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Introduction: The early part of this century saw an unprecedented growth in number and size of Australian medical schools. There was some partnering of the new schools with existing programs. Griffith, Deakin and Curtin Universities leased an established curriculum from Flinders University. Nature and rationale for curriculum leasing: The new schools had short startup times and leasing a curriculum enabled them to appoint key staff, develop facilities and meet accreditation requirements in a timely way. However, the lease arrangements were costly and the curriculum was largely determined before the Dean and key staff appointments. Outcomes of leasing: There was differential adoption of the leased curriculum. The first two years of the courses at Flinders were transferred with little change. The final two years of predominantly clinical studies were developed differently. This is explained through Michael Fullan's work on context in educational change. The context of the clinical years of the courses involved negotiations with local health services and other schools using those health services. The advantage of the leasing arrangements was that the new schools could proceed through early development and accreditation, while having time and opportunity to negotiate a clinical curriculum that engaged local health services and fulfilled the new schools' missions. [ABSTRACT FROM AUTHOR]

Context: Medical education has not been immune from forces for globalisation in the contemporary world. At the same time the social accountability of medical schools in addressing local health priorities has been emphasised. This paper explores the global–local tension in medical education through a careful selection of key overview papers. Globalisation: Globalisation in medical education has taken two main forms: economic and altruistic. The former includes licensing curricula, recruiting internationally and establishing 'offshore' schools or campuses. Altruistic collaborations focus on the spread of learning and educational innovations. Both forms bring benefits but have been subject to critique for their differential impact and focus on educational inputs rather than outputs. Social Accountability: Social accountability requires medical schools to direct their activities to local priorities and to serving local health systems. Adoption of the principles of social accountability compels all medical schools to ask questions of their educational programmes and graduate outcomes. However, these are globally interdependent questions and are the intent of some well‐known social accountability collaborations. It is naïve to think that adoption of a social accountability agenda by all medical schools would necessarily reduce global health inequity. A recent Australian example shows that workforce maldistribution, for example, is resistant to even high‐level intervention. Conclusions: It is yet too early to fully accept that 'think global, act local can be turned on its head'. There is much research to be carried out, particularly on the outcomes and impacts of medical education. Establishing cause and effect is a challenge, as is determining whether globalisation or localisation can contribute to greater global health equity. If we are ever to resolve the global–local tension in medical education, we need more evidence on the outcomes of what we do, whether globally or locally inspired. Prideaux shines a light on global vs local tension in medical education, suggesting that we need to determine the outcomes of our programs whether globally or locally inspired. [ABSTRACT FROM AUTHOR]

Turning a critical lens on the definition of programmatic assessment, Pearce and Prideaux argue that implementation in postgraduate training need not be as difficult as it seems if programs use programmatic thinking to connect elements already in place. [ABSTRACT FROM AUTHOR]

Interprofessional practice implies that health professionals are able to contribute patient care in a collaborative environment. In this paper, it is argued that in a hospital the nurses' station is a form of symbolic power. The term could be reframed as a 'health team hub,' which fosters a place for communication and interprofessional working. Studies have found that design of the Nurses' Station can impact on the walking distance of hospital staff, privacy for patients and staff, jeopardize patient confidentiality and access to resources. However, no studies have explored the implications of nurses' station design on interprofessional practice. A multi-site collective case study of three rural hospitals in South Australia explored the collaborative working culture of each hospital. Of the cultural concepts being studied, the physical design of nurses' stations and the general physical environment were found to have a major influence on an effective collaborative practice. Communication barriers were related to poor design, lack of space, frequent interruptions and a lack of privacy; the name 'nurses' station' denotes the space as the primary domain of nurses rather than a workspace for the healthcare team. I mmersive work spaces could encourage all members of the healthcare team to communicate more readily with one another to promote interprofessional collaboration. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 455-463 This paper aims to consider why general practitioners (GPs) teach, in particular by defining the longitudinal supervisory relationships between rural clinician-preceptors and students. A total of 41 individual semi-structured interviews were conducted with GPs, practice managers and students. All interviews were audiotaped, transcribed and analysed for emergent themes. In this study preceptors identified many ways in which precepting added value to their roles. However, themes relating to the doctor-student relationship were central to GP preceptors' experiences. These developed in chronological order and resulted in changes in the triangular relationship between doctor, patient and student in the consultation. Interpretive findings identify that the motivators for precepting represent a group of constantly changing interconnected factors that contribute to the defining of preceptors as central members of their professional community of practice. This critical finding challenges the simplistic organisational concept that universities can recruit and retain GPs by offering increased rewards. This paper introduces four clinical preceptor models, which involve the roles of, respectively: the student-observer; the teacher-healer; the doctor-orchestrator, and the doctor-advisor. Symbiosis between student learning and patient care was found to occur in the doctor-orchestrator model. The evolution of doctor-student relationships in long-term student placements explains how students become more useful over the academic year and sheds light on how GPs are changed through precepting as part of the complex process by which they come to recognise themselves as central members of the rural generalist community. [ABSTRACT FROM AUTHOR]

