Title: Masters of Clinical Medicine - Proposal (Draft 4)

Introduction

The Following Proposal is for the establishment of a university qualification named Masters of Clinical Medicine. This is to be sponsored by a consortium of the Postgraduate Medical Education facilities of University of Queensland and University of Newcastle. There is the possibility of support from the Postgraduate Medical Councils of both states, and potentially from the relevant state and federal government health departments. This support is yet to be formally canvassed.

This educational program is aimed at providing the opportunity of an educational structure for potential Career Medical Officers, as well as an educational opportunity for current Career Medical Officers. The Career Medical Officers Association of Australia would support this proposal, as may other organisations representing CMOs, providing the program was optional and driven by the profession (with university endorsement).

Background

The Overview:

Career medical officers have been a significant force in maintaining health services, especially in provincial centres around Australia, and are recognised industrially as senior medical staff. However, this diverse group have significant problems with recognition of a career pathway, as well as specific issues with continuing medical education. There are thought to be approximately 2000 CMOs throughout Australia.

The designation "CMO" encompasses two major groups

1. a Fixed Group ­ who have chosen a CMO career
2. a "Fluid" (or non-committed) Group ­ who are between careers and/ or assessing career options- some in non-recognised registrar training positions or studying for college exams

Both groups value medical education. However, there is a growing perception by those who have committed themselves to CMO positions that they are a distinct and valued group within the larger medical workforce and as such have legitimate and special educational requirements, at present being not addressed at all, or addressed only incompletely.

The CMOA Database has detailed information on limited numbers of CMOs. Of the 125 representatives in the database, about 50% work at least partly in Emergency Medicine. There are 116 other qualifications in the 125 CMOs on whom detailed information is collected on the database. The other areas of clinical practice, apart from Emergency, for this cohort includes general practice, prison health, forensic, palliative care, community health, paediatrics, travel medicine, and psychiatry.

The Educational and Career Problem for current medical graduates, considering options including being a CMO, are as follows:

1. Difficulty in vocational training due to family commitments, gender issues, relatively poor income and lifestyle issues.
2. Established college training programs are specialty oriented and narrow
3. Training and career progress can be intermittent or even fragmented in varying institutions or sites over years, particularly if candidates do not succeed in their chosen career or decide on a change in career.
4. CME system currently based on RACP system (flexible, optional, "self" regulated) – see below.

The Medical Profession, as well as Federal and State Health Departments, are becoming increasingly interested in the CMO career option, both in its current form and looking towards its potential. The issue of senior doctors functioning as hospitalists, for example, has been recently much discussed in the Medical Journal of Australia. The impact of the Provider Number legislation is still to reach its full effect, but the limited access of future medical graduates to independent clinical practice has led to interest in who CMOs are and what they do. The current medico-legal climate, and increasing demand for verified CME for all medical practitioners has also led Medical Boards and Postgraduate Medical Councils to consider what responsibility exists for ongoing education for CMO's. CMOs themselves, in collaboration with the Royal College of Pathologists of Australasia, have commenced a CME program that has wide-spread acceptability in the general medical community. All these forces are coinciding at present, demanding that a viable recognised career structure comes into being for CMO's, with ongoing support for CME and medical standards.

Currently Available Programmes

A large number of educational opportunities already exist for medical officers, including CMOs. Many of the learned medical Colleges run specific education programs for their trainees. Local hospitals have continuing medical education programs. Some universities and other educational institutions also provide educational opportunities for medical staff. Within the proposed consortium, the following courses are already available.

University of Newcastle Medical School already has some postgraduate programs proving useful to general postgraduates :

• Clinical Epidemiology
• Critical Reasoning
• Best Prescribing Practice
• Clinical Toxicology

Hunter Institute of Medical Health has useful programs with workshops in a number of areas, for example counselling the bereaved, Gestalt Therapy, working with families and many others.

