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Measuring quality in teaching, training and research: a puzzle with no pieces

[img_assist|nid=3390|title=Dr Will Milford Chair of AMA’s Council of Doctors in Training|desc=|link=none|align=right|width=126|height=170]With funding in the headlines and healthcare in a tight fiscal environment, July has seen the start of the roll-out of activity-based funding nationally – although the Commonwealth has guaranteed funding for the states and territories through to the end o

15 Jul 2012

With funding in the headlines and healthcare in a tight fiscal environment, July has seen the start of the roll-out of activity-based funding nationally – although the Commonwealth has guaranteed funding for the states and territories through to the end of the 2013-14 financial year.

The scramble for hospitals to adapt continues and it remains to be seen what impact this will have on hospital services. At this stage, funding for teaching, training and research remains unchanged, with continuation of pre-existing block funding.

Plans are afoot, however, for a scheduled change to activity-based funding for teaching, training and research in 2017-2018. The Independent Hospital Pricing Authority has flagged that it will be beginning work in this area within the next 12 to 18 months. It is vital that any changes to funding models for teaching, training and research are linked to performance measures that serve to enhance quality and accountability. Questions remain about how these will be developed, defined and measured.

In the Australian setting, a small number of initiatives provide information on the quality of the medical training experience.  Projects such as the Medical Schools Outcomes Database and Longitudinal Tracking Project, which tracks medical students through undergraduate education, prevocational and vocational training, and the 2010 AMA Specialist Trainee Survey, which examined the views of vocational trainees about their specialist medical education and training experience, have provided some insight in this area.

It is also worth revisiting AMA’s first Training, Education and Supervision (TES) survey.  This voluntary survey of the quality of junior doctors’ training, education and supervision was first conducted in 2009 and attracted 900 respondents. 

It delivered a mixed report card. Public hospitals provided more than 80 per cent of junior doctors with easy access to educational and information resources, and around 75 per cent of respondents reported that they received useful team- and unit-based teaching on a regular basis. 

On the other hand, nearly one-third of respondents believed that they were not provided with adequate and appropriate supervision. Similarly, 48 per cent of the junior doctors surveyed felt that their training hospital did not quarantine sufficient time from service delivery for education and training. Other significant conclusions included decreased opportunities for education and training due to inadequate investment in staffing, a culture lacking in encouragement for high-quality medical education and poor investment in the next generation of clinical teachers and researchers.

The AMA is now running the next iteration of this survey. There have already been more than 500 responses and, with two weeks to go, it should be possible to eclipse the response rate of the previous survey. For those junior doctors yet to complete it, it can be found at http://ama.com.au/dit-training-survey-2012.  It is also open to non-AMA members, so encourage those who were not emailed the survey directly to seek it out, complete it and make sure that their experiences count.

It will be interesting to see how  the increasing pressures on clinical training, particularly at the undergraduate level, might show through in this year’s survey.

It is also pertinent to learn from overseas experiences. In the United Kingdom, a comprehensive national survey of trainees is undertaken each year when registrations are renewed.

This compulsory survey measures quality against a number of different indicators, including clinical supervision, quality of care, workload and teaching. It is administered by the General Medical Council and monitors the quality of medical education and training in the UK, providing feedback that can be used to improve the training practice of local education providers.

It raises the question of whether a similar survey, under the auspices of the Australian Medical Council and administered by the Australian Health Practitioner Regulation Agency, would be worthwhile here. It would certainly help inform efforts to sustain and improve the quality of teaching, training and research – an area about which little is known and where the current tools of assessment are haphazard and incomplete.

Adequate funding of training, teaching and research, and the measurement and maintenance of its quality, are integral to ensuring that Australia’s health care remains at the high standard to which we are accustomed.  There is a unique window in the evolution of this process and the AMA will be there to ensure that the views of doctors, both senior and junior, are included. With a long race on the horizon, there remains much work to be done. 


Published: 15 Jul 2012