Issue 26 / 9 July 2012

MEDICAL schools are not generally regarded as progressive agents of social change. The truth is that they tend to be bastions of medical establishment and tradition the world over.

Students are mostly the sons and daughters of an urban elite and clinical education remains grounded in tertiary medicine and its tribal institutional cultures.

The pursuit of institutional prestige through expensive biomedical research is the main game — and “impact” in terms of betterment of the human condition is measured, very imperfectly, by international journal citation indices and competitive grant income.

Yet our ageing population, the challenge of non-communicable diseases and cost pressures in health systems demand a different approach.

If communities are to be assured of affordable and effective patient- and population-centred health care into the future, a revolution is needed in the production of doctors and generation of medical knowledge.

Socially accountable medical education” is the proposition that medical schools accept an obligation to align teaching, research and service activities to jointly identified community needs.

The international movement for socially accountable medical education is gathering momentum. The ideas are also being taken up closer to home with development of a coalition of schools interested in these ideas within the Medical Deans Australia and New Zealand.

One international grouping is the Training for Health Equity Network (THEnet). Working on the principle of “social accountability in action”, this is a consortium of institutions committed to achieving health equity through medical education, research and service that is responsive to the priority needs of communities.

As an authentic community of practice and working in partnership with others, THEnet seeks to transform medical education, build institutional capacity and shape policy to make health systems around the world more equitable.

In Australia, James Cook University and Flinders University are part of this collaboration, as are nine other schools in Belgium, Canada, Cuba, Nepal, the Philippines, South Africa, Sudan and the US.

Despite their disparate contexts, there is much experience in common among these institutions in their struggles to establish innovative programs or challenge conventions from within. The development of an international evaluation framework to assist medical schools seeking to become more attuned to community needs has been an important piece of joint work.

The Training for Health Equity Network institutions embrace values of equity, relevance, quality, efficiency and partnership. Working with — and within — communities and local health systems, they look to recruit students who represent their target populations and to align curriculum and pedagogies with priority community needs.

They also aim to produce graduates who are technically, socially and culturally suited to work in this way. The schools are advocates for change and work with stakeholders to transform health systems to be more relevant to community needs.

Viva la Revolución!

Professor Richard Murray is the dean of medicine and head of school at James Cook University, Queensland and president of the Australian College of Rural and Remote Medicine.

Posted 9 July 2012

22 thoughts on “Richard Murray: Toppling ivory towers

  1. Anonymous says:

    It is concerning to read of what appears to be politically-correct green-left ideology starting to distort medical education. It is interesting to see that a medical school in Cuba is involved. Will Professor Murray and other THEnet activists be travelling to Cuba to publically call on the despotic Regime to NOT put people in jail for daring to promote democracy and freedom of political expression? One would think they are important values that THEnet should embrace. Oh, sorry it’s not politically correct to criticize REAL human rights abuses if they occur in Cuba.
    Maybe Professor Murray should travel to the Sudan and publically call out President Bashir for overseeing the murder of tens of thousands of innocent civilians. In fact Bashir has recently called for Sudan’s new constitution to be “100 per cent Islamic”. He has been quoted as saying: “And we tell non-Muslims, nothing will preserve your rights except for Islamic sharia because it is just.” I wonder if those are the values that THEnet champions.

  2. Sean Stevens says:

    I am a GP who has practiced my whole career in an area of workforce need and while I share some of Richard’s concerns about Ivory Towers, I also have major concerns about using medical school intake and training for social engineering. Some of my best training experiences were seeing rare conditions that are only treated in tertiary settings.

    Equally some of the best surgeons and medical specialists I know have quirky personalities that wouldn’t have passed the social engineering test. I think it is important to have a balance of intake that includes those who have the highest academic scores, without the need for a personality test – we still need our pathologists, medical researchers and cardiothoracic surgeons!

  3. anonymous says:

    The problem with such approaches are unintended consequences. Often by using screening processes for certain personality characteristics all that really happens is you end up with people like the assessors – upper middle class and slightly left wing. Without very careful thought you can end up excluding applicants from other social groups because they think differently and do not use the right language. Rather than being more inclusive you end up with a worse situation than you started with. I also do agree that it is important not to exclude the somewhat unusual people who have contributed so much to medicine by not accepting the status quo of the day.

  4. Rob the Physician says:

    “Interesting”…….but based on fallacy that medical education equates to ‘ivory tower’ status! In this day and age we are witness to great changes taking place around the globe and we are seeing “the shakeable, being shaken”!! Therefore there are many reasons we base our lives and our profession on the “unshakeable foundation” !!!
    Proverbs 3:5

  5. Barbmidwife says:

    This is really interesting concept but nowhere does it state the entrance test will be altered. Entrance to medical school remains within the realms of social privilege. I declined an offer to go to medical school in the early 80s as I wanted to stay a nurse.
    Some of my best teachers – medical & nursing – were not politically correct or tolerant. There has to be a balance and understanding of the richness that comes with diversity!
    I love visiting a GP that is so busy typing & looking into a computer they forget about the person struggling in front of them. Caring is about using all your sensory perceptual skills and not all those that fit a text book or computer screen.

