1.  INTRODUCTION
2.  EDUCATION AND TRAINING:   UNDERLYING PRINCIPLES
3.  EDUCATION AND TRAINING: SUGGESTED MODELS
4.  SUMMARY

Career Medical Officers (CMOs), Hospital Medical Officers (HMOs), Senior Medical Officers (SMOs) and Community Medical Officers are a relatively new development in medical manpower. It is only in the past twenty years that any consideration has been given to this group as a distinct subset of the medical workforce and only in the past two years that they have organised themselves into an association with common interests and goals.

In negative terms these doctors can be described as "non-Family Medicine non-Specialist medical practitioners".

In more positive terms these people would say that the role(s) that they perform are legitimate career options and can be as satisfying as any in family medicine or speciality practice.

CMOs (and similar in the various states) are present in significant numbers because there is a need for their services. This is apparent in rural and suburban hospitals, both public and private, and also in increasing numbers in community settings. The major contributions that they bring to the health community are experience and stability - factors that are often missing when there are 10 or 12 week rotations of relatively inexperienced trainees.

Finally in terms of definitions, it is worth repeating that CMOs are not RMOs and they are not "failed specialists". Such ideas were always inaccurate and are now even more so in view of the experience and competence of many of these doctors.

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Based on discussions held at the Career Medical Officers Association Meeting, Albury Hospital, August 1997

i) Flexibility

CMOs need educational material that can be accommodated within a very wide range of lifestyle and work practice settings. These include but are not restricted to high service medical positions, shift work, remote area practice, non-accredited positions, part-time medical work, integrating education and training with major non-medical responsibilities such as raising a family, performing non-medical duties and local and family commitments to particular areas.

Educational material that can be brought to these doctors or can be provided in small intensive courses are far superior to those that require months or years at a particular institution such as a teaching hospital or university.

ii) Independence

CMOs need to have significant control over any programs that are instituted for their education and training. This is not to say that they want control over individual courses - this obviously resides in the body conducting the course (College or University for instance) - however they do want their interests in such things as accreditation and implementation looked after by those that have an understanding and commitment to CMO ideals.

In general terms this means CMOs themselves, although it could possibly be some neutral body such as the various PMCs. Colleges have their own trainees as their primary educational responsibility and would have neither the time nor the inclination to be involved in such a large heterogeneous group of medical practitioners.

iii) Portability

CMOs would like any education and training to be acceptable across institutional and state boundaries. This is already the case with most courses offered by colleges and universities and should not be a problem with the development of new units.

iv) Portfolio of Education and Experience

Due to the wide variety of work undertaken by CMOs, ranging from Psychiatry to Emergency, from Drug & Alcohol to Developmental Disability, and the consequent wide range of educational and training need, it would seem sensible to have each doctor responsible for a portfolio of service appointments and courses undertaken - perhaps on a common form - to allow easier comparison with other CMOs. Again, this is a practice that could suit many other medical practitioners and may help in the accreditation process.

v) Accreditation

This is one of the most difficult areas associated with the training and educational needs of Career Medical Officers. Who is to be responsible for the accreditation of positions and training of these doctors? What courses and what terms are to be accepted in their training? Who is to oversee the accreditation process is a difficult problem and one that has no obvious answer.

Some possibilities are: PMCs, AMC, Medical Colleges, an Association of CMOs themselves or a new board set up specifically for the purpose. Whatever the composition of the accrediting body it must have major input from CMOs themselves to have any chance of success. The acceptance of the educational component of the accreditation process is relatively easy in that many of the courses that appeal to CMOs already have wide acceptance in the medical community.

It is with the accreditation of the workplace experience that problems may arise. The old model of attachment to a teaching hospital for all or part of the training will not work for these medical practitioners and there is an urgent need to construct a protocol that provides accreditation for those service positions where many CMOs are currently employed.

vi) Integration

It would make economic and logistic sense to dovetail the education and training needs of these doctors with that of the wider medical community. A course in management of severe trauma has equal relevance to all those who are involved in treating these patients whether they are surgeons, emergency physicians, paediatricians, isolated rural practitioners or career medical officers. To reinvent the wheel for each subgroup in the medical community is an obvious waste of resources. This is not to say that each group does not require specific training for itself alone, however where there is common knowledge that is needed across the divisions of medical practice, it makes sense to pool resources and expertise.

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3.  EDUCATION AND TRAINING: SUGGESTED MODELS

i) Modular

From the above discussion it can be seen that one of the most appropriate forms of education for this category of doctor is that of the modular unit. Current examples of this type of program are the EMST (Early Management of Severe Trauma) run by the College of Surgeons and the ELS (Emergency Life Support) course run by the College of Emergency Physicians.

These courses are practical, intensive, have well defined goals and end points and are highly regarded by the general medical community. They provide the necessary skills for those CMOs working in EDs and are much sought after by this group.

It would seem possible and advantageous to have similar modules in such areas as paediatric emergencies, psychiatric disorders, developmental disability, drug and alcohol disorders, and in fact almost any area of medicine would lend itself to this format. The demand for such courses would in many cases be far wider than the CMO community and both Colleges and Universities would be capable of providing expertise for this type of education.

ii) University

There are already many university courses available that appeal to CMOs , most in the form of MM (Masters of Medicine). Dr Brennan in his report on non-specialist hospital careers has made a comprehensive list of the relevant courses and universities.

iii) College Diploma

This is a good option for those who want to go into greater depth in a particular field. The DipObs & Gyn and DCH are examples of this model of education and training. Many CMOs feel that similar courses offered by the colleges would be readily accessed. The old DA was very useful to those, often in remote locations, who had to give anaesthetics, and there would be strong interest in a Diploma of Emergency Medicine.

iii) Self -Directed (Log Book)

The College of Pathologists has already trialed a system of self-directed learning with the use of log books (Dr Brooke Murphy - University of Sydney) and the CMOA (Career Medical Officers Association) have expressed interest in this method of continuing education.

iv) Electronic

Anyone with access to a PC and a modem knows the enormous variety and depth of educational material available on the internet. Many universities, colleges, journals and special interest groups have excellent material already available, and many are offering interactive education forums via this medium. Any educational package designed for the next century will rely heavily on this mode of communication.

v) Other

There are other options, one of the most attractive perhaps is a combination of all or some of the above.

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4.  SUMMARY

There has been more interest in CMOs in the past three years than in any time in the past. Some of this is driven by the Health Insurance Amendment Act 1996 and its probable effects on career choice for recently graduated doctors. However there is no doubt that interest was increasing for many other reasons both from the CMOs and from various medical and government bodies.

Now is a good time to address the issues raised by this interest and hopefully solve the problems that have arisen by a hitherto piecemeal approach.

From the viewpoint of the CMOs themselves the major issues are:

- Appropriate Education and Training opportunities
- Accreditation for training and work experience
- Appropriate career path and remuneration for their practice
- Involvement by CMOs in all discussions and at all levels on the above issues.

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