The profession of medicine

CHAPTER 25 The profession of medicine

When you finish this chapter you should be able to:

The study of medicine in Australia

The oldest medical school in Australia is at Melbourne University, established in 1862; however, many medical schools are extremely new. For example, Deakin started in 2008. Medicine was traditionally a 6-year degree in almost all Australian universities and this usually consisted of 3 years of preclinical work and 3 years of clinical work. The pre-clinical years consisted of learning anatomy, physiology, biochemistry and pathology much like an undergraduate science degree. In the clinical years, the students were based in the teaching hospitals and learnt at the bedside, following more senior doctors around the wards, into theatre and clinics, learning clinical and procedural skills on patients, learning about their illnesses, admitting them to the hospital, looking after them when they were inpatients — learning by learning on patients.

The traditional way of learning medicine has changed in the last few years with almost all the established medical schools undergoing some sort of curriculum reform. While most undergraduate degrees in Australia are still 6 years, divided into pre-clinical and clinical years, there have been changes with more clinical skills and patient contact being introduced into the pre-clinical years. Also, many medical schools have adopted problem-based learning (PBL) as the basis of their curriculum. In a PBL curriculum, students still attend lectures and practicals but a large part of their studies is taught through the PBL process. The process of PBL is to use a patient problem, such as pneumonia, to start to learn about the inflammatory response, the anatomy, histology and physiology of the lungs, microbiology of infection and pharmacology of antibiotics. In groups of about eight and facilitated by a tutor, students discuss the case and the knowledge underpinning the condition. A lot of the learning is self-directed, with the students investigating the learning issues that arise from the case on their own and then presenting and discussing this with the group. The rationale is that the PBL process encourages students to be self-directed learners and this, in turn, should assist them in becoming lifelong learners, although this has not been proven (Finucane, Johnson, Prideaux 1998).

Since 1996, a number of postgraduate medical courses have been introduced into Australia based on the ‘American’ model of a 4-year postgraduate degree. These 4 years are also divided into pre-clinical and clinical years.

One of the major difficulties for medical schools is their ability to provide students with access to patients for students to learn on. This is a problem across the sector for every health profession, from paramedics to medicine, nursing and allied health. With more medical schools and more students in medical schools in Australia, there are fewer patients per student. Additionally, patients are now more likely to refuse to be examined by a student or a have a procedure performed by them, and hospital clinicians are busier and have less time to spend teaching. Access to good quality teaching in the clinical years is a dilemma all medical schools are now facing.

Entry requirements for medicine

In the past, when all medicine schools were undergraduate, entry into medicine was based on Year 12 scores except in exceptional circumstances. This led to concern that medical schools were selecting only those with academic ability and not interpersonal skills. There is no doubt that medical students do require a high level of academic ability to cope with the amount and complexity of knowledge that must be acquired, however, most complaints about doctors are made about their lack of ability to communicate (Pincock 2004) not their lack of knowledge. Medical defence organisations (professional insurance organisations for doctors) run workshops to reduce a doctor’s risk of being sued and the major focus of these workshops is improving communication skills, not knowledge. Some medical schools introduced an interview as part of the entrance criteria to get a rough approximation of students’ interpersonal skills, communication skills or reasoning skills. The validity of the interview and other selection methods has recently been called to question as if it is not clear whether these selection methods are actually choosing medical students who will graduate with better communication skills or not (McManus & Powis 2007).

Most medical schools in Australia use the Undergraduate Medical Admission Test (UMAT) for undergraduate medical courses or the Graduate Australian Medical Schools Admission Test (GAMSAT) for graduate medical courses as an entrance exam. There are other health-related professions which also use the UMAT. Selection into a medical course is also based upon Year 12 or university marks or grade point average (GPA) and in some cases an interview. Additionally, some medical schools use a written portfolio submission. The weighting universities give to these entry requirements is different across the country. Both the UMAT and GAMSAT are overseen by the Australian Council for Educational Research (ACER). There are preparatory workshops advertised widely, that candidates can pay to attend, which ‘claim’ to increase their chances of scoring well in the tests and performing well in the interviews.

The demand to get into medicine is high. Some of the reasons may be:

Traditions associated with medicine

Options in postgraduate training

Table 25.1 is a list of medical colleges’ specialties and subspecialties, taken from the college websites. The list of specialist medical colleges can be found on the AMC website (see online resources at the end of this chapter). Please note that when someone refers to the specialty of medicine, they are referring to ‘internal medicine’ which is what a physician practises. Some doctors decide not to enter a specialty training program immediately and are in the general basic program. The amount of time to train to be a specialist varies from 4 years for general practice up to 7 years for physicians. The amount of time needed to be a specialist varies between countries.

Table 25.1 Postgraduate medical colleges in Australia

Area Speciality Sub speciality
Medicine General physician Cardiology, clinical genetics, clinical pharmacology, endocrinology, gastroenterology and hepatology, geriatric medicine, haematology, immunology and allergy, infectious diseases, intensive care medicine, neonatal/perinatal medicine, nephrology, neurology, nuclear medicine, oncology, rheumatology, sleep medicine and thoracic medicine. Also, occupational medicine, rehabilitation medicine, public health and palliative medicine
Surgery General surgeon Cardiothoracic surgery, otolaryngology, head and neck surgery, neurosurgery, orthopaedic surgery, paediatric surgery, plastic and reconstructive surgery, urology, vascular surgery
General practice General practitioner Rural and remote general practitioners
Psychiatry General psychiatry Child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, psychoanalysis and psychotherapy
Obstetrics and gynaecology Obstetrician and gynaecologist Gynaecological oncology, maternal fetal medicine, obstetrical and gynaecological ultrasound, reproductive endocrinology and infertility and urogynaecology
Paediatrics Paediatrician Community child health, paediatric emergency medicine, paediatrics and child and adolescent psychiatry, paediatric rehabilitation medicine
Anaesthesia Anaesthetist Pain medicine and intensive care
Pathology Pathologist Anatomical pathology, chemical pathology, genetics, haematology, immunology and microbiology
Radiology Radiologist Nuclear medicine and radiation oncology
Ophthalmology Ophthalmologist  
Rural and remote medicine   Aboriginal health, rural medicine
Emergency medicine Emergency physician  
Dermatology Dermatologist  
Medical administration Medical administrator  

These case studies represent some of the specialities in medicine and some personal comments by doctors on their work. This information was sourced from real case histories but names and identifying details have been changed.

Mar 24, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on The profession of medicine
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