Assessment for selection in medicine and the health professions should follow the same quality assurance processes as in-course assessment. The literature on selection is limited and is not strongly theoretical or conceptual. For written testing, there is evidence of the predictive validity of Medical College Admission Test (MCAT) for medical school and licensing examination performance. There is also evidence for the predictive validity of grade point average, particularly in combination with MCAT for graduate entry but little evidence about the predictive validity of school leaver scores. Interviews have not been shown to be robust selection measures. Studies of multiple mini-interviews have indicated good predictive validity and reliability. Of other measures used in selection, only the growing interest in personality testing appears to warrant future work. Widening access to medical and health professional programmes is an increasing priority and relates to the social accountability mandate of medical and health professional schools. While traditional selection measures do discriminate against various population groups, there is little evidence on the effect of non-traditional measures in widening access. Preparation and outreach programmes show most promise. In summary, the areas of consensus for assessment for selection are small in number. Recommendations for future action focus on the adoption of principles of good assessment and curriculum alignment, use of multi-method programmatic approaches, development of interdisciplinary frameworks and utilisation of sophisticated measurement models. The social accountability mandate of medical and health professional schools demands that social inclusion, workforce issues and widening of access are embedded in the principles of good assessment for selection. [ABSTRACT FROM AUTHOR]

The article discusses curriculum design in medical education. It references the author's article in a previous issue of the journal, entitled "The Emperor's New Clothes: From Objectives to Outcome" as well as the article "The Promise, Perils, Problems, and Progress of Competency-Based Education" by C. Touchie and O. ten Cate, which appears in the current issue. Topics discussed include competency-based medical education, outcomes-based education, and entrustable professional activities (EPAs).

Objectives The practice of having medical students see patients in a general practice setting, in their own consulting rooms, prior to the GP preceptor joining the consultation does not increase general practitioner (GP) consultation time. How do GPs meet the needs of both patient and student without extending consultation time? This study sought to quantify and compare GP consultation activities with and without students. Methods This was a prospective cohort study of 523 videotaped consultations. Consultations were analysed in 15-second intervals using a modified Davis observation code to define GP activity. Estimated marginal means were calculated using mixed model analysis accounting for confounding factors. Results In comparison with consulting alone, GPs precepting a student spent 37 seconds less time examining patients ( P = 0.001), 41 seconds less on patient management, and 1 minute, 31 seconds less on clerical and other activities ( P < 0.001). This created time for GPs to take a history from both the student and patient (39 seconds longer; P = 0.002) and to teach students (1 minute, 10 seconds; P < 0.001). Discussion General practitioner activity in the consultation changes significantly when precepting a student; GPs spend longer exploring the history in order to unpack the student’s clinical reasoning, verify the patient’s story and resynthesise the information. They spend less time on examination, management and clerical activities and presumably delegate or defer these activities. Conclusions This organising of clinical activities in order to meet the needs of both patient and student is likely to require different processing skills to solo consulting. [ABSTRACT FROM AUTHOR]

