International Briefs

Medical education in Australia is dynamic and going through a period of unprecedented change, according to the Australian Medical Council (AMC).Announcing the outcome of its medical school accreditation reviews and other decisions made at its Annual General Meeting on 25 November 2005, AMC President Dr. Joanna Flynn said the volume of change under way in medical education was reflected in the AMC’s medical school accreditation program.In 2004, the AMC accredited three new medical schools. In 2005, the AMC reviewed the progress of these schools, agreed to assess the plans for another new medical school, and the plans by one established school to offer its medical course in Malaysia in 2007.In 2004–2005, the AMC also reviewed Australia’s first three graduate-entry medical programs, which were introduced in 1995–96, and continue to produce quality graduates.“The changes are being driven by increased collaboration and better cross-fertilization of ideas between schools – ensuring all schools are improving to meet the quality of the best,” Dr. Flynn said.She also stated that, since its inception, the AMC had deliberately not stipulated what direction medical education in Australia should take. Instead, it had consciously fostered an environment of collaboration between universities and active peer review, to maximize best practice across medical schools.‘The level of innovation we see now and the diversity of approach to medical education in Australia demonstrates the value of this approach,” Dr Flynn said.Before the Council meeting, the Minister for Health and Ageing, The Honorable Tony Abbott MP, advised the AMC that a case had been made for the recognition of the new specialties of pain medicine and palliative medicine. As a result, the AMC considered the education and training programs available for doctors who wish to train in the new specialties. The AMC has advised the Minister on the accreditation of training programs in both specialties.The AMC also confirmed it had submitted its report to the Minister on an application by the Australian College of Rural and Remote Medicine (ACRRM) for recognition of rural and remote medicine as a distinct specialty. The report will be published on the AMC’s website after the Minister has considered the report and released his decision about ACRRM’s application.AMC accreditation is mandatory for all university medical schools, which must meet explicit accreditation standards. The accreditation process involves detailed analysis of the proposed curriculum and medical school resources, rigorous review of clinical training opportunities and visits from clinical and community based assessment teams.General trends identified in 2004 were carried through to the 2005 accreditation process – including a greater focus on student directed learning, increased breadth of clinical experience beginning from first year and more emphasis on communication skills training.All medical schools reviewed during 2005 received positive assessments from an AMC Assessment Team. Detailed Accreditation Reports are available on the AMC website (www.amc.org.au). A range of strengths is detailed in each report and in all cases opportunities for improvement were identified in order to promote continuous improvement.In summary: The University of Notre Dame Australia (UNDA) is a new medical school. The AMC reviewed the first year of the program (implemented in 2005) and the University’s plans for Years 2 and 3 of the course. The AMC commended UNDA on its progress and collaboration with the University of Western Australia concerning clinical placements for students.The University of Tasmania is beginning a new five-year program, reflecting a complete turnaround in curriculum and approach. The AMC congratulated the medical school’s leadership, the staff commitment and the support of a wide range of other stakeholders, including the State and Commonwealth health departments, for the successful redevelopment of the course.The Australian National University Medical School is now implementing Year 2 of its four-year program, which developed from a clinical school of the University of Sydney. The AMC found the ANU program to have strong community support, backed by support from ACT Health for staffing and capital development. Particularly commended are the population health resources available to the school.The University of Auckland Medical School is a well established and well regarded school. It has implemented a major curriculum renewal strategy in the last three years. The AMC has commended the commitment of the University, the staff and clinical teachers to a high quality medical course relevant to the health care needs of the communities of New Zealand, the Pacific and beyond.The University of Queensland and The University of Sydney are both older established schools which are now graduating students from their graduate entry four-year programs. The implementation of the programs in these schools, together with Flinders University, marks the beginning of the current period of diversification, and collaboration between medical schools.Reprinted from the Australian Medical Council website.College of Physicians and Surgeons of Alberta (CPSA) Council President Dr. Gordon Arnett recently took center stage in Calgary as one of several guest speakers at the 9th Annual Glen Edwards Day Lectures.Put on by the University of Calgary’s Faculty of Medicine, the lectures focused on Issues in Patient Safety and attracted more than 200 people, including orthopedic surgeons, residents and allied health professionals interested in musculoskeletal injuries.Dr. Arnett’s 20-minute presentation began with a review of the College’s mission statement and how it plays a key role in ensuring and enhancing patient safety. “Our mission is to serve the public and guide the profession,” he noted. “Ensuring our members are clinically competent and meet professional standards is an absolute necessity in ensuring patient safety.”The concept of professionalism was the central focus of the presentation and is also a key component of Dr. Arnett’s speeches for the 2005 CPSA Regional Tour. In both instances, he outlines scenarios that help physicians understand the link between professionalism and patient safety. These include: The need for disclosure. When harm occurs – the CMA’s medical code of ethics clearly outlines the physician’s responsibility for full disclosure to the patient and the family. This approach is fully supported by the CPSA.The need for physicians to be clear in their communications with patients, colleagues and co-workers.Unnecessary delays in treatment, prescription mistakes, lack of follow up – all of these can be caused by poor communication and go against the basic tenet of professionalism – to put the patient’s needs before one’s own.Dr. Arnett’s speech also touched on the College’s complaints