News

A Shortage of Patients for Teaching Students

Australia's urgent need for more medical graduates to tackle doctor shortages is facing another critical problem. A Newcastle study published in the current issue of the Medical Journal of Australia, has shown that teaching hospitals are increasingly unable to provide students with necessary 'hands on' experience required for future practice.

Co-author, Dr Leslie Olson, Senior Lecturer in the Faculty of Health at the University of Newcastle, said the health workforce of the future might not have the clinical skills to deliver quality assessment and treatment.

Motivated to conduct the study by students' complaints that "there aren't any patients on wards we can see", the researchers have found the gripes are actually true, and that there is a pressing need to establish alternatives to traditional teaching hospitals.

The study simulated the experience of medical students attempting to see patients, and found that on any given day, there are about twice as many students as available patients. Of the 1960 patients audited, less than half were available to be seen (959) and only two-thirds of those (645) gave permission for an examination.

Professor Brendan Crotty, Clinical Dean of the University of Melbourne, said in an accompanying editorial "several factors are contributing to the shortage of patients with whom the students can develop their skills.

"The patient shortage is being caused by reduced lengths of stay, 'hospital in the home' programs, and elective surgery patients being admitted and discharged on the same day. In addition, some elective surgery procedures students need to learn about are increasingly being performed in private hospitals. The privatisation of hospital outpatient clinics also reduces student exposure to ambulatory care," Professor Crotty said.

Patients in the modern system are sicker and less inclined to see students, and students are not exposed to patients with more 'mainstream' injuries or illness in the way they once were. Medical students are also competing with postgraduate and vocational trainees and overseas-trained doctors preparing for the Australian Medical Council exam.

"Australia urgently needs more medical graduates, but there are not enough suitable public hospital inpatients for the clinical teaching program of the new medical schools.

"The apparent lack of planning in decisions about the new medical schools will almost certainly exacerbate the problem identified in the study. This might have been avoided if the recent spate of medical school expansion had been based on consultation with educators rather than driven by political considerations," Professor Crotty said.

The way forward is not entirely clear, but Professor Crotty offers several suggestions for exposing students to patients in settings outside teaching hospitals, and calls on the State and Federal Governments to consider them urgently.

He nominates general practice, specialists' private rooms, privatised clinics and private hospitals as starting points, but acknowledges the constraints of time and space, as well as the financial disincentives, many practitioners would face in aiding students.

"Pilot programs to address the disincentives would be an excellent place to start, but would require a level of collaboration between federal and state governments," Professor Crotty said.

"Private hospitals are major beneficiaries of the medical education system yet most contribute little to the training of their medical staff.

"A system must be worked out to redress this situation. Taxpayers provide large sums of money to support the private health system and we should insist that some of it is allocated to training the future health workforce," Professor Crotty said.

Another solution put forward by Professor Crotty is expanding the use of simulation-based clinical teaching. Although it is no substitute for direct patient contact, it is an effective way to teach some clinical skills.

"The long overdue, but poorly planned expansion of medical schools will exacerbate the problem. If tomorrow's doctors are to graduate with adequate clinical skills, we urgently need to expand clinical teaching into sites other than public hospitals," Professor Crotty said.

CONTACT Dr Leslie OLSON 0418 649 611 / Les.Olson@newcastle.edu.au

Professor Brendan CROTTY Mobile / Daytime contact

Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471

Media Contacts

Federal 

 02 6270 5478
 0427 209 753
 media@ama.com.au

Follow the AMA

 @ama_media
 @amapresident
‌ @AustralianMedicalAssociation