Australia is a young country in medical education terms. Traditionally courses followed a 6-year British model with a pre-clinical/clinical divide. There is no national licensing system. After graduation there are two postgraduate years followed by specialist training. From the mid-1990s there has been considerable expansion and innovation in medical education. There are now 19 medical schools with a mix of 4-, 5- and 6-year courses. The creation of rural clinical schools has fostered new clinical placements and community-based programmes. Indigenous health is a priority. There is a nationally accepted curriculum framework in Indigenous health for all medical schools. Clinical teaching remains as a significant challenge especially with the increasing number of medical schools and students. There are also important issues in aligning a teaching hospital-based system with the health services of the future. Medical education research is a developing discipline. There is an emerging national recognition of research and schemes to promote young researchers. The Medical Schools Outcomes Database project is providing an important impetus to career choice and outcomes research. While the period of expansion may have ceased, Australian medical education still faces considerable challenges posed by a new health care reform agenda. [ABSTRACT FROM AUTHOR]

The article examines issues related to a symbiotic model for clinical education. A symbiotic curriculum is predicated on a mutually reinforcing relationship between medical schools and health services, where both gain. Medical students benefit from excellent learning opportunities while medical school staff and students contribute to and enhance the health services in which they are engaged.

Abstract: Medical education is a rapidly expanding discipline with its practitioners drawn from a mix of backgrounds. Among them there is an increased understanding of the centrality of the curriculum process in the translation of educational ideas in practice. There are four main trends that underlie this increased understanding: a widened conception of the major elements of curriculum and their interactivity; a more conceptual and global view of curriculum, the incorporation of ideas from the educational literature and the need for a dynamic overarching model of curriculum. The latter will provide a framework for the ongoing curriculum challenges in the field. [Copyright &y& Elsevier]

Background Flinders University has developed the Parallel Rural Community Curriculum (PRCC), a full year clinical curriculum based in rural general practice in South Australia. The examination performance of students on this course has been shown to be higher than that of their tertiary hospital-based peers. Aim To compare the learning experiences of students in the community-based programme with those of students in the tertiary hospital in order to explain these improved academic outcomes. Method A case study was undertaken, using an interpretivist perspective, with 3 structured interviews carried out over 2 academic years with each of 6 students from the community-based programme and 16 students from the tertiary hospital. The taped interviews were transcribed and analysed thematically usingnud*ist software. Results The community-based programme was successful in immersing the students in the clinical environment in a meaningful way. Four key themes were found in the data. These represented clear differences between the experiences of the community-based and hospital-based students. These differences involved: the value that students perceived they were given by supervising doctors and their patients; the extent to which the student's presence realised a synergy between the work of the university and the health service; opportunities for students to meet the aspirations of both the community and government policy, and opportunities for students to learn how professional expectations can mesh with their own personal values. Conclusion This study has provided empirical evidence for the importance of the concept of symbiosis in understanding quality in medical education. [ABSTRACT FROM AUTHOR]

The introduction of graduate entry medical courses requires attention to models of decision-making and change. Much of the educational literature describes change as either centralised or decentralised with the latter claimed to be more effective. Recently Fullan has argued for the importance of an ongoing culture of change. This paper examines the change culture of two medical schools adopting graduate entry courses; Flinders University in South Australia and St George's Hospital Medical School, London.Comparative case study was used. Key informants were interviewed and documents and records analysed. Data were cross-checked and categorised to generate models of change.There were four components of the change culture at Flinders but they were not sufficient on their own to generate change. The process was triggered by a significant external event. The nature of the change was also important. The descriptive model developed suggested a complex interplay of factors rather than attributing the success of the change to the change mechanisms adopted alone. The model was tested for explanatory potential at St George's. The culture there was described as both‘macro-innovative’ and‘micro-conservative’. External events were also important but they exerted a positive force. A more centralised approach was adopted.The models developed represent change as‘dynamic, complex and open’ rather than a simple centralised or decentralised dichotomy. While some of the elements of a change culture were evident at both schools there were longer term questions of sustainability. This has implications for development of all programmes but particularly for graduate entry schools. [ABSTRACT FROM AUTHOR]

