Medical specialist education and training in Australia

Is it heading in the right direction? he preceding article by Clarke and Morgan (page 685) discusses a new form of education and training for medical specialists in Australia. The programs at the Australian School of Advanced Medicine at Macquarie University have pre-Fellowship (general specialist training) and post-Fellowship (sub-specialist training) components. 1 Here, I concentrate on the former. Both the formal university involvement and the new funding model proposed in the article have major implications that warrant widespread discussion. The authors imply that the university environment will enhance the educational experiences of trainees, but they have not provided supporting evidence. If it is true that the new model of training will result in better outcomes than our current system of medical college training in hospitals, should we consider other alternatives? In Canada, most specialist training programs are contracted to university medical schools and affiliated hospitals by the Royal College of Physicians and Surgeons of Canada. 2 Would this be a better approach for Australia? Alternatively, should there be competing programs? Traditionally, medical specialist education and training has been seen to be both a public good and a benefit to the individual, with costs shared between the Australian taxpayer and trainee. For almost all trainees employed in public hospitals, the taxpayers' costs have been met by hospital budgets. It has not been possible to separate out the costs of specialist training because most training is directly associated with patient care. 3 There has been considerable debate as to whether the additional costs are significant and whether the benefits to the system outweigh the costs. Undoubtedly, trainees incur costs — unpaid overtime, fees to the specialist colleges, and fees for courses, attending lectures and meetings and the like. The Commonwealth Government, with some understandable ambivalence from state governments wishing to protect the public hospital workforce, is seeking greater private-sector involvement in specialist training. The reason is not only to cater for increased numbers of medical graduates, but because many essential learning experiences in most specialties are now available only in the private sector. 4 These include less complex elective surgery, such as stripping of varicose veins, repair of bunions, and plastic surgery procedures, much of dermatology, rheumatology and endocrinology, and management of patients with anxiety and less complex depres-sive disorders. Funding remains contentious. The sums initially suggested by the Commonwealth Government during the discussion process would have barely covered salaries and on-costs …