Diversity and consistency: a case study of regionalised clinical placements for medical students
Mavourneen G. Casey A D , Michael David B and Diann Eley CA Medical Education Unit, School of Medicine, Mayne Medical Building, The University of Queensland, Herston Road, Herston, Qld 4006, Australia.
B School of Public Health, Public Health Building, The University of Queensland, Herston Road, Herston, Qld 4006, Australia. Email: m.david@uq.edu.au
C Medical Education Unit, School of Medicine, Mayne Medical Building, The University of Queensland, Herston Road, Herston, Qld 4006, Australia. Email: d.eley@uq.edu.au
D Corresponding author. Email: m.casey3@uq.edu.au
Australian Health Review 39(1) 95-100 https://doi.org/10.1071/AH14033
Submitted: 13 February 2014 Accepted: 16 September 2014 Published: 17 December 2014
Abstract
Objective A major challenge for medical schools is the provision of clinical skills training for increasing student numbers. This case study describes the expansion of the clinical school network at The University of Queensland (UQ). The purpose of the study was to investigate consistency in medical education standards across a regional clinical teaching network, as measured by academic performance.
Methods A retrospective analysis of academic records for UQ medical students (n = 1514) completing clinical rotations (2009–2012) was performed using analysis of covariance (ANCOVA) for comparisons between clinical school cohorts and linear mixed-effects modelling (LEM) to assess predictors of academic performance.
Results In all, 13 036 individual clinical rotations were completed between 2009 and 2012. ANCOVA found no significant differences in rotation grades between the clinical schools except that Rural Clinical School (RCS) cohorts achieved marginally higher results than non-RCSs in the general practice rotation (5.22 vs 5.10–5.18; P = 0.03) and on the final clinical examination (objective structured clinical examination; 5.27 vs 5.01–5.09; P < 0.01). LEM indicated that the strongest predictor of academic performance on clinical rotations was academic performance in the preclinical years of medical school (β = 0.38; 95% confidence interval 0.35–0.41; P < 0.001).
Conclusions The decentralised UQ clinical schools deliver a consistent standard of clinical training for medical students in all core clinical rotations across a range of urban, regional and rural clinical settings. Further research is required to monitor the costs versus benefits of regionalised clinical schools for students, local communities and regional healthcare services.
What is known about the topic? To help meet the demand of increasing numbers of students, Australian medical schools locate clinical training outside the traditional tertiary hospitals. However the viability of maintaining teaching standards across regional and rural locations is uncertain.
What does this paper add? Maintaining teaching standards outside established urban teaching hospitals and across a diverse range of urban, regional and rural clinical settings is viable.
What are the implications for practitioners? Decentralised clinical teaching networks provide consistent quality of clinical placements while diversifying exposure to different patient populations and clinical environments. These important outcomes may not only alleviate the strain on clinical teaching resources, but also help address the maldistribution of doctors in Australia.
References
[1] Association of American Medical Colleges. AAMC Physician workforce policy recommendations (updated September 2012). 2012. Available at: https://www.aamc.org/download/304026/data/2012aamcworkforcepolicyrecommendations.pdf [verified May 2014].[2] Health Workforce Australia. Health Workforce 2025 – Doctors, Nurses and Midwives – Volume 1. 2012. Available at: https://www.hwa.gov.au/sites/uploads/FinalReport_Volume1_FINAL-20120424.pdf [verified May 2014].
[3] Australian Bureau of Statistics. Year book of Australia, 2012: geographic distribution of the population. Canberra: Australian Bureau of Statistics; 2012. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1301.0~2012~Main%20Features~Geographic%20distribution%20of%20the%20population~49 [verified May 2014].
[4] Health Workforce Australia. Mapping clinical placements: capturing opportunities for growth: supply (clinical training provider) study. 2011. Available at: https://www.hwa.gov.au/sites/default/files/mcp-cog-supply-report-a20111028.pdf [verified May 2014].