As medical schools make use of an increasing variety of clinical teaching settings, it is of interest to find that that there is very little published research that explores the actual learning activities undertaken by students in different environments. This study was designed to describe and analyse a typical week for students learning the same curricular material in one of three Australian settings: an urban tertiary teaching hospital, a remote secondary referral hospital and a rural community-based programme. Twenty-eight students completed week-long learning logs in weeks 9 and 35 of a 40-week academic year. Each student recorded his or her activity in 15-minute intervals for each week. Analysis of these data revealed that, compared with the hospital-based students, the community-based students reported greater patient contact, more time spent in clinical settings and increased time supervised by experienced clinicians. Whilst the community-based students valued their learning in clinical settings more highly than the learning they undertook at their home, the opposite was found for the tertiary hospital-based students. This study, the first to compare student activity in these three prototypical settings in the medical education literature, provides empirical evidence supporting community-based programmes as credible alternatives to traditional teaching hospital-based environments. [ABSTRACT FROM AUTHOR]

IntroductionThe last 10 years has been an interesting time for Australian medical education despite reduced funding. WorkforceThere are five main workforce trends: a rural/urban maldistribution, a need for more specialists, public hospital staffing difficulties, increasing female practitioners and under-representation of indigenous practitioners. Issues facing the DeansLack of resources is a problem facing Deans, with pressure for clinical service in teaching hospitals. Entrepreneurial activities have been undertaken including the enrolment of overseas students. Medical schools have also responded to important government initiatives. Developments in medical educationAustralia’s 11 medical schools have undergone significant reform in the last decade. There is a mix of four (graduate), five and six year courses. Australia’s new medical schoolJames Cook University opened the first medical school in northern Australia in 2000. The School admits students from rural, northern Australian and indigenous backgrounds. It has a strong regional mission. Rural and community-based educationGovernment funding to address the maldistribution of the workforce has led to the establishment of rural clubs, Departments of Rural Health and community-based programs. The first two postgraduate yearsThere have been recent moves to improve education in the two years following graduation. This includes the initiation of national projects in curriculum and assessment. Postgraduate and continuing medical educationPostgraduate programs in Australia are being reformed to build on the changes in undergraduate education. CME is also under review. ConclusionAustralian medical educators should build on the recent reforms and take on some of the new directions in medical education. [ABSTRACT FROM AUTHOR]

Context In 1996–97 three Australian medical schools adopted 4-year graduate medical courses. The schools formed a consortium to establish common admissions processes and to collaborate on curriculum and staff development. Outcomes: admissions Outcomes in admissions included the construction of an entry test and agreement on common application procedures. Structured interviews and measures of prior tertiary performance were adopted in each school with some local variations. Formal structures were put into place to manage the development of the test and admissions procedures. Outcomes: curriculum and staff development No formal structures were put into place for curriculum and staff development. While the advantages of common approaches were recognised, it was accepted that it was also important to generate local ownership and commitment to the new courses. Outcomes of educational consortia should not be judged solely by the nature of joint ventures but by the way in which membership of the consortium changes the priorities and practices within the institutions. Examples of the operation of this principle within the three schools include: use of visiting experts to refine and modify approaches to problem-based learning; use of staff from partner institutions to facilitate implementation of the courses; sharing information technology expertise; cooperation in the construction of feedback mechanisms, and sharing advice on fulfilling accreditation requirements. Conclusion The Consortium has had an important impact on Australian medical education. There is a need for further analysis of the two methods of operation of the consortium, formal and informal, and their relation to its overall functioning. [ABSTRACT FROM AUTHOR]

In this article, several authors discuss aspects of the measures used by medical colleges in the selection of students for medical programmes. The authors mention that a common method used by such schools is to identify the distinction between cognitive elements and non-cognitive measures. Moreover, the authors relates on three articles published within the issue such as one predictive validity studies, one on students with equal ability and another on older mature medical students.

