Issue 1 / 21 January 2013

A SHORTAGE of senior medical educators and growing demand for their expertise has prompted leading Australian educators to call for a more defined career pathway for medical education.

In an editorial in the latest MJA the authors said the lack of defined career pathways, a failure to formally recognise medical education as a specialty, and the emphasis many universities placed on research at the expense of teaching had resulted in an erratic supply of medical educators. (1)

Lead author Professor Wendy Hu, professor of medical education at the University of Western Sydney, told MJA InSight the impetus to write the editorial came last year when six universities in NSW and the ACT were seeking heads of medical education at the same time, “with no new people in the pipeline”.

Coauthor Professor Jill Thistlethwaite, professor of medical education at the University of Queensland, told MJA InSight there was a growing demand for senior medical educators in Australia and internationally, and a shrinking pool of senior educators. “We need to think about nurturing the next generation.”

Professor Hu described the current path to being a medical educator as “patchy and piecemeal”. She said stiff competition for limited medical education research grants, a dearth of departments of medical education and no defined vocational end point could dissuade younger clinicians from pursuing education as a career path.

The authors outlined an approach to further develop the discipline by targeting medical students, medical graduates and medical education specialists. For medical education specialists, they recommended specialty recognition; an Australasian academy of medical educators, and more resources for medical education research.

Professor Simon Willcock, chair of the Confederation of Postgraduate Medical Education Councils, said he agreed with the editorialists’ position, but had concerns about the suggestion that medical education be recognised as a specialty.

“One of the mistakes we’ve made in medicine is to build lots of specialty silos. This creates a very expensive and, at times, disintegrated system where people have lots of expertise but it isn’t broadly shared across the system”, he said.

Professor Willcock agreed that universities had disinvested in medical education. He said education and training was often viewed as the poor cousin to “anything associated with research”, which attracted funding.

However, he said medical education had now reached a fork in the road. “We need to decide whether we develop a specialty of medical education where people go down a narrower and narrower path and become the gurus, or whether expertise in medical education can be integrated as part of a more generalist scope of professional practice that might include clinical work, administration work, leadership, education and training and research”, Professor Willcock said.

It was also essential that medical education and training was aligned with current community and workforce need, he said. “One of the problems [when] people become very expert in a narrow area, particularly if they move away from clinical practice, is that they … often lose the focus or alignment with what we are educating and training for. I don’t think people should give up clinical practice to be purely an educator.”

Professors Hu and Thistlethwaite agreed that maintaining a connection to clinical practice was essential.

Professor Thistlethwaite said an Australian academy of medical education would be complementary to specialist colleges. “It would certainly not be your only college — most of us would stick with our disciplinary colleges”, she said, adding that the academy would also include non-medical educators.

Professor Hu said it was also important to acknowledge medical education as a professional obligation for all doctors.

“Medical education is something that everybody should do to some extent, and we understand that pursuing medical education as a career will appeal to a smaller number of people. That’s why we have argued for a whole range of strategies”, she said. “But we don’t yet have a comprehensive analysis of medical education workforce needs so we can make sound recommendations about what is needed to deliver quality medical education.”

Dr Will Milford, chair of the AMA’s Council of Doctors in Training, said medical educators and supervisors had been forgotten in the past decade of rapid expansion of medical schools and medical training.

“They are the ones that bear the biggest brunt of trying to support and educate and train medical students, interns and prevocational doctors”, he said.

He said a nationally consistent scheme of professional credit and qualifications for medical educators would provide appropriate recognition and, in turn, attract more doctors to medical education.

– Nicole MacKee

1. MJA 2013; 198: 8-9

Posted 21 January 2013

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19 thoughts on “Medical educator pool shrinks

  1. Tom Ruut says:

    I would like to support the notion that a medical educator needs to have active clinical involvement. This is a sine qua non! More recognition needs to be paid to teachers and especially good teachers – the students know who they are! At the moment medical education is regarded as an add on:something you do if you have the time. Remember the series in the MJA? “Teaching on the Run”, says it all!

  2. "about to retire" says:

    An untapped source of teachers are the senior members of the profession who are at the point of retirement, often with decades of experience and who, unless they remain fully registered with AHPRA, are not allowed to teach after ceasing clinical practice i.e.a complete waste of an invaluable resource.

