Heading Home... Overseas?
Thursday, August 21, 2008
Overseas experience is fast becoming a standard part of the comprehensive medical education.
These experiences, as such, can be part of an Elective, or more recently, as a Clinical Rotation. The difference between the two is important; an Elective often has more of an unstated objective. It's less well defined, and is frequently approached from one of two points. Either, the student chooses an elective purely so they can travel, with medicine as the excuse, or the student has an area of interest that their elective hospital specializes in. The student may or may not be job seeking for the future. I should point out that the Elective rotation may also be taken domestically - it's not compulsory travel. Far from it, actually, as students cover all their own costs, including accommodation.
Comparatively, the clinical rotation primarily educates the student. It emphasises typical cases, encompassing diagnosis and management of patients in a systematic and best practice context using evidence based medicine. Simply put, a clinical rotation is all about how to do what you're gonna do. At my Uni, almost all students do all their clinical rotations at local metropolitan or affiliated rural/remote hospitals within the state. I'm pretty sure it's like that across Australia; I'm willing to appreciate that it may not be quite the same in the US.
There presently seems to be a bit of a kerfuffle regarding 'international student' clinical rotations in New York. The NY Times had a write up on it. Summarily, there appears to be four points of contention; firstly, that students from a non-American university are taking training places in NY hospitals from American Med students. Secondly, that the non-American university in question is 'sub-standard' (at least one medico quoted in the article insinuates that all overseas Med Schools are substandard), thirdly, that the non-American university is merely a 'backdoor route' for students that couldn't make it into US schools, and fourthly, that the arrangement is completely money driven and there are numerous inside connections.
In the last two days, UQ has announced that a new international Clinical Rotation will be available in 2009. The Dean of the School sent an email to all 1200+ students proudly announcing the new partnership with the Ochsner Health System group in New Orleans, USA. Oschner's website says that it is "One of the largest, non-university based physician training centers in the U.S.", and was established by Dr A Oschner, who first discovered the link between Tobacco and Lung Cancer.
According to the announcement, students will be able to do up to four of their seven clinical rotations, as well as their Elective, in the Big Easy. In fact, 'we definitely will be able to offer Core Clinical Rotations in medicine, surgery and mental health (Year 3), and medical and surgical specialities and paediatrics (Year 4)'. The SoM already has well established programmes in Brunei, but the school hopes that the new programme will help UQ "become recognised as Australia's leading School, and 'Australia's global medical school", and it sounds pretty exciting, really.
In the context of the NY Times article above, this new development unleashes a number of debates.
UQ have quite a few international students, mostly Canadians and Americans. According to the SoM website, there's up to 100 in a year, or 25%. These students get hammered financially and hence generate a stack of revenue for the school. Yesterday, I discussed the new programme with two of my mates who are from the States; they are thrilled. The idea that they can spend most of their clinical rotations 'back home' for the final two years of their degrees is immensely appealing. They were planning on hunkering down under for a further two years, but being so much closer to home will be an opportunity too good to pass up.
This makes good sense for these guys; they're planning on practicing in the US when they finish. I'd be surprised if there's a genuine problem with this, given that there's a shortage of physicians in the US (just like here in Oz), and given the fellows in question will be sitting USMLE Step 1 along the way, they should be just as qualified as their US-based colleagues. Interestingly, there's no way of ensuring or the UQ students on the New Orleans rotation have sat and/or passed USMLE. This would theoretically place the students completing their clinical rotations in the US at a disadvantage to their American peers, and this could impact their future employment, especially if they're made to look like idiots. I haven't yet mentioned the need to provide adequate and relevant assessment from 10,000km away. This in itself provides many challenges. I believe that students whom will benefit most should be selected, with USMLE Step 1 a minimum. Moreover, some financial incentives should be offered, and certainly some accommodation made available, in order to make this a fully equitable opportunity to the class.
I reckon that the number of international students at UQ is about right. For my mind, this, combined with the Australian doctor shortage, is something that should be considered. I also feel that in practice it's a moot point; it would be unrealistic to train international students on the premise that they will only work in Australia. I don't really think that's the aim anyway, but it does add another dimension to the discussion.
The question is; What makes a good medical school? Where one university is berated in the media for creating opportunities for its' students, another claims itself to be a world leader. Certainly, international experience is increasingly a fundamental aspect of Medical education. This experience should not come at the expense of well rounded, current, relevant training. Nor should it come at the expense of a University's reputation for producing graduates of the highest standard. UQ does not want to gain a reputation as a 'lecture and turf' institution, but it also wants to make available a broad range of clinical experiences. What makes the pre-clinical programme at an institution 'world class'? I certainly don't think it is as simple as a specific entry criteria.
For UQ to conquer what Robbie Williams could not, they must do so carefully. The school must maintain its reputation. They can only do this by equipping its graduates with all the skills required to practice medicine at the highest level. They must implement rigorous assessment to ensure that only competent students graduate.