The article focuses on the conformity of the journal "Medical Education" to the contemporary standards on ethical publication. It requires evidence of approval by an appropriate human research ethics committee for papers which report research involving human subjects. The editorial team seeks evidence that papers meet such requirement before they are sent for review.

The article discusses strategies in medical education research. Choosing placement within the education subpanel, rather than the panel containing epidemiology, public health, health services research and primary care, needs careful thought. Medical educational research needs to understand these fields and, therefore, its competitors, well, and present its research, in particular its methodologies and outcomes, in a manner that fits the common context. In Australia, National Health and Medical Research Council funding, especially the prestigious programme grants, reward not only individual track records but focused research programmes with a core research team and high levels of higher degree students.

Examines the curriculum design as an expression of ideas in practice for medical teaching. Need for curriculum to be in a form that can be communicated to those associated with the learning institution; Curriculum must be responsive to changing values and expectations in education; Elements of a curriculum; Prescriptive vs. descriptive models.

Editorial. Focuses on changes in the model of clinical teaching. Improvement of student learning components; Function of models under range of conditions.

Editorial. Focuses on research in medical education. Consequences of not locating work within its theoretical context; Highlights of a conference of the Association for Medical Education in Europe.

Presents a question-and-answer advisory on medical education. Decision-making structures required for curriculum change; Evaluation of outcomes of innovative courses in medical education; Examples of outcome evaluation studies in medical education.

The article discusses the methodology of social network analysis and its potential applications in medical education. Topics covered include waves of migration into medical education, metaphor of the education sciences, and how intersections between the theories underpinned by social network analysis research can produce new concepts within theories and refinement of the theories themselves.

The article comments on workforce issues that have become some of the important drivers of the medical education reform in the 21st century. A paper by Joyce and McNeil examined participation in the workforce by Australia medical graduates. Retention and workforce distribution are two of the factors affecting medical workforce.

Presents an introduction to the August 2005 issue of the periodical "Medical Education."

Presents a commentary on the reports of medical education reforms in Great Britain which are studied in this issue. How there have been similar changes in medical schools in Australia; Key factors that have been driving the reforms; Government role in funding these changes and how that carries some obligation; Difficulties in trying out reforms before researching their effectiveness; Call for collaborate research from all medical schools; Belief that this would best suggest the most effective physician education.

Editorial. Provides insights on the specification and measurement of outcomes of medical education in all its stages using articles in the Number 38, 2004 issue of the "Medical Education" journal. Need for the education of members of the medical workforce to be competent and caring professionals; Critique of competency models in graduate medical education; Restricting nature of outcomes particularly if written in the form of narrow competencies.

Editorial. Comments on the state of medical education research. Quantitative or qualitative design; Impact of the widening diversity of medical education; Insights on several theories.

Editorial. Focuses on problem-based learning in medical education. Idea that the effects of the approach are small, except in the area of student satisfaction and clinical reasoning abilities; Discussion of a paper by Smits and colleagues in this issue which reviews problem-based learning in postgraduate and continuing education.

Editorial. Discusses the elements of a curriculum model for medical education. Medical programs as product-focused; Relevance of learning both to communities and to students; Medical programs as interprofessional in character.

Focuses on the need to teach cultural diversity and awareness to medical students. Limited places worldwide where delivery of health care occurs in mono-cultural contexts; Impact of a patient's cultural identity to his interactions with the health system; Influence of culture on health status.

Presents a question and answer advisory on medical education. Issue on the changing nature of medical practice; Factors influencing students' choice of career; Effectiveness of online education.

Narrates the author's experience on lectures in psychology. Introduction to the dictum that ‘assessment drives learning’ Lessons learned on being a rejected nicotine addict; Limitations of lecturers.

Investigates the gap between theory and practice on medical education. Details of the theories of medical education; Applicability of the theories in teaching and learning programs of medical education; Emphasis on power relations in teaching and learning.

Examines the factors that influence ethnic diversity policies in medical schools. Example of such policies in Australia; Challenges of developing a curriculum for culturally or ethnically safe practice; Importance of selecting the right people to develop and implement such programs.