  6. Anonymous says:

    Case in Point: The wholesale failure of recognition by the medical community of attention deficit/hyperactivity disorder (ADHD) as a significant learning disorder and disability. Through ubiquitous application of opinion and value based judgements, rather than use of judgements based on EVIDENCE, the medical community in Australia has across the board succeeded in denying a large group of affected people access to support and assistance. We are thereby failing as practitioners (who claim to respect and work on the basis of scientific principles), and we are missing opportunities to advocate effectively. By our ongoing populist approach to ADHD we act in complete contradiction to our claimed Hippocratic principles, by increasing stigma and barriers to care to many vulnerable people. A paradigm shift is needed, one involving critical evaluation of the evidence surrounding all aspects of this condition. A great challenge for some who are well used to pontificating subjectively and illogically from on high, but one that needs to be undertaken. Thank you Professor Murray.

  7. SHRINK says:

    I graduated MBBS (Adelaide) in the late 1960s, as a kid from the western suburbs on a Commonwealth Scholarship. My father worked for the SA Railways. Most of the students in my year were on such scholarships. A minority were from Adelaide’s “elite” medical families. Only a few in my year became “ivory tower” academics.

    So I find this “Comment” somewhat puzzling.
    Does it reflect a much more recent trend?

  8. Phillip Chalmers says:

    Same old tired left wing rhetoric reminiscent of the support given to the Viet Cong revolutionaries who replaced the highly skilled and responsible Superintendents of their hospitals with the cleaners after the US withdrawal.
    Notice Vietnam medicine is not a world beater.

    Inequity is economic and political. By all means strive for generous budgets and aid grants to be used in a locally appropriate fashion like universal infant immunisation given precedence over any 21st century cardiac surgery and artificial fertility.

    Doctors do the work on the ground, let the political classes apportion the “slice of the cake” and the community exercise their elective power over them to give remedial and preventative health priority over spending which could be considered discretional.

    Those who self-select as doctors in UK, US, Canada and Oz are not disgracing themselves as a class, just include a smattering of odd-balls and criminals along with all/any other classes.

  9. don moyes says:

    My experience of medical school selection started with my own selection…. an interview after obtaining a reasonable level academically. (I was in the lower levels of academia! Birmingham UK)

    I spent several years in the dean’s office at Wits Univ in Johannesburg and was on the selection team for over a decade. Selection was academia plus marks for achievement outside the classroom. With some 230 places about 50 got in (and 50 excluded!) due to the selection aggregate not just on academia. NO marks for offspring of graduates. Unpopular with the medical fraternity? Sure was !!

    At Adelaide I was involved to a small degree with the same type of evaluation. Hugely unpopular in some quarters.

    These three selection processes attempted to be inclusive of the huge variety of skills needed throughout the medical spectrum. You are attempting to select the rural practitioner, pathologist, surgeon, medical writer, etc.

    Only a process which is wide in its detail will acheive the balance needed to cover all the various fields.

  10. Physician says:

    This piece is full of baseless assertions – the people I graduated with were from a range of social backgrounds, including one who still calls himself an anarchist. “Socially accountable medical education” is just a euphemism for left wing political brainwashing – of which there is already too much in places like Sydney University medical school. I heard some radiologists complaining the other day about new Fellows with “plenty of empathy but not enough anatomy”.

    As a dean you need to be very careful about messing around with a system which has delivered some of the best health care in the world. And if you push left wing politics, you’ll alienate many of your alumni, and damage your university’s reputation.

  11. Anonymous says:

    This piece contains some very big, bold words. I think one needs to see whether the actions that follow and the results that will be obtained live up to the big words that preceded.

  12. john porritt says:

    Medical schools which accept only those with high IQ cannot ever hope to promote social consciousness in their narrowly selected, often unworldly students.
    Better to encourage the very few of them who understand
    humanity to follow up, later, the narrow-minded medical degree with further qualifications in social studies, social practice and real life experiences.

  13. John Hunter says:

    Professor Murray lists Cuba as one of the advanced medical schools putting forward a socially revolutionary teaching programme. The professor is evidently not aware that Castro’s doctors were proud that their country had the highest rate of lobotomy in the world, and similarly proud of having banned homosexuality and incarcerated gay men in mental hospitals. (See, Ronald Radosh, “Commies – a Journal Through the Old Left, the New Left and the Leftover Left.” pp 121 – 131, Encounter Books, San Francisco 2001.) James Cook is in good company in having its dean espouse revolution – pity about the anatomy lessons.

  14. docstrange says:

    Judging by the posts and our indigenous healthcare gap the article hits the nail on the head. What is so wrong with wanting to achieve a more fairer distribution of the healthcare and knowledge we produce at our universities?

    Whether this group and its plans will manage is a different story, so is the question of whether there is a political agenda embedded – once countries like Cuba are involved a fair comment.

