment of disease, maintenance of ‘wellness’ etc, I would say “none”. On the other hand, if he/she means ensuring that doctors have an awareness of the types of meaningless diagnostic tests and unproven CAM treatments their patients may be indulging in, I would say “quite relevant”.

  6. Anonymous says:

    It is not worth continuing to emphasize that significant number of double blind clinical trials have been carried out on the role of supplements e.g., Vit D in cardiovascular disease is just one case. Isn’t it important to provide knowledge about such supplements to the potential medical graduates which may help them in deciding about the diagnostic tests to be considered for example in CAD patients because the proven role of Vit D in CVD? This type of information is a part of nutritional medicine!

  7. Rob Loblay says:

    Information on good nutrition, including folate & iron supplementation in pregnancy, having adequate calcium & Vit D, drinking fluoridated water, maintaining a healthy weight, dietary advice for diabetics etc is just part of Good Medicine. Calling it ‘Nutritional Medicine’ brings along too much unproven baggage.

  8. Sue Ieraci says:

    Rob Loblay is right – the oft-repeated myth that “medical students are not taught about nutrition” is just plain wrong. There may not be a topic called “nutrition” – because becoming nourished is part of staying alive. We start learning about nutrition early on in the clinical sciences – organic chemistry, physiology, pathology. We learn the role of vitamins and the pathology of their deficiencies. We learn about the additional therapeutic role of substances such as magnesium. Orthodox medicine is already “integrative” – it integrates all the clinical sciences and evidence-based therapies.

  9. Anonymous says:

    Glad to see the comments by Sue Ieraci although it would be even better if a program such as the one introduced at the Harvard Medical School on nutrition was introduced in the medical schools in Australia [see http://nutrition.med.harvard.edu/ for further information].

  10. Sue Ieraci says:

    Anonymous – can you explain how “it would be better” if the Harvard program were introduced into Austalia? Which aspects of that course are not covered in an Australian medical education?

  11. Anonymous says:

    In response to Sue Ieraci’s question, it perhaps would not be unwise to form a subcommittee by each medical school to analyze the course content in the curriculum. This what Harvard Medical School did to address this matter; this is only one person’s way of thinking.

  12. Prof Alex J Crandon says:

    I fear that as usual the Govt. will not listen to those in the know about the need or otherwise for a medical school at Curtin. They never listened over the last 30+ years as the medical profession warned them of a coming medical shortage. Now they think the problem can be fixed by throwing tax payers money at the problem and creating an over-supply of junior doctors. The problem is there aren’t jobs for them all and there aren’t the senior medical staff in hospitals to teach them.
    If the Govt. thinks that a glut of doctors will drive some to remote/rural areas and provide increasing competition in urban area driving down costs, they are sadly mistaken. The majority will stay in urban areas and if you look overseas, you will see that the best care is provided when doctors are busy and are not looking for work. They will only treat that which needs to be treated or operated on. Provide an over-supply of doctors and every patient referred will be treated/operated on, whether they need it or not because the doctor concerned has got to pay his mortgage and feed his family.
    The more the politicians tinker around with our tertiary education system the worse it gets. Universities were and should still be centres for higher learning and critical thinking. When we had a a small number of universities that required good academic/intellectual skills to gain entry they fulfilled this role. Since turning all of our technical colleges into universities and dropping the entry requirements we have badly dumbed down the system; is it any wonder we can’t find enough people doing science/maths/engineering.
    having worked in the University system, both here and overseas, I have seen the gradual disintegration of academic excellence in universities to the point where it is now not uncommon to have students who cannot write a correct sentence or research a topic. This is compounded by the introduction of both meaningless courses and studies in subjects that have absolutely no scientific merit or logical basis for existence, e.g., homeopathy etc., which have been shown to be based on nothing.
    How we fix the problem I have no idea and it may not be fixable; we can thank our politicians again for another mess.

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