Editorial. Discusses guidelines for writing articles about medical curriculum change. Introduction that sets out the local context; Statement of the nature and substance of problems or issues that were addressed through the change; Evidence and data that should be used to build up a coherent argument.

Cites the issue of obtaining ethics approval for research in medical education. Plan to stimulate and publish high quality research in medical education; Imperative of obtaining grant-funded income; Pursuance of research in greater quantity by the medical academics.

Objectives Using a novel longitudinal tracking project, this study develops and evaluates the performance of a predictive model and index of rural medical practice intention based on the characteristics of incoming medical students. Methods Medical school entry survey data were obtained from the Medical Schools Outcome Database (MSOD) project implemented in all Australian and New Zealand medical schools and coordinated through Medical Deans Australia and New Zealand, the representative body for the Deans of 18 Australian and two New Zealand medical schools and faculties. The medical school commencement survey collects data on students’ education and family background, including rural upbringing, personal circumstances and scholarships, and on their practice intentions in terms of location and specialty. The MSOD will also allow tracking of medical graduates after graduation. Logistic regression modelling was used to develop a predictive model of rural practice intention. Split-sample validation was used to gain some insight into the stability of performance of the model. Results Response rates to the MSOD survey exceeded 90% on average. The model findings confirm and extend previous research examining the association of medical student characteristics with intention to take up rural medical practice. The statistically significant independent factors in the model included students’ rural backgrounds, financial arrangements and intentions regarding specialist versus generalist practice upon graduation. Model performance was good, with an area under the receiver-operator characteristics curve of 0.86, and reproducible, with an area in a validation sample of 0.83. Conclusions The model and related index provide important insights into individual factors associated with rural practice intention among students commencing medical studies. The model can also provide a means for optimising the use of scarce medical programme resources, thereby helping to improve the supply of rural medical practitioners. This study illustrates the power and potential of a robust, consistent, systematic longitudinal tracking project. [ABSTRACT FROM AUTHOR]

Objectives The multiple mini-interview (MMI) overcomes the limitations of the traditional panel interview by multiple sampling to provide improved objectivity and reliability. Reliability of the MMI is affected by number of stations; however, there are few data reporting the influence of interview duration on MMI outcome and reliability. We aimed to determine whether MMI stations can be shortened without affecting applicant rankings or compromising test reliability. Methods A total of 175 applicants were interviewed and assessed at 10 8-minute stations. Applicants were scored once after 8 minutes at five control stations and twice after 5 minutes and 8 minutes at five experimental stations. Scores at 5 and 8 minutes were compared using t-tests and correlation coefficients. Rankings of applicants based on 5- and 8-minute scores were compared using Spearman’s rank order coefficient. The reliability of the MMI was examined for 5- and 8-minute scores using generalisability theory. Results Mean scores at 5 minutes were lower than mean scores at 8 minutes. Cumulative scores at 5 minutes were also lower. There were highly significant correlations between 5- and 8-minute scores at all experimental stations (0.82–0.91; P < 0.01) and between the cumulative scores at 5 and 8 minutes (0.92; P < 0.01). There was a strong correlation between applicant rankings based on cumulative 5- and 8-minute scores (Spearman’s rank order coefficient 0.92). Reliability was not affected. Conclusions Reducing the duration of MMI stations from 8 to 5 minutes conserves resources with minimal effect on applicant ranking and test reliability. [ABSTRACT FROM AUTHOR]

Context At Flinders University, Adelaide, a subset of students on the 4-year, graduate-entry medical course chooses to spend Year 3 based in rural general practice as part of the Parallel Rural Community Curriculum (PRCC). This programme is equivalent to the tertiary teaching hospital option in terms of student educational outcomes. However, there is concern that this success comes at the cost of lost consulting time for the general practitioners (GPs) who supervise these students. Objective This study aimed to quantify the impact of medical students on the consulting time of rural GP supervisors. Methods We carried out a prospective cohort study using analysis of videotape recordings. Study subjects were GPs supervising PRCC medical students and working from their own consulting rooms in the clinic setting. Main outcome measures were mean consultation times in sessions with and without medical students. Results Using mixed model analysis accounting for clustering of consultations within doctors, and controlling for confounding factors, the estimated marginal mean of regular consultation time was 13 minutes, 27 seconds, which was not significantly shorter than that of precepting consultations (12 minutes, 48 seconds) or parallel consultations (12 minutes, 24 seconds). Conclusions Consultation length does not increase when rural GPs supervise medical students using a parallel consulting model. [ABSTRACT FROM AUTHOR]

