Committee of Presidents of Medical Colleges

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Position Paper on Support by Health Jurisdictions for the Teaching of
Vocational Trainees
Background
The Education Subcommittee of Committee of Presidents of Medical Colleges (CPMC) deals with educational matters that are common across all medical colleges. An issue that has been raised at a number of recent forums on postgraduate medical education is that of support for training of vocational trainees by hospitals and area health authorities. As a consequence, the CPMC has asked the Education Subcommittee to prepare a position paper that will be sent to the health jurisdictions and to the Productivity Commission about this matter.

Position
Vocational medical training has successfully operated on an "apprenticeship" model in teaching hospitals. This "on the job" clinical experience with patients is enhanced by direct supervision and teaching with a focus on clinical reasoning and judgement and is further supplemented by structured teaching sessions provided by senior hospital staff and medical colleges, by self-directed learning after hours and, more recently, by newer technology such as video conferencing and synthetic training environments for practical and procedural skills.

Hospital-based training, both practical and theoretical, is delivered by staff specialists and visiting medical officers, the latter undertaking such teaching on a pro bono basis.

Teaching (or learning) and clinical service are inextricably linked - direct one to one supervision and teaching in the context of patient care such as ward rounds, the operating room or the emergency department are good examples. While some countries have actively pursued the unbundling of financing for clinical service and teaching, this has not been widely successful and currently there is little enthusiasm within the Australian medical colleges to pursue this line. However, the formal acceptance that teaching is an integral responsibility of the health jurisdictions, from the state/territory health department level through to area health authority and individual hospitals, and that it contributes to safe and effective health care is not generally articulated within current governance structures.

Specialists and trainees report that support for teaching, particularly allowing trainees protected time (in the order of 2 hours per week) to attend formal teaching sessions, is not uniformly provided and both staff specialists and VMOs report similar variable support for their teaching activities.

The CPMC firmly believes that all health jurisdictions should encourage and preferably mandate teaching activities, including quarantined time for trainees, as well-trained trainees provide good clinical service. Teachers also should receive protected time to ensure that they are able to teach, given that they are in general willing to commit the time and effort to teach effectively.

The CPMC believes that jurisdictional support should be fostered strongly and preferably given the status of a key performance indicator when performance of local health authorities and hospitals is being assessed.

5 July 2005