Entrance InformationNew ZealandUniversity of Otago

About Medicine at the University of Otago

The University of Otago – an Overview

The University of Otago is New Zealand’s oldest university (established 1869), and currently is ranked highest out of the New Zealand universities for research quality (according to the government-run performance-based research fund). It consistently ranks in the top 100-200 universities worldwide in international university rankings, where it closely competes with Auckland university for the title of highest-ranked NZ university.

The main campus is located in Dunedin, New Zealand’s sixth-largest city (population 120 000). Founded by Scottish settlers (whose influence can still be easily seen today) and once the largest city in the country, Dunedin retains a strong heritage and a rich selection of historical buildings, including the main university clocktower and the medical school’s Scott and Lindo Ferguson buildings.


The clocktower building at the main Dunedin campus

Despite Dunedin only being a small city, the University of Otago is the second largest university in the country. As a result the largest industry in Dunedin is tertiary education (closely followed by healthcare), and students comprise almost a quarter of the population. For this reason Dunedin is often referred to as “New Zealand’s university city”, with 75% of Otago’s undergraduate students originating from outside Dunedin, moving away from home to study.

About the medical school
The medical school forms a very important part of the university as a whole. 100 years ago there were as many medical students at Otago as there were arts and science students combined! Even now, the medical school pulls in 75% of the university’s external research funding.

Having been founded in 1875 (making it the 3rd oldest medical school in Australasia, behind Sydney and Melbourne), and serving as the country’s only medical school for nearly 100 years, the school also has a very rich history. In the research sphere discoveries of note include the first description of the pathogenesis of Graves’ disease (which was the first time an autoimmune disease process had been identified), discovery of the link between iodine deficiency and goitre, and important advances in neurophysiology (nobel prize-winning neurophysiologist John Eccles was based at Otago for 7 years in the 1940’s). This rich history can still be seen today in the collection of the anatomy museum, containing many specimens up to 100 years old that would be unobtainable today.

More recent research successes include the awarding of the Rutherford medal (the NZ Royal Society’s highest honour, granted to one NZ scientist per year) to researchers from the medical school in both 2010 and 2011.


The Lindo Ferguson building, Dunedin school of medicine

In the 1960’s medicine at Otago further advanced with the establishment of the Christchurch school of medicine and the Wellington school of medicine. Consequently, the Otago faculty of medicine is now spread over 3 major campuses, each of which runs as an independent medical school (although the 3 schools closely collaborate). Christchurch is NZ’s second-largest city and the main city of the South Island, while Wellington is NZ’s capital city. The role of the Christchurch and Wellington campuses is discussed below.

The Medical Course

The Otago medical course is a 6 year programme that leads to graduation with MB ChB (bachelor of medicine and bachelor of surgery). The course is divided into 4 phases: Health Sciences First Year (HSFY), Early Learning in Medicine (ELM) (years 2-3), Advanced Learning in Medicine (ALM) (years 4-5), and Trainee Internship (TI) (year 6).

The first 3 years of the course (HSFY and ELM) must be completed in Dunedin. For years 4-6, the class is evenly divided between the Dunedin, Christchurch, and Wellington schools of medicine (although significant parts of years 4-6 may be spent outside the 3 cities). While the teaching and curricula vary between the 3 schools, all work towards the same core competencies and the final barrier exam after 5th year is common to all 3 schools, meaning that everyone graduates with the same degree.

Health Sciences First Year (HSFY)
The role and structure of HSFY is detailed in the admissions article: http://www.medstudentsonline.com.au/content/otago-medicine-entrance-information-390/

Early Learning in Medicine (ELM)
ELM forms a continuous programme lasting 2 years, occurring over years 2 and 3 of the course. Teaching is through lectures, tutorials, and labs, with patient contact being very limited (although still present). A typical week would contain 8-10 hours of lectures, 8 hours of tutorials (with 10-16 students per tutorial group), and 4 hours of labs.

Due to the integrated nature of the programme, each year is run as one paper (worth 120 points) – MICN201 in 2nd year and MICN301 in 3rd year.