Introduction: As universities rely more heavily on rural GPs to precept medical students, the formation of symbiotic partnerships benefiting students, universities and GPs, becomes imperative. In order to develop and consolidate these partnerships universities must understand who their rural GP preceptors are and how precepting impacts on them. Methods: A review of the literature was undertaken to determine the significant themes of student impacts from articles where conclusions were clearly based on empirical findings. Results: Forty-three articles were included in the final review, but only nine specifically looked at impacts on rural GPs. Impacts were categorized into six domains: personal; time; patient care; professional relationships and professional development; business and infrastructure; and recognition and remuneration. Conclusions: Literature specifically addressing the impact of precepting on rural GPs is scarce. Further studies are required to evaluate the relationship between the quality of teaching delivered to students, the type and length of student attachments and the likely impacts on rural GPs. [ABSTRACT FROM AUTHOR]

After much discussion and planning, Flinders University in Adelaide, South Australia recently introduced a new Graduate-Entry Medical Program (GEMP) which centres on problem-based learning (PBL). We describe the factors that stimulated the development of this new course, discuss its aims and philosophies and provide a brief outline of its structure. Advice and practical help was freely provided by several institutions who had undertaken similarly radical curricular reform and without this, a difficult task would have been much harder. We hope that our experiences will be of interest and help to others who are considering curricular reform. [ABSTRACT FROM AUTHOR]

Introduction In an attempt to address the rural medical workforce maldistribution and the concurrent inappropriate caseload at the urban tertiary teaching hospitals, Flinders University and the Riverland Division of General Practice decided to pilot, in 1997, an entire year of undergraduate clinical curriculum in Australian rural general practice. This program is called the Parallel Rural Community Curriculum (PRCC). This paper is a discussion of the aims of the programme; student selection; practice recruitment; curriculum structure, and academic content, together with lessons learnt from the evaluation of the first cohort of students’ experience of the course. Methods Independent external evaluators undertook a thematic analysis of a series of structured interviews of students and faculty involved in both the PRCC and the traditional curriculum. The mean examination results were determined and a rank order comparison of student academic performance was undertaken. Results The eight selected volunteer students reported greater access to patients and clinical learning opportunities than their mainstream counterparts and learned clinical decision making in the context of the whole patient, their family, and the available community resources. They identified patients with ‘core’ clinical conditions and had a longitudinal exposure to common diseases, whereas hospital-based peers had a cross-sectional exposure to highly filtered illness. The PRCC students’ academic performance improved in comparison with that of their tertiary hospital peers’ and in comparison to their own results in previous years. Conclusion The PRCC curriculum has cut across the traditional clinical discipline boundaries by teaching in an integrated way in rural general practice. It has affirmed the potential role of true generalist physicians in undergraduate medical education. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards. ..ASA-Design: Cohort study. Setting: Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital. Participants: All 371 medical students who did their year 3 study from 1998-2002. Main outcome measures: Mean student examination score (%) at the end of year 3. Results: The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group). Conclusions: These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students. [ABSTRACT FROM AUTHOR]

This article explores how work-based interprofessional education (IPE) influences collaborative practice in rural health services in Australia. Using a qualitative case study design, three rural hospitals were the focal point of the project. Marginal participant observations (98 hours) and semistructured interviews (n = 59) were undertaken. Participants were medical practitioners, nursing and midwifery professionals, physiotherapists, paramedics, social workers and administrative staff, who provided services in relation to each hospital. Data in the form of audio recordings and field notes, including researcher reflections were recorded over a three-year period. Whilst this study comprised of three phases, this article explores the extent to which collaborative practice was present or not before and after IPE. An inductive content analysis resulted in the following themes: Conceptualizing Collaborative Practice, Profession-Driven Education, and Professional Structures and Socialization. Community of practice theory is used to explore the barriers created through profession-based communities of practice. [ABSTRACT FROM AUTHOR]

