[Undergrad] Medical Student Tsunami - how it affects premedschool students

[chinaski]

We have to put the students somewhere!

Putting them somewhere where they won't be adequately taught isn't the answer.

I'm not going to say that General Practice is a perfect substitute but in the UK it has been integrated quite well. Some studies on the effectiveness of GP for education/training had quite positive results. 1 2 3

The first citation claims that students' impressions of rural teaching is favourable. This is not surprising. Rural teaching is usually very friendly and positive. Indeed, many of the rurally based students I have met on secondments have been overwhelmingly positive about their experiences. Regardless, students aren't a great barometer of ability - just because somebody loves their learning, doesn't necessarily mean they are learning the right stuff. My anecdotal experience is that many of these students have big gaps in their knowledge - not willfully - just borne out of lack of breadth of experience and teaching.

One of the other citations (sorry - can't recall which) suggests that GP and rural teaching is adequate for first year students. This I wouldn't contend. First year students aren't in the nitty-gritty of their clinical years - so teaching the fundamental basics out of a hospital setting isn't unreasonable. My main concerns lie in the later years, wherein students are supposed to being prepared to work as interns, with an adequate skills and knowledge base essential to that job.

I'd also point out that all of the above studies don't look at ability as interns. Passing med school exams ain't necessarily a good predictor for success as a graduate.

In short: GP and rural rotations, however much spin the Government puts on it, won't provide the same teaching that a tertiary teaching hospital does. Whilst I am also quick to point out that bread-and-butter is important for students (rather than ultra-specialised pathways, as seen in many big hospitals), that bread-and-butter, IMO, isn't best delivered outside. For instance, even your basic medical specialties (eg nephrology, oncology, infectious diseases, cardiology) differ wildly in delivery and infrastructure when you compare urban and regional hospitals. In some areas, they don't exist as specialties at all. To learn gold standard practice, it's essential that you are exposed to it.

 

[ceejay]

Let's just give up shall we?

 

[steve mate]

Putting them somewhere where they won't be adequately taught isn't the answer.

With too many in the teaching hospitals they won't be adequately taught there either...

Well if we at least use General Practice for the more junior years it will take the load off the teachers who teach all the other students and jnr doctors.

I don't know if there are suggestions to have GP completely replace the hospital time, but it will probably have to play some supplementary role to free up hospital space and teachers.

I think a good test of GP V Hospitals will be when wollongon pump out their first grads. 1 of their 4 years is spent with a rural GP...

 

[chinaski]

With too many in the teaching hospitals they won't be adequately taught there either...

Very true.

Well if we at least use General Practice for the more junior years it will take the load off the teachers who teach all the other students and jnr doctors.

It's not a bad idea, so long as it's balanced with adequate hospital time (and preferably, time in both regional AND tertiary hospitals, rather than in one demographic to the exclusion of another). Then again, leaning into the GP sector would set a difficult equation for schools (such as Sydney) who are very much hospital based in their syllabus, from first year onwards.

 

[steve mate]

"For every complex problem there is an answer that is clear, simple, and wrong." - H. L. Mencken

 

[ceejay]

It's not a bad idea, so long as it's balanced with adequate hospital time (and preferably, time in both regional AND tertiary hospitals, rather than in one demographic to the exclusion of another). Then again, leaning into the GP sector would set a difficult equation for schools (such as Sydney) who are very much hospital based in their syllabus, from first year onwards.[/quote]

Great idea to relieve the pressure off the metro hospitals. Not as convenient for the students, but a mere side effect. As long as the quality is maintained, which is the essence of this argument.

 

[chinaski]

"For every complex problem there is an answer that is clear, simple, and wrong." - H. L. Mencken

How true. Just open more med schools. It'll fix the doctor shortage.

 

[Raj]

How true. Just open more med schools. It'll fix the doctor shortage.

Well, it is not a complete solution in itself, but is a factor amongst many others which could potentially and together solve the current problem. As ceejay has written, it needs to be balanced by guarantee of intern position, provision of adequate training and experience, distribution of doctors all over Australia, et al.

- Raj

 

[Matt]

Well, it is not a complete solution in itself, but is a factor amongst many others which could potentially and together solve the current problem. As ceejay has written, it needs to be balanced by guarantee of intern position, provision of adequate training and experience, distribution of doctors all over Australia, et al.

- Raj

That's the the thing Raj, it's not a complete solution in and of itself, but it is a complete problem in and of itself. Creating problems to solve problems is not in anyway commendable.

Of course it needs to be balanced by guarantees of proper training but this thread is about the med student tsunami, afterall. The very thing that is threatening provision of proper training.

 

[zvyx]

maybe there's a way to lure retiring consultants to go back to teaching? like a significant financial bonus, or appeal to their emotions, or something...

 

[chinaski]

maybe there's a way to lure retiring consultants to go back to teaching? like a significant financial bonus, or appeal to their emotions, or something...

A few consultants who have retired still keep their hand in, teaching wise. Obviously they are more use to junior students, given that they don't work anymore (therefore, cannot give much hospital based teaching given their lack of patients and expired clinical privileges). These guys are a minority, though - and with good reason: remember, these people have already spent their whole lives teaching. Retirement is meant to mean the end of work! I recently met up with an old boss of mine who retired last year. Says he doesn't know why he didn't do it years ago: he finally has time to do all the things he's always wanted to do, and to spend time with his family (who had been playing second fiddle to the hospital all these years). I don't imagine any amount of financial incentive would be enough to convince him to come back (particularly given that he's already pretty comfortable).

