Monday, 20 June 2016

More postgraduate training places should be a priority

Much has been written recently about the imperative for a Bendigo-based medical school.To avoid any confusion in this discussion, there is already a medical school in Bendigo. The Monash Medical School site at Bendigo was established by Monash University in 2002, and now in partnership with the University of Melbourne, is an important part of Monash Rural Health.

It has a proud record of delivering a world-class medical education to a significant (indeed growing) cohort of rural origin students, including local students, with around 100 students undergoing their clinical training in the region at any one time. Across Victoria, Monash Rural Health delivers nearly three times the Federal Government required level of rural-based clinical positions, with our follow-up data showing around 20 per cent of this region’s graduating students practising in rural locations.

Proponents of the Murray Darling Medical School say they would provide local opportunity by admitting more Bendigo students and address the need for more local doctors. However this is not possible.Frustratingly for rural regions such as Bendigo, current legislation prevents all publically funded medical schools from being selective – there is a legal requirement to admit students from all backgrounds and regions in a transparent fashion.

Monash University has a number of programs in place to increase enrolment of rural based students in the medical degree - currently 27 per cent of the nearly 2000 students in the Monash University Medical School are of rural origin. And we are seeing many of these students return to work in rural and regional areas.

The solution to rural and regional workforce shortages is certainly not creation of yet another regional medical school but rather it is to establish viable, affordable, regional medical postgraduate training programs, which allow regional medical school graduates to complete specialist training in regional locations.

In Victoria, we already have one of the highest rates of medical graduates per capita in the world. There are also more medical students (and postgraduate year 1 doctors (interns)) per capita in regional Victoria than in Melbourne. The real problem is that the students and interns are forced back to capital cities for prolonged (4-7 years) postgraduate training programs because these are limited in rural and regional areas.

These programs are where newly minted doctors experience and learn in a specific vocational area, be it in general practice, surgery, psychiatry or any one of a number of postgraduate training areas.These young doctors require training that is appropriate to the needs of rural and regional communities, predominately in general practice and general specialisations.

This is why three Victorian medical schools at Monash University, the University of Melbourne and Deakin University, have developed a proposal to establish four regional Victorian postgraduate training networks, a proposal we hope to implement with support of Commonwealth funding over the coming year, including one in Bendigo.

However, the goals of this regional training pipeline will be put at risk by establishing another medical school in our region. This will only dilute the scarce resources, energies and supervisors, taking precious capability away from postgraduate training to service the new school. It will further increase pressure on rural graduates and interns to move to a capital city, where they will enrol in highly specialised training programs, not necessarily appropriate for rural and regional practice.

The medical school system is not failing. There have been significant gains in the long term accrual of rural doctors. But the job is only half done. It simply makes no sense to waste money on reinventing the wheel. There is a clear imperative to channel resources towards supporting postgraduate training programs that will improve pathways for our rurally educated doctors to stay and complete their vocational training in the region.

Professor Robyn Langham
Head, School of Rural Health

Monash University 

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