Objectives:The Deakin University School of Medicine commenced in 2008 as a rurally focused medical school in south-eastern Australia. This research was designed to examine the effectiveness of the school’s adoption of small regional clinical school settings. Methods:A retrospective cohort study of the first two cohorts of students was employed to assess academic performance at each of five geographically dispersed clinical training sites, with varying student cohort sizes. The Dundee Ready Education Environment Measure (DREEM) questionnaire provided quantitative data regarding the students’ perception of their educational environment. The data were analyzed using univariate and multivariate analyses. Results:The highest examination scores, and greatest satisfaction with educational environment, were associated with the clinical school that had a small-sized group of students and was not co-located with another medical school. These differences remained after adjusting for multiple potential confounding factors. Conclusion:The smaller sites appear to have provided superior support for student learning in this new medical school. This advantage diminishes when smaller cohorts are co-located with students from other medical schools. Cohort size and co-location of medical school curricula may be important independent variables for researchers to consider when comparing the results of clinical education innovations in different settings. [ABSTRACT FROM PUBLISHER]

In this article, the author discusses the importance of communicating effectively with ethnic minority patients. The author states that achieving cultural competence among ethnic minority groups lies with the health professionals who provide the service. The author notes that health care professionals must be able to reflect upon their practices.

Background: This review, which focused on faculty development initiatives designed to improve teaching effectiveness, synthesized findings related to intervention types, study characteristics, individual and organizational outcomes, key features, and community building. Methods: This review included 111 studies (between 2002 and 2012) that met the review criteria. Findings: Overall satisfaction with faculty development programs was high. Participants reported increased confidence, enthusiasm, and awareness of effective educational practices. Gains in knowledge and skills, and self-reported changes in teaching behaviors, were frequently noted. Observed behavior changes included enhanced teaching practices, new educational initiatives, new leadership positions, and increased academic output. Organizational changes were infrequently explored. Key features included evidence-informed educational design, relevant content, experiential learning, feedback and reflection, educational projects, intentional community building, longitudinal program design, and institutional support. Conclusion: This review holds implications for practice and research. Moving forward, we should build on current success, broaden the focus beyond individual teaching effectiveness, develop programs that extend over time, promote workplace learning, foster community development, and secure institutional support. We should also embed studies in a theoretical framework, conduct more qualitative and mixed methods studies, assess behavioral and organizational change, evaluate transfer to practice, analyse key features, and explore the role of faculty development within the larger organizational context. [ABSTRACT FROM AUTHOR]

Objectives As community settings are being used increasingly in undergraduate medical programmes, this study aimed to explore and compare the clinical experiences of students in hospital-based and community-based training programmes. It measured students' clinical participation and compared the perspectives of Year 3 medical students in three different models of clinical education: a tertiary hospital block programme; a community hybrid programme, and a rural longitudinal integrated clerkship ( LIC) programme. Methods The study used a mixed methodology approach to examine the clinical experiences of students through the analysis of logbooks and semi-structured student interviews. This involved the quantitative analysis of 88 logbook weeks, data from which were triangulated through the analysis of 101 individual interviews using grounded theory. Results A total of 35 students across the three different clinical training models participated in the study. The results demonstrate significant differences among the three models in students' clinical participation and suggest that community settings provide more opportunities to students for meaningful engagement in patient care activities. Conclusions Consistent wider and more direct access to patients for students, as found in the community-based model, provides a pathway for engaging students in the learning processes, and a step towards making them aware of their learning needs and knowledge. Interviews provide evidence that authentic clinical activities can be enhanced through structured systems of supervision and through the provision of authentic roles for students in clinical teams. [ABSTRACT FROM AUTHOR]