The Graduate Medical ProgramThe Graduate Medical Program

Dr. Chris Roberts and Prof Ann SeftonThe Office of Teaching and Learning in Medicine

Medical Education in AustraliaMedical Education in Australia

• 15 Medical Schools nationwide– 7 Undergraduate programs– 8 Graduate programs

• Workforce shortage in Australia– Increase of 5 new med schools since 2001– Shift towards graduate medicine over 10 yrs

• Academic– 50% non-med sciences

• Ethnicity– 15% North American international students,

10% Asian-descent• Gender

– 60% female

The studentsThe students

Where will you go?Where will you go?

For 1st year vocational training i.e. 2012• 33% General Practice• 14% Adult medicine• 13% Adult surgery• 8% Anaesthetics• 8% Psychiatrists• 6% Emergency Medicine

What is our course so good?What is our course so good?

• Because our graduates are competent at clinical skills

• Good science knowledge

• Self confident

• Good team workers

• A bit argumentative

Patient

How shouldI talk tothis patient?

Why do they thinkthey’re ill?

Why is the patientill?

Is the illnesspart of a pattern?

How do Iknow myadvice isthe best?

What affects andguides ourrelationship?

Communication skills

Patients’ perceptions

Basic and Clinical Sciences

Epidemiology and Public Health

Evidence-based medicine

Professional Development

114 clinical problems

Basic science and clinical medicine integrated

Science is clinically led

Generic Graduate Skills

Patient and Doctor Theme

Personal/Professional Development Theme

Basic and clinical sciences Theme

Community and Dr Theme

MBBS specific outcome objectives

Clinical Competencies

Basic and Medical Sciences

Curriculum ThemesCurriculum Themes• Patient-Doctor (PDt)

• Clinical skills, diagnostic method, bedside manner

• Basic & Clinical Sciences (BCS)• Basic sciences, medical sciences

• Personal/Professional Development (PPD)• Medical ethics, medico-legal, doctor’s health

• Community & Doctor (CDr)• Public health, EBM, statistics, health economics

Year1

2

3

4

Horizontal Integration

Year1

2

3

4

Vertical Integration Clinical Competencies

Year1

2

3

4

Vertical Integration Clinical Basic Competencies Sciences

Year1

2

3

4

Clinical Basic PPD Competencies Sciences

Vertical Integration

Year1

2

3

4

Clinical Basic PPD Population Health Competencies Sciences (CDr)

Basic Sciences

Clinical Competencies

• Curriculum outlineCurriculum outline

A typical week?A typical week?

PBL tutorial 1formulate problem

identify learning

PBL tutorial 3management plan

PBL tutorial 2plan inquiry - patient

data

diagnostic decision

Pre-clinical Years 1 & 2Pre-clinical Years 1 & 2• Lecture-based, on campus

– 12+hours of lectures per week: 8 BCS, 2 CDr/PPD– 1 hospital-based day: PDr clinical and procedural skills tutorials

• 67 PBL clinical cases– One case per week, 3 tutorials per case, 10 students per group– Original patient data, patient reports,and radiological images– PBL discussion focus on Mechanism of Disease

• Basic and clinical sciences• History and Physical Exam• Differential Diagnoses

problem trigger

Patient informationDifferential Diagnosis

PBL Tutorial Session 1

PBL Tutorial Session 2

PBL Tutorial Session 3

Self-guidedLearning Goals

problem trigger

Patient Interview

Self-guidedLearning Goals

patient results

PBL Tutorial Session 2

PBL Tutorial Session 1

PBL Tutorial Session 3

Provisional

Diagnosis

Patient informationDifferential Diagnosis

Self-guidedLearning Goals

problem trigger

diagnostic decision * research questions * feedback on the problem

patient results

PBL Tutorial Session 3

PBL Tutorial Session 1

PBL Tutorial Session 2

Patient informationDifferential Diagnosis

Patient Interview

Provisional

Diagnosis

Self-guidedLearning Goals

Self-guidedLearning Goals

How content is integrated into a complex case presentation eg “Mr Sarich’s chest pain” across learning elements:

• 1 case trigger• 6 clinical results• 7 learning topics• 6 lectures• 6 theme sessions• 1 patient data sheet• 10 formative assessment questions• other online resources

Example of PBL in Cardiology: “Mr Sarich’s chest pain”Example of PBL in Cardiology: “Mr Sarich’s chest pain”

Clinical Years 3 & 4Clinical Years 3 & 4• Hospital-based teaching and learning

– 2-days of lectures and tutorials per week• 2 PBL tutorials, one self-directed tutorial, 8 students per group

– 3 days of clinical ward experience• 8 Integrated Clinical Attachments (ICA) in Year 3• 4 Clinical Rotations (CRC) in Year 4• Join medical/surgical team on ward rounds, 1-3 students per dept.• Attend departmental lectures as scheduled for junior doctors

• PBL tutorial discussion focus on Management– Investigations– Treatment options– Follow-Up and Prognosis

1. A short case scenario2. A series of clinical reasoning steps (see below)3. Each step begins with a prompt question(s)4. A text entry for student response:　 An expert response, which may include links

to further learning, appears after the student has submitted their own response

• History• Problem Formulation• Examination• Refinement of DD• Investigations• Working Diagnosis• EBM• Management• Prognosis• Discussion Points• Reference Material

Problem solving using a specific clinical discipline approach

Perspectives of PBL ProcessPerspectives of PBL ProcessAdvantages• Mature-aged students with life experience make better doctors• Students develop a comprehensive clinical reasoning process• Learning in a clinical context• Collaborative learning and communication skills

Disadvantages• Generic clinical problem solving rather than case-specific reasoning• All problems not equal in developing problem solving skills• Knowledge developed may be biased towards one case type• Resource intensive

And FinallyAnd Finally

We make no apologies for changing the course as we go, we are always trying to make it better!!

References

University of Sydney Medical Programhttp://www.medfac.usyd.edu.au/showcase/index.phphttp://www.gmp.usyd.edu.au

University of Sydney Faculty of Medicinehttp://www.medfac.usyd.edu.au

Medical Society (MedSoc)http://www.medsoc.usyd.edu.au

Office of Teaching and Learning in Medicinehttp://www.otlm.med.usyd.edu.au/