process, and how the approach to complaint resolution is similar to the approach being touted for the patient safety movement. Our ultimate goal for the complaints process is not to punish or blame, but to improve the quality of medicine available in Alberta. “By focusing on education and quality improvement, we allow physicians to learn from their mistakes,” notes Dr. Arnett in his presentation. “In fact, many voluntarily make changes to their practice, or agree to take additional training to address concerns that were raised during the complaints process.”For more than 25 years, the College has accredited medical laboratories and diagnostic imaging facilities throughout Alberta. With the more recent inclusion of neurophysiology, pulmonary and nonhospital surgical facilities, more than 700 diagnostic and treatment facilities are accredited by the College every four years.Accreditation activities are currently managed with a variety of paper-based systems. To create a more efficient process to collect and collate data, and to monitor and guide the quality of care in these facilities, the College is moving to an electronic platform that will store information from the accreditation process and enable more meaningful and timely data analysis. This platform will also streamline the accreditation process for facilities, inspectors and the College.The College is collaborating with HealthMetrx Canada of Vancouver in the development of this digital accreditation platform (DigitalAP). It is a multi-phase project encompassing the full scope of accreditation activities, including the preassessment phase, on-site reporting, the post-assessment phase, and comprehensive standards management. With the success of DigitalAP in province-wide pilots and laboratory assessments in the Peace Country Region and Calgary Health Regions, the College has made a five-year commitment to manage the accreditation process using DigitalAP.During the next two years, pilot projects will be introduced for diagnostic imaging, pulmonary, cardiac stress testing, neurophysiology and non-hospital surgical facilities requiring accreditation. For more information on the digital accreditation platform or the pilot projects, please contact Ms. Barb Unger, Manager of the Quality of Care Department at (780) 970-6249, (800) 320-8624, ext. 249 or by e-mail at bunger@cpsa.ab.ca.A woman attended a dermatologist regarding excessive facial hair growth. According to the patient, she was reassured by the physician she could expect permanent hair reduction from the treatments.After several treatments, she expressed dissatisfaction with the results. The physician provided additional treatments free of charge. Despite the extensive treatment received, both at her cost (approximately $1,800) and at the physician’s expense (approximately $900), the patient was dissatisfied with the results. When she confronted the physician, she was told that there was adequate improvement. Some time after these clinical encounters, she received a newsletter from the physician’s office stating: I was the first doctor in (city) involved in laser hair removal. I am the only one with two sophisticated units – Lumenis’ Lightsheer and Palomar’s Estelux IPL system. These are recognized as being the best in the industry. That’s why I offer a guarantee – permanent hair reduction or your money refunded. I am the only one in (city) bold enough to make this claim.In the same newsletter, the physician also made statements implying that his/her clinic met or exceeded international standards of excellence in Photo Rejuvenation, Botox and Liposuction. The physician happily reported to patients that “in many areas of my practice, we are leading the way.”The complainant suggested that physicians hold a position of trust in society and should not be allowed to make claims and not honor them.The physician responded that the patient had olive skin with some dark and coarse hairs, as well as some light and fine hairs. It was felt that some reduction in her hair growth could be achieved. The physician indicated that at no time was she misled as to what to expect but rather she was educated about what was possible and not possible in her case. The physician provided the College with a copy of the guarantee offered to the patient stating: If there has been NO visible improvement after completing the recommended eight-treatment program, you will receive a full refund or a free package to treat that area again.The College in its investigation recognized that complete hair loss may not be a reasonable expectation, particularly in patients with darker complexion and light fine hairs. It was noted that the patient signed a consent that clearly lists the potential for a 20 percent incidence of no permanent hair loss. Furthermore, the physician offered the patient free packages of treatment when the results were suboptimal from her perspective. As a result, the College was unable to support the patient’s claim that the physician acted unprofessionally and without compassion in the provision of her care.Our review of the physician’s newsletter found it to be aggrandizing and self promoting. From the College’s perspective, advertising to the public should be factual, easily understandable and dignified. A practitioner should not make false or misleading promises or compare him/herself to others directly, indirectly or by innuendo to any other practitioner, clinic or facility.Discussions were held with the physician about the ethics of advertising. The physician agreed that the statements in the newsletter were unprofessional and committed to put in place a rigorous review process for future newsletters and promotional materials in order to ensure compliance with the College bylaws. In addition, the physician will issue an apology in his/her newsletter in which he/she undertakes in future advertising to meet the high ethical standard the public expects of the medical profession.Reprinted from issues 119, 120 and 121 of The Messenger, published by the College of Physicians and Surgeons of Alberta.The General Medical Council regulates more than 3,000 doctors in Northern Ireland and is to open its first ever Northern Ireland office before the end of the year.The GMC has appointed Alan Walker as Head of Northern Ireland Affairs to provide a local focus to its operations from December 2005. This fulfills the promise made by GMC 12 months ago to review its arrangements in Northern Ireland.“We are delighted that Alan has accepted the post of Head of Northern Ireland Affairs,” said Professor Sir Graeme Catto, President of the GMC. “Given his background in representing the interests of Northern Ireland, we are certain that the skills he will bring to the role will support the GMC’s commitment to ensuring the differing health issues in the devolved nations are effectively addressed. 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