These experiences, as such, can be part of an Elective, or more recently, as a Clinical Rotation. The difference between the two is important; an Elective often has more of an unstated objective. It's less well defined, and is frequently approached from one of two points. Either, the student chooses an elective purely so they can travel, with medicine as the excuse, or the student has an area of interest that their elective hospital specializes in. The student may or may not be job seeking for the future. I should point out that the Elective rotation may also be taken domestically - it's not compulsory travel. Far from it, actually, as students cover all their own costs, including accommodation.
Comparatively, the clinical rotation primarily educates the student. It emphasises typical cases, encompassing diagnosis and management of patients in a systematic and best practice context using evidence based medicine. Simply put, a clinical rotation is all about how to do what you're gonna do. At my Uni, almost all students do all their clinical rotations at local metropolitan or affiliated rural/remote hospitals within the state. I'm pretty sure it's like that across Australia; I'm willing to appreciate that it may not be quite the same in the US.
There presently seems to be a bit of a kerfuffle regarding 'international student' clinical rotations in New York. The NY Times had a write up on it. Summarily, there appears to be four points of contention; firstly, that students from a non-American university are taking training places in NY hospitals from American Med students. Secondly, that the non-American university in question is 'sub-standard' (at least one medico quoted in the article insinuates that all overseas Med Schools are substandard), thirdly, that the non-American university is merely a 'backdoor route' for students that couldn't make it into US schools, and fourthly, that the arrangement is completely money driven and there are numerous inside connections.
In the last two days, UQ has announced that a new international Clinical Rotation will be available in 2009. The Dean of the School sent an email to all 1200+ students proudly announcing the new partnership with the Ochsner Health System group in New Orleans, USA. Oschner's website says that it is "One of the largest, non-university based physician training centers in the U.S.", and was established by Dr A Oschner, who first discovered the link between Tobacco and Lung Cancer.
According to the announcement, students will be able to do up to four of their seven clinical rotations, as well as their Elective, in the Big Easy. In fact, 'we definitely will be able to offer Core Clinical Rotations in medicine, surgery and mental health (Year 3), and medical and surgical specialities and paediatrics (Year 4)'. The SoM already has well established programmes in Brunei, but the school hopes that the new programme will help UQ "become recognised as Australia's leading School, and 'Australia's global medical school", and it sounds pretty exciting, really.
In the context of the NY Times article above, this new development unleashes a number of debates.
UQ have quite a few international students, mostly Canadians and Americans. According to the SoM website, there's up to 100 in a year, or 25%. These students get hammered financially and hence generate a stack of revenue for the school. Yesterday, I discussed the new programme with two of my mates who are from the States; they are thrilled. The idea that they can spend most of their clinical rotations 'back home' for the final two years of their degrees is immensely appealing. They were planning on hunkering down under for a further two years, but being so much closer to home will be an opportunity too good to pass up.
This makes good sense for these guys; they're planning on practicing in the US when they finish. I'd be surprised if there's a genuine problem with this, given that there's a shortage of physicians in the US (just like here in Oz), and given the fellows in question will be sitting USMLE Step 1 along the way, they should be just as qualified as their US-based colleagues. Interestingly, there's no way of ensuring or the UQ students on the New Orleans rotation have sat and/or passed USMLE. This would theoretically place the students completing their clinical rotations in the US at a disadvantage to their American peers, and this could impact their future employment, especially if they're made to look like idiots. I haven't yet mentioned the need to provide adequate and relevant assessment from 10,000km away. This in itself provides many challenges. I believe that students whom will benefit most should be selected, with USMLE Step 1 a minimum. Moreover, some financial incentives should be offered, and certainly some accommodation made available, in order to make this a fully equitable opportunity to the class.
I reckon that the number of international students at UQ is about right. For my mind, this, combined with the Australian doctor shortage, is something that should be considered. I also feel that in practice it's a moot point; it would be unrealistic to train international students on the premise that they will only work in Australia. I don't really think that's the aim anyway, but it does add another dimension to the discussion.
The question is; What makes a good medical school? Where one university is berated in the media for creating opportunities for its' students, another claims itself to be a world leader. Certainly, international experience is increasingly a fundamental aspect of Medical education. This experience should not come at the expense of well rounded, current, relevant training. Nor should it come at the expense of a University's reputation for producing graduates of the highest standard. UQ does not want to gain a reputation as a 'lecture and turf' institution, but it also wants to make available a broad range of clinical experiences. What makes the pre-clinical programme at an institution 'world class'? I certainly don't think it is as simple as a specific entry criteria.
For UQ to conquer what Robbie Williams could not, they must do so carefully. The school must maintain its reputation. They can only do this by equipping its graduates with all the skills required to practice medicine at the highest level. They must implement rigorous assessment to ensure that only competent students graduate.