The Hunter Postgraduate Medical Institute currently provides extensive programs with documented certification in :

• Paediatrics (Diploma)
• Obstetrics

The Hunter Postgraduate Medical Institute also offers other courses in areas, as identified by local medical practitioners. For example, local medical staff suggested a recent course in Dermatology, which was organised. There is also experience in the Hunter region, associated with the University of Newcastle, with distance education modules. One example is a Masters course, looking at Evidence Based medicine, which is relevant and enhances research skills. This works using distance education plus two weekends per year with accreditation of similar courses.

QMEC has extensive experience in postgraduate education. They have been responsible for PGY 1 and PGY 2 Programs, as well as Bridging Courses for AMC Candidates. They have also been instrumental in courses for Infectious Disease management, especially HIV/ AIDS Courses.

Proposal

There is a perceived need for broadly based, flexible, modular educational program covering areas useful to CMO's.

The proposal is for the development of a Masters of Clinical Medicine, accessible to medical graduates. It is perceived that this course may be of interest to potential CMOs and current CMOs, including those considering specialty training. The Masters Clinical Medicine could be general and include both hospital and community based subject areas, or be specialised to Masters Clinical Medicine (Hospital) or Masters Clinical Medicine (Community), depending on the electives chosen.

It is essential that the Masters course is an option for CME and career development, not viewed as compulsory by employers or Health Departments or Medical Boards. Recognition of prior learning and a clinical focus are seen as critical components of this Masters program. In fact, a proportion of the Masters must be completed in clinical settings, and all units must have relevance to the clinical arena. A modular format with access to distance education approaches is the most viable. A minimum of two thirds of the course must be directly clinically relevant for completion of the Masters.

The Masters would require 8 – 12 (depending on credit point weighting) modules to be completed. It is anticipated this would usually occur over a three year period. Three (3) modules would be considered essential for completion of the course, and the other modules would be purely elective. All the essential and elective modules would be chosen by the candidate from a pool of accredited and recognised modules. (The essential pool comprising eight (8) and the elective pool likely to be of a reasonable size to reflect the diversity of CMO's.) The potential exists for 2 – 4 modules to provide a Certificate in Clinical Medicine, and 4- 8 modules to provide a Diploma of Clinical Medicine. Essential subjects options could include Evidence Based Medicine, Public Health, Epidemiology and others, as negotiated.

Queensland Medical Education Institute (and similar bodies in other states) has developed and is trialing a broadly based educational programs for PGY1 and PGY2 ­ completion in July 2000. This programme pattern flexibility may be useful model.

These qualifications will be developed in such a manner, as to be of benefit to the recipient, both for employment purposes and future career aspirations, including transfer to a specific clinical discipline via a learned medical College. The flexibility will exist for this education programme to be useful to medical practitioners in a wide variety of clinical fields, depending on the electives chosen.

Challenges/ Opportunities

CHALLENGES

• Recognition of Prior Learning and Accreditation of clinical experience
• Negotiation with ACRRM for training and recognition ­ especially in rural areas
• Get Medical Administration on line as well
• Setting up of Mentoring system ­especially in provincial hospitals
• Payment rates for training positions for CMO’s
• Difficult part is to link to provider numbers and financial renumeration
• Linking with Royal Colleges for partial recognition of qualification, if specialty route chosen later
• Pay by unit Masters program with scholarship back up ­ dicitation as part of system
• Expense is an issue

OPPORTUNITIES

• Workforce Planning Opportunity, especially for leave at end of year - need to look at places over break at end of year to train (fill gaps) and do rural locums when people are most flexible and needy (with family commitments) - potential for clinical training placements for CMO's and hospitals
• Potential Career Pathway proposed unique, as optional and university backed qualification
• CMOA actively inclusive ­ incompatible with forming a College, but potential to provide information to potentially interested medical graduates
• Website to link to for UQ and Newcastle Uni - distance education more real
• QMEC background ­ MEO to help clinical teachers ­ coal face education with hands on experience in Newcastle
• Peter Love surveying National Emergency Departments to find the people working in Emergencys
• Commonwealth will be approached to fund first cohort through and set up program – initial need for Project Officer to expand proposal and collect relevant data
• Certifiable education
• Creating vocational registration in similar streams in hospitals, and community health, as develop courses and criteria
• Opportunity to trial modular education on relatively small select group - ?before offering to wider medical community.