COSA, Cancer Council call for cancer training improvements in medical education inquiry


The Clinical Oncological Society of Australia (COSA) and The Cancer Council Australia recently provided a joint submission to a Department of Education, Science and Training (DEST) study aimed at determining how Australian medical schools can ensure undergraduates have the right skills, knowledge and professional attitudes to become successful interns and continue their professional development after graduation.

The submission, prepared by The Cancer Council’s advocacy hub with expert advice from the joint Oncology Education Committee and COSA Council, drew heavily on the Ideal Oncology Curriculum to make a number of recommendations designed to ensure cancer management skills in undergraduate and postgraduate medical students reflected the disease’s impact on the community.

It was the latest in a series of joint submissions to public consultations focusing on reform of the medical sector in preparation for population ageing. Other recent inquires include the Productivity Commission’s review of the medical workforce, which looked at systemic barriers to best practice from education through to workforce planning and service delivery, and a study into the economic impact of changes in medical technology. Copies of the joint submissions to these consultations are available at www.cancer.org.au/policy_submissions.

Background

Key stakeholders across Australia have been engaged in widespread debate about medical training in universities, prompting the former Minister for Education, Science and Training, Dr Brendan Nelson, to commission a study that essentially asked the question: “What makes for success in medical education?”

The study looked into graduate learning outcomes, including expected skills and knowledge, and the transition to internship and postgraduate specialist training. It was first proposed by Minister Nelson in an address to the Australian Doctors’ Fund in February 2005.

A roundtable discussion with peak medical bodies was held in May 2005 to discuss the scope and focus of the study, which led to the establishment of a steering committee tasked with clarifying the scope of the study and identifying the relevant strands of research required. The steering committee endorsed several complementary research methodologies for three separate but related strands of research, to investigate the educational outcomes required and how well those requirements are being met.

The research will be completed through a combination of contracted consultancies and DEST activities, which included the public consultation to which COSA and The Cancer Council responded.

Strands 1 and 2 are examining the knowledge, skills and professional and cultural attitudes required to prepare graduates for internship and future specialist training, while Strand 3 is examining models of clinical education and the use of clinical teachers in medical education.

The findings will be analysed and consolidated in a final report to inform the future development of undergraduate medical education in Australia, which is expected to be presented to the new minister, Julie Bishop, early in 2007.

COSA/The Cancer Council Australia response

The study’s terms of reference examined undergraduate and postgraduate competencies, ‘readiness’ and attitudes, and undergraduate clinical education models that addressed the need for greater efficiency at the intern level and as preparation for postgraduate training.

A centrepiece of the response by COSA and The Cancer Council was our concern about the decline in cancer management skills observed in medical students and graduates over the past 10-15 years, at a time when the burden of cancer is increasing in step with population ageing.

Much of the evidence to support our recommendations was based on a comparative study published in the Medical Journal of Australia in 2003, indicating that recent medical graduates had less exposure to cancer patients than those who had been trained 11 years earlier.1 The submission also drew upon two previous studies that demonstrated that the comparative reduction in skill levels was part of an alarming, longer-term trend.2,3

As a more general point, COSA and The Cancer Council emphasised that much-needed improvements in cancer management training can be applied to all clinical disciplines and are particularly relevant to communications skills, medical ethics and the principles of life-long learning – all essential to continual improvement in the healthcare system and among individual professionals.

COSA and The Cancer Council’s key recommendations in the context of the terms of reference are that:

  • DEST identifies the improvement of cancer management competency as a core medical education priority.
  • Minimum standards in cancer management competency for graduates be established nationally, along with a mechanism to monitor continual improvement in postgraduate cancer skills and knowledge.
  • DEST scopes ways in which COSA and The Cancer Council Australia’s Ideal Oncology Curriculum can be adopted throughout Australian medical schools.
  • Undergraduates and interns perform minimum clinical cancer management practice and that a cancer exit exam, based on the outline developed by COSA and The Cancer Council, be incorporated into relevant medical curricula.
  • DEST explores options to ensure students in rural locations have adequate access to clinical experience in all elements of multidisciplinary cancer care, including modalities such as radiation therapy for which there is limited local infrastructure.
  • DEST notes the decline in interns’ cancer management competency observed in recent studies and identifies reversing this trend as a priority for graduates and in prevocational and postgraduate training.
  • DEST supports the introduction of a national system of credentialing for cancer professionals, to help ensure that postgraduate training in major clinical disciplines translates to ongoing adherence to best practice.
  • DEST explores opportunities to translate the increase in Australian Government support for independent cancer clinical trials into improvements in medical education.
  • DEST identifies improved communication skills as an increasingly important competency for students involved in all areas of cancer management.
  • An increased understanding of the role of complementary medicines and patient interest in them be incorporated into medical curricula where appropriate.
  • The increased role general practitioners play in cancer prevention and early detection, particularly in the diagnosis and treatment of skin cancer, be factored into prevocational and postgraduate training.
  • Training modules in the prevention and treatment of chronic disease be developed nationally, according to current epidemiological evidence and projections.
  • The role of practising clinicians as on-the-job trainers of medical undergraduates and interns be formally recognised and supported through national train-the-trainer and incentives schemes.

COSA and The Cancer Council Australia, through The Cancer Council’s advocacy hub, will continue to monitor developments. Cancer Forum readers who would like to express their interest in the process should contact their COSA Council representative to be informed about this and any other advocacy/policy activity.

References

1. Barton MB, Tattersall MHN, Butow P et al. Cancer knowledge and skills of interns in Australia and New Zealand in 2001: comparison with 1990, and between course types. MJA. 2003; 178(6): 285-9. 2. Smith WT, Tattersall MHN, Irwig LM, Langlands AO. Undergraduate education about cancer. Eur J Cancer. 1991; 27: 1448-1453. 3. Tattersall MH, Langlands AO, Simpson JS, Forbes JF. Undergraduate education about cancer: a survey in Australian medical schools. Eur J Cancer Clin Oncol. 1988; 24: 467-471.

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