  3. Tom Ruut says:

    I could not agree more with “about to retire’.It is a tragic loss of highly talented and motivated pool of manpower.

  4. MARTIN KNAPP says:

    I agree with “about to retire” and with Tom Rut but I also suggest that those needing more senior input into teaching or/and medical education (or are they the same?) might look at the already retired and the almost retired. I have been working in regional locations for the over 20 years, as locum and doing “fly-in” clinics for 12 of those years. I consider that my previous expeperience as an educator and teacher in several medical schools around the world has been underused. There must be many more who have left the work-force more recently who could make useful contributions.

  5. daman langguth says:

    Universities have totally alienated many clinicians, and to some extent have invented the specialty of educationalism, which is taken up by those who pretend to actually be involved in healthcare. Education in medicine, like in all fields, not just the professions, is key to the development of one’s field of interest/work. I know of one university that asks for job applications including key selection criteria each year, when the service is essentially provided gratis. What a suprise people don’t help.

  6. Ken Sleeman says:

    Just another “semi-retired” practitioner who has written on the subject of the untapped resource of senior doctors who can teach whilst working in hospitals so that our younger colleagues can slave away to establish themselves in private practice and/or research.
    Yet it seems to be extremely difficult to obtain entry to the education field in these circumstances. I am told by some that funding is the problem, by others that even after completing preliminary programs, they hear no more.

  7. Arthur Anderson says:

    I totally agree with “about to retire”. I have been retired from clinical practice in Anaesthesia and some Int. Care for over 12 months and was involved in teaching med.students, RMOs, ICU staff, as well as Mica ambulance officers. Thanks to AHPRA, insurance is now a prior to registration, and the joy of teaching (with part-time clinical) is not worth $30,000 annual insurance which I had been paying (this still carries on for the next few years after retirement). If AHPRA is serious they would address this anomaly to encourage teaching from those near/or retired.
    Retiring was a bit of an insult, as to be registered as “retired”, I had to agree to a police check!! I am now not qualified to write a prescription. I was a life saver one day and dangerous the next!

  8. John Porritt says:

    Another retired medical doctor, psychotherapist and medical educator [MHPEd NSW], I love teaching, so much so that I have been teaching on all the above in a NSW region U3A position in the last few years. I’m retired but not yet decrepit and once taught medical students, young doctors, nurses, health and social workers. Does anyone wish to use my services, or is there no scheme by which I and other experienced and competent teachers, of whom there are not a few, I suspect, might be utilised?

  9. Christine Gestier says:

    I am heading towards retirement but with a long career in General Practice. I feel it is important to pass on what I have gleaned from this experience so when possible I teach under- and postgraduates.The difficulty is that now I am working part time, rather than reduce my consulting time I often have to attend the rooms specially to provde the required teaching. The renumeration for these activities is certainly not worth my time or effort – I must be doing it for some other reason? With increasing demand for training practices, a considerable increase in teaching fees would tempt other practices to be involved
    You can’t learn from books or online what one can teach from experience!

  10. retired hurt says:

    There is another issue…. people with an enthusiasm for medical education are being pressured to leave because their ambitions to train junior doctors clash with initiatives that make health systems “efficient” at the expense of reduced training. I received pressure, abuse and ultimately non-renewal of visiting contract as an indirect consequence of my 7 years as Director of Training. Those who love training are not being defended in the world of hospital politics! One of the advantages of moving training and education to the private sector would be that such doctors are immune to hierarchical pressures.

