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22 Nov 2016

The turmoil of the Trump election has overshadowed one of the greatest things about the US presidential campaign: that it’s now over. I’m fairly certain you’re sick of hearing about it too, and you’ll be glad to know this isn’t an article about Donald. No, it’s about fear and opinions becoming truths.

You see, Donald wants to build a giant wall, and he wants Mexico to pay for it. He’ll be quite saddened to find that his wall will have the exact opposite of its intended effect, with more Mexicans presently leaving the US than entering it. A fitting outcome really, in a beautifully ironic serendipity.

I’m sure those closer to the reality are angrily exploding at their various newspaper headlines and television grabs with Donald continuing to espouse lies. But if you say something often enough, it doesn’t need to be true; it just needs to be true enough.

This is the case with medical internships in Australia.

No, we don’t want to build a wall to keep interns out. Yes, we do want to re-examine medical internship in Australia.

The greatest flashpoint of this discussion has been the COAG Health Council’s Medical Intern Review. If you look at the terms of reference, the very first line says: “Australia has a high quality and well trained medical workforce”. It doesn’t exactly sound like the world is falling apart, does it?

But the implicit assumption in the discourse has been that internship is broken. Why commission such a review if it isn’t?

In defence of the review, this was not the language that was used. It was the language that grew to occupy the new space that was created.

The AMA’s position has always been that internship has room for improvement, but is not fundamentally broken.

However, since the review, every forum I’ve attended on prevocational training and education has worked off of the incorrect basis that internship is broken.

In a world where we “stop the boats”, you shouldn’t underestimate the power of language.

Despite no reliable evidence that internship is broken, this is now our baseline working point. And it’s dangerous one, because it justifies truly crazy ideas, like moving internship into medical school.

It also comes with an opportunity cost. We’re so busy talking about the unbroken internship that we don’t discuss the increasingly broken prevocational space as a whole.

This is now more relevant than it has ever been before.

Internship is a protected space, with clear safeguards around training and education. Registrars are protected by their respective colleges and accreditation processes.

But what of the prevocational and non-vocational doctors?

When the sea of interns moves onwards, they’ll soon find a lack of career pathways and, with minimal regulation over the prevocational space, it’s a disaster waiting to happen.

Residents won’t be doctors anymore; they’ll be a poor excuse for a labour hire arrangement.

The AMA Council of Doctors in Training recently discussed a number of Position Statements around the pre-vocational space. We have always believed in quality teaching, appropriate learning opportunities and clear support structures, and we strengthened these calls in 2016.

We have always opposed early streaming, and we call for early choices to help develop a flexible workforce, for the health of Australia and for appropriate career opportunities.

We strongly believe that all prevocational positions should be accredited, to prevent exploitative employment practices in intellectually void terms and placements.

We call for the support of supervisors, to ensure teachers are free to teach. We believe that medical school should prepare you for internship, but we do not believe that internship belongs in medical school.

The AMA is often painted as a monolithic agent, resisting inevitable change.

I spend my time working with doctors in training from all states and territories to change the landscape of prevocational medicine in Australia for the better, so I resent that statement.

I take solace in the fact that the “half truthers” eventually get bored and move on, while the AMA remains on topic.

We’re working for a brighter prevocational future, and we’ll make it there.



Published: 22 Nov 2016