    How many of the commentators actually took the time to check the embedded web-link and read something about this training for health equity network?
    “The Evaluation Framework was intended for schools to take a critical look at their performance and progress towards greater social accountability, as well as assist them in establishing priority areas for research and improvement.”

    Nobody seems to even consider that a part of their job – the more reason to write articles like this and shake the ivory tower of western rich medicine – from the rich for the rich.

  15. Anonymous says:

    Dream on Richard Murray! What breathtaking socialistic waffle! NOW I know why recent graduates are completely lacking in all the basic medical skills. Starting with anatomy, as a radiologist, I have lost count of the number of young graduates who refer to the 1st MP joint as the proximal IP joint of the thumb. Wouldn’t have a clue! They admit to you their anatomical ignorance quite readily and are quite intimidated by it. Basic pathology: pathetic etc etc. I could go on and on. Collectively, those academics responsible, hang your heads in shame. We have a whole generation of medical graduates who KNOW they have been dudded by these airy fairy academics who have NEVER had to make it in the reality of everyday medical practice. It is just so depressing to read such rubbish. Someone should call a Royal Commission over this absolutely parlous situation.

  16. Kevin Marks says:

    This article as stated above is full of baseless assertions and social mumbo-jumbo.
    The first article of real rubbish I have read in this forum.
    It does not deserve any further analysis.

  17. drphil says:

    I was at UNSW 71-6. We had far less silver spoons than were at USyd at the time. I’ve seen my fair share of them in the meantime. I recently was enraged by a “precious princess from Prahran” (level 6 registrar) who told me, after an obstetric incident that she only wanted to do IVF anyway.

  18. Anonymous says:

    It is sad to see the amount of hatred and distrust for left-wing politics that this article has generated (I guess it shows most doctors really are a bunch of money hungry Tories). Coming from a lower class rural background I’m all for a bringing the “Ivory Tower” down and actually selecting students from the communities they are needed in (after all history has shown as that neither the carrot or cane will get urban doctors to work in regional areas). Good for you Prof. Murray and I hope this movement is more than just a means of promotions for those involved!!

  19. Remotedoc says:

    I am with Richard on this one. I am a medical educator and remote area doctor and I have been involved with medical student selection and training for 20 years. I have watched with dismay as the selection of students has changed and is now heavily interview based – and seems to be biased to the selection of the most articulate and sometimes that means the most manipulative students and future doctors. They all say the “right” things but when it comes to the crunch few actually really want to work in the areas of greatest need – and lowest material reward. There needs to be a better way as we are missing people who would be great doctors and do great things. So a couple of medical schools chosing a different way will be great. Vive la difference!

  20. Anonymous says:

    Well, it is not the promotion of socially accountable medical education or the desire to increase the medical coverage of underserved rural population that is the problem with this article. As one comment puts it, “I hope this movement is more than just a means of promotions for those involved”. This piece is full of cliches and stereotypes. The other problem, as highlighted by some other comments, is the undesired consequences in terms of eroding the academic and knowledge base of medical education. This erosion is often associated with those types of curricula.

  21. Chris says:

    To “Anonymous” (the underprivileged rural-background doctor) – You want more people in medical school like yourself to back to the country and serve the greater good. Have you moved back to the country to work? Statistically, probably not. Country med students stay metro. The reasons doctors don’t want to work in the country are the same reasons accountants and lawyers don’t want to. And yet, we don’t get all self-righteous and egalitarian demanding that all law schools accept large numbers of rural students to solve the “rural lawyer crisis”. This double standard has alway infuriated me. Let’s select the “best” students we can, and then make the country an attractive option instead of this unsuccessful path we’ve been on for 2 decades.

  22. david de leacy says:

    I have truly wonderful compromise to help take the heat of this particular debate that I assume Richard Murray has deliberately instigated, presumeably as means of obscuring distracting from falling medical school standards.
    Maybe all the medical students at that bastion of academic excellence, JCU, should be selected only from the postgraduate social science collective so that the required indoctination processes with their accompanying polemics then can be banished from his post-graduate medical degree. Maybe JCU can then readjust their medical degree so as to ensure that their students are provded complete training in basic anatomy, biochemistry, pharmcology, pathology and all the basic scientific tools needed for medical competency etc within the four year time frame available rather than the ‘Readers Digest’ type of training that now occurs. This is Dick’s liver go figure. It truly is depressing that people such as Richard Murray are now regurgitating all the social engineering claptrap of the failed radical left of the 1960s in todays medical schools. That nonsense has lead directly to the shambles and over politicisation and dumbing down of the wider education system within the public sector schools in this country. Also, is it really such a good thing Professor Murray, in an open democratic society such as Austrlia to insult intelligent adult graduate students in their mid-twenties (who have been voting for eight years and who arrived from other faculties) by demanding they must be re-educated by the self appointed ‘great and the good’ in how to think ‘correctly’ so as to be responsible human beings and doctors? What absolute humbug. You really need to capture them in the first seven years as per the Jesuits if you want proper brain washing.
    Yes the tongue is firmly in the cheek regarding my first sentence.

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