The content itself is divided into four components:
1. Medical Science

By far the largest component of ELM, this teaches the basic science that underpins clinical medicine. Teaching is via lectures, labs, and tutorials with a strong expectation that independent learning will also occur outside of this. The content is divided into block modules and vertical modules. The block modules are taught sequentially, one at a time, and are:

  • 2nd year: behavioural medicine; musculoskeletal; cardiovascular; respiratory; gastrointestinal
  • 3rd year: nervous system; metabolism and nutrition; renal; endocrine; reproduction, development, and ageing; regional and clinical anatomy

The vertical modules are spread across the full 2 years, with teaching from each module occurring where it best relates to what is being taught in the rest of the course at the time. The modules are:

  • bioethics; blood; cancer; evidence-based practice; genetics; hauora Maori (mainly taught through the Maori immersion week in 2nd year); infection and immunity; pathology; pharmacology; professional development; psychological medicine; public health

2. Clinical Skills

This teaches basic interviewing and examination skills, with the aim of allowing the student to transition smoothly into 4th year, where regular patient contact begins (see ALM). Teaching is via one 2 hour tutorial every week for the duration of ELM. There are 10-11 students in each tutorial group with a dedicated tutor present for the whole tutorial. Generally students practice on each other during these tutorials (and so gain familiarity with what is “normal”), but occasionally there are opportunities to practice on volunteer patients from the community.

3. Healthcare in the Community (HIC)

HIC is a diverse course with a variety of aims with the overall purpose being to put doctoring in context. The focus is not on medical science or clinical skills, rather on learning to appreciate the patient as a person, understanding the context in which healthcare occurs, and developing good reflective practice.

Teaching is via one 2 hour tutorial every week. There are 10-11 students in each tutorial group with a dedicated tutor present for the whole tutorial. However, often a tutorial will be replaced with some activity outside the classroom, in keeping with the HIC philosophy of teaching via experiential learning. Examples of such activities include:

  • Visiting patients in their homes to talk about their experience of illness.
  • Working as assistant caregivers in aged care facilities.
  • Visiting a rural community for a week to appraise the community health needs and delivery of healthcare.
  • Completing a 6 week course in an area of the humanities.
  • Visiting allied health professionals in their workplace to learn about their role in the multidisciplinary healthcare team.
  • Visiting a kindergarten to gain some practical experience of early childhood development.

As part of HIC, 3 reflective essays must be completed throughout ELM, which must draw on material from the entire ELM course to provide a personal response to a set question (e.g. “what should the role of doctors be in influencing the lifestyles of their patients?”).

4. Integrated Cases

Throughout ELM students work on a variety of cases (one per fortnight) that are designed to integrate material from across the curriculum in the context of a patient (real or simulated). There is one 2 hour tutorial every week (a total of 2 tutorials per case) which involve working through a variety of tasks relating to the case at hand. There is a strong expectation to prepare for case tutorials, and independent learning tasks are given to complete between the 2 tutorials. Across the tutorials there is a gradual transition from tutor-guided to student-guided learning, with tutorials transitioning from the tutor being present for the full 2 hours to only being present half the time (so each tutorial becomes 1 hour without a tutor followed by 1 hour with a tutor).

Assessment

Assessment throughout the year is purely formative – i.e. intended to help guide the student in their learning, but not contributing to the final end-of-year grade. However, in order to gain terms you must complete all formative assessment and demonstrate satisfactory attendance and professional attitudes throughout the year. Failure to gain terms results in a fail for the year overall.

All summative assessment occurs in the form of 5 exams at the end of the year:

  • 3 short answer exams – each of these is a 3 hour case-based examination which can cover any content in the course to date (which means that the 3rd year exam covers 2nd and 3rd year material). These 3 exams are marked as a whole to give one mark, and must be passed in order to progress to the next year.
  • OSCE – a 4 station OSCE (with the potential for another 4 stations if necessary) covering the material taught in clinical skills. In order to progress to the next year the OSCE must be passed overall and a minimum standard achieved in both consultation and examination skills.
  • OSPE – a laboratory-based exam covering anatomy, histology, and pathology that must be passed in order to progress to the next year.

The final mark for the year is reported as fail, pass, or pass with distinction.

An extensive summary of the ELM programme is available here: (link – 1.7MB)


The Hunter Centre, Dunedin – location of all ELM tutorials, and hub of the ELM programme

Advanced Learning in Medicine (ALM)
For year 4 onwards students are placed in one of the Dunedin, Christchurch, or Wellington schools of medicine. If demand for one or two of the schools exceeds the number of available spaces then some students may have to be balloted to the undersubscribed school. A condition of entry into 2nd year medicine is the signing of a document stating that you accept you may be placed in a city you don’t want. However, in reality the number of students who end up unhappy with the city they are placed in is very small.

Years 4 and 5 are clinically focussed, with students rotating around attachments in a variety of areas and a large amount of patient contact. The exact content and style of teaching varies between the 3 schools.

