The flexible delivery of a postgraduate medical education program

In 1994 Edith Cowan University developed a postgraduate program in occupational medicine in response to a request from the Malaysian College of General Practitioners. For the past two years the University has delivered the program by a variety of strategies to medical practitioners in Malaysia. The basic course materials have been prepared in the traditional print mode. The use of advanced educational technology, such as CD ROM and internet, has had limited application to date because these instructional modes remain inaccessible to some students in Malaysia. The distance education materials have been supplemented by lecturers visiting Malaysia to conduct orientation sessions at the commencement of the semester and a review program at examination time. Other activities include a mid-semester weekend seminar conducted in Kuala Lumpur by Australian practitioners with expertise relevant to the program. Students are required to complete a two-week placement with an occupational physician in Australia. In developing the curriculum an inter-institutional curriculum committee was formed to ensure that the program was relevant to the needs of Malaysian medical practitioners. The University also worked closely with the Faculty of Occupational Physicians in the Royal Australasian College of Physicians to ensure the integrity of the program. As both Australian and Malaysian occupational health and safety legislation are based on British legislation, cultural differences did not impact significantly on the development of the curriculum. The success of the program has led to its implementation in other countries in the region.

It has been said that much of the information acquired by today's first year medical students will be out of date by the time those students graduate. In a world where knowledge is expanding at an exponential rate it is essential that medical practitioners have access to a comprehensive program of continuous medical education. However, we are all too familiar with the conundrum - how do busy practitioners get the time to maintain their medical knowledge? Of course, there is a variety of ways by which doctors are able to keep abreast of current developments. There is the time honoured professional journal. These days it is difficult enough to keep up with knowing about current publications, let alone the contents of any one journal. There seems to be a new journal being published every month. Many doctors do keep up to date by selective reading of relevant journal publications. There is also the traditional annual conference of those associations to which the practitioner belongs. Such conferences provide a vital means of keeping doctors abreast of current issues and developments. Then there are the weekend workshops that provide an important means of focussing on a specific topic.

It is somewhat ironical that universities have played such a limited role in the provision of postgraduate medical education. After all, these institutions are the powerhouses of research. The dean of an Australian medical faculty recently claimed that his faculty accounted for some 90% of all research funds spent in his university. This figure may well be reflected in most universities that house a traditional school of medicine. It is legitimate to ask about the teaching programs of medical faculties, and to examine how effective they are in disseminating the outcomes of their research programs to the practitioners in the field.

One reason why medical faculties have not been vitally active in the provision of postgraduate education is that it has been seen to be the responsibility of the professional colleges. However, more and more colleges are recognising that they do not have the resources required to maintain a comprehensive continuous medical education program. Some of these colleges are entering into productive arrangements with universities to develop programs appropriate to the needs of their members.

A further reason for the minimal involvement of medical faculties in postgraduate education has been the reluctance of some these faculties to deliver their programs to meet the needs of potential students. That is, many faculties which do offer postgraduate courses require the students to attend these courses on a full time basis. Of course, it is not always possible for a medical practitioner to relinquish his or her practice for two years or more to complete a master degree or an MD. I believe it is possible for universities to provide postgraduate medical education programs on a much more flexible basis for practising doctors.

Occupational Medicine, Health and Safety: A case study

Subsequently, a joint curriculum committee was formed with representatives from the Academy and the University. The committee met on a needs basis initially to determine the nature of the program. At the outset the committee recommended the development of three awards to allow students the flexibility to pursue their studies to a level appropriate to their professional needs. The Postgraduate Certificate of Health Sciences (Occupational Medicine, Health and Safety) comprises four subjects as listed below:

• OHS5101 Prevention of Accidents and Ill-Health at Work
• OHS5102 Diseases of Occupation
• OHS5105 Principles and Practice of Occupational Health Service
• OHS5201 Ergonomics, Safety Technology and Workplace Design

The Postgraduate Diploma of Health Science (Occupational Medicine, Health and Safety) builds on studies undertaken for the Postgraduate Certificate award. Thus, the studies completed for the Postgraduate Certificate can be credited towards the Postgraduate Diploma. However, in addition students must complete the following units:

• OHS5103 Occupational Health and Safety Legislation, Management and Compensation
• OHS5104 Epidemiology for Occupational Health and Safety

Students wishing to acquire advanced knowledge in the field of occupational medicine will proceed to the Masters degree and complete:

• OHS6101 System Safety Management and Emergency Planning
• OHS6102 Rehabilitation Medicine
• OHS6201 Prevention of Accidents and Ill-Health at Work 2
• OHS6202 Independent Research Project

Once the Faculty of Occupational Medicine and the University Council had endorsed the content and structure of the awards the Faculty was able to proceed with developing the courses. The course preparation team included University staff with expertise in occupational medicine, consultant physicians with specialist knowledge, curriculum design experts from the University department of distance learning, the Faculty librarian, and members of relevant professional associations. The team worked exhaustively to order supplementary library materials, to prepare students' notes and sets of readings.

Delivery of the course entails the following activities:

1. Orientation
   At the commencement of the semester one or two university lecturers will meet with the students in Kuala Lumpur. The purpose of the orientation is to brief the students on the nature of studying the course by distance education, to apprise them of the administrative requirements of the University, and to give the students an overview of the courses they will be studying that semester. Students are provided with textbooks, lesson notes, study guide and readings as required for their studies that semester.

2. Students are required to submit written assignments based on their prescribed readings and practical experience to their lecturers throughout the semester. Students are encouraged to keep in contact with their lecturers through internet, by fax or mail, or by telephone. Lecturers are expected to be in regular telephone contact with students to ensure that they do not feel isolated from the University.

3. During the semester the Faculty will conduct a weekend seminar focussing on a particular aspect of the program being studied at the time. The seminar will be presented by Faculty staff and may include consultant specialists from the field. In the past attendance at these seminars has been restricted to doctors enrolled in the course. However, as a result of recent discussions with the Academy of Family Physicians we have agreed that the seminars should be available to all interested medical practitioners.

4. In the final week of the semester lecturers from Perth visit Kuala Lumpur once again. The purpose of this visit is to review the material covered during the semester with the students.

5. At the request of the Academy of Family Physicians students are required to complete a two week placement in Perth. The students have the opportunity to interact with leading occupational physicians, to investigate safety systems that have been established in Western Australian industrial settings, and to gain a practical understanding of the occupational health and safety legislation as it operates in Perth.

These awards are also available in Indonesia through the Department of Manpower. In 1996 we will be delivering the awards in occupational medicine to the other countries in the Asian-Pacific region.

Conclusion

There have been a number of very positive outcomes arising from our involvement in the provision of postgraduate medical education to the Asian-Pacific region. The University has benefited substantially from the opportunity to work with overseas organisations. The quality of our programs has been enhanced by the opportunity for staff to gain an international perspective on their area of study. By understanding the problems and issues confronting colleagues in other countries one has a far greater appreciation of one's own circumstances. The Faculty has also benefited from the opportunity to collaborate with other organisations in research. While it is easy for the Faculty to recognise the benefits that accrue from such activities, we hope that other benefits are enjoyed by our partners.

Please cite as: Underwood, R. and Gamble, R. (1996). The flexible delivery of a postgraduate medical education program. Different Approaches: Theory and Practice in Higher Education. Proceedings HERDSA Conference 1996. Perth, Western Australia, 8-12 July. http://www.herdsa.org.au/confs/1996/underwood.html