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07 Dec 2017


In many ways, the health system in Australia is on the brink of transformation. From moving away from fee-for-service as with NDIS and healthcare homes, to standardisation of private health insurance, to improving the use of personal data through information technology, disruption is clearly on the horizon.

However, in many ways medical education is still well behind when it comes to revolution. From outdated assessment methods, to courses no longer fit for purpose for the learner or the community, it is interesting to see where change must be made.

Thankfully, we have seen this year in both the Australian Medical Council (AMC) and the Medical Deans of Australia and New Zealand (MDANZ), a renewed push to improve teaching and learning into the future. But what might this look like?

I recently attended a workshop by the AMC focussing on the usefulness of programmatic assessment. Programmatic assessment as I understand it is a method of assessment where no one task is designed to ‘pass’ or ‘fail’ a learner. Instead, assessments are seen as individual data points that reflect an aspect of the learner’s knowledge at a certain time point. Through multiple assessments, at different times and through different methods, assessors can more accurately discover the strengths and weaknesses of the learner, leading to a clearer pass or fail.

While this may sound ‘softer’ than old school competencies, this may represent the opportune way of ensuring safe practice. No one OSCE or Mini-CEX assesses all aspects of the medical job, but together they give a picture of the learner. The added benefit is that programmatic assessment lends itself to more useful and more personalised feedback. Even through web-based adaptive testing, learners may now receive ‘tailored’ feedback on their performance. This is starting to gain traction in medicine, in useful teaching tools such as AMBOSS out of Germany. Question banks like those used for the USMLE are fast-becoming a way in which medical teaching is already transforming.

Another crucial part of the future health curriculum is social accountability. I was introduced to social accountability as an issue at the International Federation of Medical Students’ Associations (IFMSA) general assembly. Built upon the 5 pillars of equity, quality, relevance, efficiency and partnerships, social accountability in medical school means that students should get taught what they need to benefit their community. This may often go against the university’s business interests, in favour of providing education that is most appropriate to the learners. In an Australian context, curricular inclusions of indigenous health in context, treating those from culturally and linguistically diverse (CALD) backgrounds, and even tackling rural health issues falls under this banner. Similarly, medical school needs to be accessible to diverse members of the community, just as healthcare is.

Finally, interprofessional education (IPE) has a long way to go in Australian medical schools. Interprofessional education refers to classes or courses where learners from different health disciplines learn together. Multidisciplinary teams are now the foundation of the health unit in Australia, and yet most new medical graduates couldn’t tell the difference between an occupational therapist and a physiotherapist. Early silo-ing may be convenient but it adds to a culture of distrust and confusion, and students co-learning and co-producing their educational experience would be the key to solving this.

These are just a few of the many changes going on in medical teaching now and into the future. For me it comes down to preparation of the learner; and in medicine, we are lifelong learners. With programmatic assessment, social accountability and interprofessional education, we will hopefully continue to see the best doctors, prepared for the needs of our patients. 


Twitter: @robmtom

Published: 07 Dec 2017