The rotations for each school are:

Dunedin
4th year: Medicine (8 weeks); Surgery (8 weeks); Psychological medicine (8 weeks); Urban general practice, public health, and ENT (8 weeks)

5th year: Musculoskeletal and emergency medicine (8 weeks); Womens’ and Childrens’ health (8 weeks); Rural general practice (8 weeks); Medicine/ophthalmology (8 weeks)

Christchurch
4th year: General practice (8 weeks); Cardio/respiratory medicine (4 weeks); Cardiovascular/plastics/dermatology (4 weeks); Surgery/oncology/haematology (4 weeks); Emergency/gastroenterology/GI surgery (4 weeks); Healthcare of the elderly (4 weeks); Otolaryngology/ophthalmology/addiction (4 weeks)

5th year: Womens’ health and developmental medicine (8 weeks); Paediatrics (4 weeks); Psychological medicine (4 weeks); Musculoskeletal (4 weeks); Neurology and neurosurgery (4 weeks); Public health (4 weeks); Advanced medicine (4 weeks)

Wellington
4th year: General practice (5 weeks); Public health (5 weeks); Medicine (10 weeks); Surgery (10 weeks)
5th year: Child and adolescent health (10 weeks); Musculoskeletal and skin (5 weeks); Primary health care/general practice (2 weeks); General medicine and subspecialties (5 weeks); Psychological medicine (5 weeks); Reproductive, sexual, and womens’ health (5 weeks)

In all 3 centres there is additional vertical module teaching (e.g. pathology, bioethics, hauora Maori). In Christchurch and Wellington this occurs every Thursday, while in Dunedin this occurs in 3 whole class teaching weeks spread throughout the year. All 3 centres also have a short selective at the end of 5th year to explore an area of interest.

Teaching outside the main centres
A large amount of teaching outside the 3 cities occurs in ALM. In Dunedin all students have to spend some time outside of the city, for 4 weeks in 4th year (either at Invercargill or Timaru hospital), for the 8 week rural general practice rotation in 5th year, and sometimes a further 2 weeks in Invercargill will be required in 5th year. In Wellington placements may occur throughout the greater Wellington region, extending as far as Paraparaumu for general practice placements.

Additionally, in 5th year the rural medical immersion programme (RMIP) is offered. This involves spending the entire year in a rural community (e.g. Queenstown, Blenheim, Balclutha, Greymouth, Masterton), working on a one-on-one basis with a GP mentor, linking in with local specialist services, and some intensive whole group urban sessions spread throughout the year. The RMIP is a young programme but has produced some fantastic results and is highly competitive (in 2010 there were 47 applicants for 20 spaces).

Assessment
Students must perform to a satisfactory standard in all modules (rotations and vertical modules) as determined by in-course assessment to pass the year. For 4th year the overall grade for the year is only reported as pass or fail, although individual modules may give out more detailed results (including the possibility of achieving “potential distinction” for each).

A set of common exams (the same for all students across Dunedin, Christchurch and Wellington) at the end of 5th year must be passed to progress to 6th year and consist of an OSCE, essay-based exam, and 2 EMCQ exams. The final grade for 5th year is reported as fail, pass, or pass with distinction. A grade of “distinction” represents high achievement in the 5th year exams and high achievement throughout both 4th and 5th year as determined by in course module assessments.


University of Otago, Christchurch: Main building

Trainee Internship (TI)
This capstone year serves as a transition between medical school and internship and consists of 6 rotations (medicine, surgery, general practice, psychological medicine, paediatrics, O & G) and a 3 month elective. A small educational stipend is paid to students to acknowledge that by this stage they are contributing to the healthcare team. Formal examinations only need to be sat by those students identified by supervisors as borderline or as particularly high achieving. In the case of the former this is to clearly establish a pass/fail grade and in the case of the latter this is to award the grade of distinction and various prizes.

It is possible to complete the TI year outside of the 3 main cities. For example, students based in Christchurch may complete all or part of the TI year in Nelson, and students based in Wellington may complete all or part of the year in Palmerston North or Hawke’s Bay. The possibility of establishing a rural TI option is also being investigated.


Otago University central library, Dunedin

BMedSc(Hons)
An option available to medical students is the completion of a BMedSc(Hons). This involves a year of full-time research culminating in the writing of a thesis and may be undertaken between 3rd and 4th year or between 5th and 6th year. As a result the total time required to complete the medical course becomes 7 years, but results in graduation with MB ChB, BMedSc(Hons). Generally 15-20 students per year take up this option. A very small number build on this to complete an intercalated PhD.

Links

Otago university website: www.otago.ac.nz
Otago faculty of medicine website: micn.otago.ac.nz
Otago medical education website: hedc.otago.ac.nz/magnolia/meg/Home.html (contains a lot of good information about the Otago course)