 

[steve mate]

In a meeting at the AMA (NSW) they were talking about supporting tax incentives to draw extra teachers... it was to get the retired drs teaching but it was more for the doctors from the private sector...

 

[Angavar]

The answer to the title of this thread is simple: more competition and more stress. Bear in mind, that this added competition and stress is the direct result of those people who failed to consider the (IMO, blatantly obvious) consequences of increasing the number of MBBS graduates. I mean, what bright spark came up with the idea of increasing medical students without contemplating where they would be trained or who was going to train them once they graduated? Or, (more likely), did they give it some thought and then put it in the too hard/ don't care basket?

At the end of the day we're going to need a lot more large, teaching hospitals to service the aging "Baby Boomer" generation. The only reason that we don't have those hospitals yet (as far as I can see) is because hospitals cost a lot of money. Increasing the number of MBBS graduates was most likely a political stunt to make people think the government was doing something (which just exacerbated the problem). To solve the real problem, as others posters have stated, you need more fully trained doctors in more hospitals. In other words: more money. Given the current budget deficit in NSW , that's not going to be happening as fast as any of us would like.

Perhaps, as others have suggested, I'm being a bit unrealistic in expecting all my training opportunities to fall at my feet once I've made it to med school. But, as others have pointed out, the degree by itself is useless without an internship. With regards to degrees in Law, Journalism and Engineering you're set and laughing once you've got your degree. Surely med students deserve no less?

My point is, find those responsible for this disaster and vote with your feet. Don't just complain about the added burden, complain to the right people.

 

[Matt]

To solve the real problem, as others posters have stated, you need more fully trained doctors in more hospitals. In other words: more money.

Money would undoubtedly go some way toward fixing the problem but you can't buy fully trained doctors. Private doctors aren't going to jump ship to teach if you offer them more money, they make more money than the government could ever afford to give them where they are (generalising).

 

[anonymouse]

Money would undoubtedly go some way toward fixing the problem but you can't buy fully trained doctors. Private doctors aren't going to jump ship to teach if you offer them more money, they make more money than the government could ever afford to give them where they are (generalising).

Overseas trained doctors yo.

 

[Matt]

Overseas trained doctors yo.

Well that's a good point. Of course there are issues (there are always issues): like the ethics involved in importing doctors from overseas (countries like Iran, for example, might need those doctors we're importing). For obvious reasons a lot of imported doctors come from developing countries. Then there's the difficulty involved. There've been many failed attempts to recruit doctors from overseas. Gaining registration is also quite difficult in Australia for overseas trained doctors but imagine the public outcry if you tried to change that.

It's still a good point though. What you're looking for is a country with an excess of competent doctors and the UK is one potential example but, of course, it's still difficult.

 

[chinaski]

Well that's a good point. Of course there are issues (there are always issues): like the ethics involved in importing doctors from overseas (countries like Iran, for example, might need those doctors we're importing). For obvious reasons a lot of imported doctors come from developing countries. Then there's the difficulty involved. There've been many failed attempts to recruit doctors from overseas. Gaining registration is also quite difficult in Australia for overseas trained doctors but imagine the public outcry if you tried to change that.

It's still a good point though. What you're looking for is a country with an excess of competent doctors and the UK is one potential example but, of course, it's still difficult.

Without wanting to set off a flame war, let me just say this: importing doctors from first world countries has been historically difficult, largely because you can't recruit unless you offer a big fat pay cheque which is competitive with what they could earn at home. US doctors, for instance, stand to make a heck of a lot more dosh by staying in the US, rather than coming out here, even if we do have the attractions of a nice lifestyle and beautiful beaches etc etc.

So where, therefore, do the glut of our overseas trained doctors hail from? Developing/third world/comparatively disadvantaged countries. This leads to problems on the job - cultural differences, language barriers, disparities between quality of and approach in clinical practice, and so on. I am not tar-and-feathering all overseas trained doctors here - but I would point out that it's a very, very, very fraught issue in hospitals right now, to the point of some clinicians cheering on an oversupply of locally produced graduates, because it will lead to an end to our reliance on overseas trained doctors.

 

[Matt]

[offtopic]I went to a GP professional development night a couple of months ago and there wasn't one GP there who didn't have a heavy accent >_>. I can't remember the exact percentage but something like 70 or 80% of GPs in the Campbelltown area are overseas trained. [/offtopic]

 

[chinaski]

[offtopic]

[offtopic]I went to a GP professional development night a couple of months ago and there wasn't one GP there who didn't have a heavy accent >_>. I can't remember the exact percentage but something like 70 or 80% of GPs in the Campbelltown area are overseas trained. [/offtopic]

You seriously don't want to get me started on the wrongs of sending those guys out into the wilderness. Talk about unsupported...![/offtopic]

 

[Hardy]

This leads to problems on the job - cultural differences, language barriers, disparities between quality of and approach in clinical practice, and so on.

Shh! I hear the AMC helicopters closing in!