[5] Van der Weyden M. Increased medical school places: a crisis in the making? Med J Aust 2006; 185 129
[6] Rabinowitz HK, Diamond JJ, Markham FW, Wortman JR. Medical school programs to increase the rural physician supply: a systematic review and projected impact of widespread replication. Acad Med 2008; 83 235–43.
| Medical school programs to increase the rural physician supply: a systematic review and projected impact of widespread replication.Crossref | GoogleScholarGoogle Scholar | 18316867PubMed |
[7] Maley M, Worley P, Dent J. Using rural and remote settings in the undergraduate medical curriculum: AMEE Guide No. 47. Med Teach 2009; 31 969–83.
| Using rural and remote settings in the undergraduate medical curriculum: AMEE Guide No. 47.Crossref | GoogleScholarGoogle Scholar | 19909036PubMed |
[8] Jones R, Higgs R, De Angelis C, Prideaux D. Changing face of medical curricula. Lancet 2001; 357 699–703.
| Changing face of medical curricula.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7lvFykug%3D%3D&md5=55d71b1edd2056ac02af79e36f1ca866CAS | 11247568PubMed |
[9] University of Queensland. The School of Medicine, campuses and teaching sites. 2014. Available at: http://www.som.uq.edu.au/about/campuses-and-teaching-sites/clinical-schools/.aspx [verified May 2014].
[10] Australian Medical Council Limited. Standards for assessment and accreditation of primary medical programs by the Australian Medical Council 2012. 2012. Available at: http://www.amc.org.au/images/Accreditation/FINAL-Standards-and-Graduate-Outcome-Statements-20-December-2012.pdf [verified May 2014].
[11] Department of Health and Ageing. Rural Clinical Training and Support. Canberra: Australian Government; 2012. [updated May 2014] Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/work-st-rcs [verified May 2014].
[12] McLean R, Pallant J, Cunningham C, DeWitt D. A multi-university evaluation of the rural clinical school experience of Australian medical students. Rural Remote Health 2010; 10 1492 Available at: http://www.rrh.org.au/Articles/subviewnew.asp?ArticleID=1492
| 20818841PubMed |
[13] Sen Gupta T, Hays R, Kelly G, Bu PG. Are medical student results affected by allocation to different sites in a dispersed rural medical school? Rural Remote Health 2011; 11 1511 Available at: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1511
| 1:STN:280:DC%2BC3M7jtFeisw%3D%3D&md5=7bc207258e24b92b886c84460aa8f532CAS | 21244193PubMed |
[14] Couper ID, Worley PS. Meeting the challenges of training more medical students: lessons from Flinders University’s distributed medical education program. Med J Aust 2010; 193 34–6.
| 20618112PubMed |
[15] Norris TE, Schaad DC, DeWitt D, Ogur B, Hunt DD. Longitudinal integrated clerkships for medical students: an innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Acad Med 2009; 84 902–7.
| Longitudinal integrated clerkships for medical students: an innovation adopted by medical schools in Australia, Canada, South Africa, and the United States.Crossref | GoogleScholarGoogle Scholar | 19550184PubMed |
[16] The Consortium of Longitudinal Integrated Clerkships (CLIC). CLIC overview. 2011. Available at: http://www.clicmeded.com/ [verified May 2014].
[17] Australian Qualifications Framework Council. Australian qualifications framework, 2nd end. 2013. Available at: http://www.aqf.edu.au/wp-content/uploads/2013/05/AQF-2nd-Edition-January-2013.pdf [verified September 2013].
[18] Prideaux D, Roberts C, Eva K, Centeno A, McCrorie P, McManus C, Patterson F, Powis D, Tekian A, Wilkinson D. Assessment for selection for the health care professions and specialty training: consensus statement and recommendations from the Ottawa 2010 Conference. Med Teach 2011; 33 215–23.
| Assessment for selection for the health care professions and specialty training: consensus statement and recommendations from the Ottawa 2010 Conference.Crossref | GoogleScholarGoogle Scholar | 21345061PubMed |
[19] Willoughby TL, Gammon LC, Jonas H. Correlates of clinical performance during medical school. Acad Med 1979; 54 453–60.
| Correlates of clinical performance during medical school.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE1M7ps1KgsA%3D%3D&md5=c8590c38ea360390b006e4cd9e4386e3CAS |
[20] Reteguiz JA, Crosson J. Clerkship order and performance on family medicine and internal medicine National Board of Medical Examiners Exams. Fam Med 2002; 34 604–8.
| 12269537PubMed |
[21] Department of Health and Ageing. Rural and regional health Australia: your local and aged care information system (updated January 2014). 2014. Available at: http://www.ruralhealthaustralia.gov.au/ [verified May 2014].
[22] Rattner SL, Louis DZ, Rabinowitz C, Gottlieb JE, Nasca TJ, Markham FW, Gottlieb RP, Caruso JW, Lane JL, Veloski J, Hojat M, Gonnella JS. Documenting and comparing medical students’ clinical experiences. JAMA 2001; 286 1035–40.
| Documenting and comparing medical students’ clinical experiences.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrhsF2qtw%3D%3D&md5=8b279349ef80f87174e77ea2934bd525CAS | 11559287PubMed |