  11. Dr. John B. Myers says:

    I would be happy to lecture as i am still presenting at International peer reviewed meetings and at the national level in several areas of clinical practice. Remuneration, recognition and holidays would be appreciated. Unless doing clinical work i see no reason for educators to be insured. I also believe strongly that AHPRA and Medical Boards are neither appropriate arbiters of education, educators or content. Being a registration body is not an entitlement to having a say as they are not credentialed for what they do or profess to do. In short bureaucracy has no place in medical education nor does it ensure good clinical practice or encourage inquiry and creativity and research; rather it (the self elected and self serving bureaucracy and watchdog) spells the death knell for good evidence based practice and for creating a fertile learning environment for students’ minds and hopeful experience. Educators must also have an impact on legislation which is unfair or short-sighted, as is the current Professions Registration Act 2005 as the patient’s viewpoint need not even be taken into account. Education must focus on patient’s Rights and that Rights be safeguarded in General. Educating the medical profession is incumbent on us, but so is the recognition that we have failed to educate politicians and the public which is an essential component of medical education that considers Rights and responsibility (rather than quality and safety – the bureaucrat viewpoint) as part of our duty of care.
    As a profession, whether in full time or academic practice it is our duty to ensure accountability and evidenced based practice not only in medicine but in law as well, through a “System of Evaluated Decisions” subjecting them to objective and prospective review to bring the legal profession and Judicial process to account, including Boards and AHPRA, instead of allowing the anecdotal system to continue to prevail, above the law and beyond and even without account.

  12. Preeti Shanbag says:

    I agree with Tom Ruut that a medical educator needs to have active clinical involvement.I would add that active involvement in research is also needed.The three are not mutually exclusive. The hidden curriculum plays a large role in any professional education including medical education and students need good role models.I work in India and teaching especially of undergraduates is regarded as a necessary evil by most faculty and passed on to junior staff and residents at the slightest pretext citing administrative pressures, meetings etc as an excuse. As stated by Tom Ruut, the students are fully aware who the good teachers are and seek them out but there is no recognition of good teachers by peers or administrators.

  13. physician says:

    I am a VMO hospital physician. I have been teaching both undergraduate students and FRACP candidates for many years, but spend much more time with the FRACP candidates. My reasoning is this – the Universities pay me nothing, and the College of Physicians pays me nothing, but the Universities are paying many other people to educate the students, whereas the FRACP candidates are basically entirely dependent on people like me for their clinical teaching. I enjoy teaching and I plan to do it for the rest of my life.

  14. Rose says:

    Making medical education a specialty would be excellent if we wish to train doctors to sit behind a desk, use the internet, and practise medicine online . If we want to train clinicians to take a history, examine patients, do office procedures like debride /close a wound, remove a foreign body etc then experienced Specialists and GPs are far more valuable than full-time medical educators/researchers if training is for clinical practice.

  15. Sue Ieraci says:

    Rose is right. Students can learn theory on their own. They need active (or recently active) clinicians to teach clinical practice.

  16. Kate Sullivan says:

    It sounds like what is needed is a change in culture. My experience as a student was largely that of tutorials crammed in around the edges of a clinician’s busy schedule, with very little bedside teaching. Lessons were often poorly planned and cancellations were frequent as the tutors attempted to juggle full-time clinical practice with voluntary teaching positions, many of whom were likely never formally taught how to teach. It would seem that currently there is little professional or financial reward for clinical educators, and without actively promoting the importance of such roles their uptake is unlikely to improve.

    There are already some excellent programs which are addressing this, notably the Teaching on the Run workshops, the introduction of Medical Educator rotations in some training programs, and more recently the HETI LEAP program. In just a few years of operation, HETI’s LEAP program has resulted in several junior doctor-led education initiatives, however the longer term achievement of culture change will take some time.

    Such programs need to be promoted and receive greater financial support to allow them to reach their longer-term objectives, as well as making teaching a more feasible career choice through the provision of suitable part time clinical positions and incentives.

  17. Anonymous says:

    Thanks to AHPRA despite my post graduate degree in Family Medicine I would not spend any time ‘educating’ students or junior doctors. I have given a lifetime of often free service with no thanks.

  18. jay rao says:

    This would be ideal for someone working part time in a teaching hospital in transition to retirement phase (like myself) and be able to teach as well as train medical students and junior doctors, should be encouraged by all universities and hospitals

  19. Rose says:

    Teaching students overlaps with funding EDs with Medicare Local money in each hospital-extra clinical staff in ED translates to increased time for ED staff to train students, (and interns) at the interface of the ED, GP practice, and inpatient clinical medicine, which is far more use than training students on dummies. How does a student elicit a history from the dummy, perform a clinical exam, assess level of consciousness , perfusion , blood loss, on an inert object attached to a monitor?

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