Monash University Publishing | Contacts Page
Monash University Publishing: Advancing knowledge

From a broom cupboard: 20 years of rural health at Monash University

Ch 09. Gippsland Medical School

Taking advantage of opportunities as they arise

Associate Professor William Hart, Professor Judi Walker, Associate Professor Shane Bullock

The first graduates from the Gippsland Medical School of Monash University started as interns in 2012. As a result of their experience of being trained in Gippsland, many will choose to return to rural areas to provide services to otherwise underserviced populations. To date, for 2013, all 10 Gippsland Regional Intern Training places have been accepted by Gippsland Medical School graduates.

In 2006, funding was approved for Monash to establish extra Commonwealth Supported Places in the medical program. This funding involved the establishment of a new graduate entry program at Monash’s Churchill campus in Gippsland – the Gippsland Medical School – and the Extended Rural Cohort of students to undertake most of their three-year clinical placements in north-western Victoria. In this graduate entry version of the Monash medical degree, students achieve their degree in four years, rather than the five required by direct entry – school-leaver – students at Clayton and in Malaysia.

Capital grants from state and federal governments totalling $12 million enabled infrastructure upgrades at the Churchill campus to create the medical school base, and also at the clinical sites of the new school. These included those affiliated with the School of Rural Health’s two regional clinical schools in Gippsland and at Peninsula Health at Frankston, a major outer south-eastern metropolitan hospital bordering the Gippsland region.

Extra Commonwealth Supported Places were sourced in 2007 and 2008. Gippsland Medical School took its first intake of 57 students in 2008, growing to 89 in 2012. The 2012 student number consisted of 65 Commonwealth Supported Places with the balance made up of international students.

Gippsland Medical School achieved full accreditation from the Australian Medical Council at the first attempt. There have been no problems attracting a good quality student cohort, including local and international students, both Commonwealth Supported and full fee paying.

On 1 January 2011 the Gippsland Medical School was amalgamated with the School of Rural Health. As originally conceived and established, Gippsland Medical School was in an ambivalent position in relation to the regional clinical schools in Gippsland. This move relieved the tensions generated by different approaches to rural medical education and competition for clinical places in Gippsland, paving the way for the next era in the School of Rural Health’s growth and development.

Foundations

Staff

The Gippsland Medical School founding head was Professor Chris Browne, who worked with the Pro Vice-Chancellor of the Churchill campus – Professor Brian McKenzie and then Dr Harry Ballis – to lay the human and physical foundations for the new medical school.

Chris, a thirty-year Monash veteran, had first come to the Department of Biochemistry in the medical faculty at Monash from Oxford, UK, before heading off to become a research fellow in medicine at McGill University in Montreal. He rejoined Monash in the Department of Physiology in January 1982. He spent 10 years as part of the fetal physiology research program led by Professor Geoff Thorburn. From 1995 he took on many leadership roles within the faculty, developing and designing medical courses and programs. In 1999, he helped develop and introduce the faculty’s new school structure with the dean, Professor Nick Saunders.

In 2002 Chris was elected as the first president of the Monash University academic board. During 2004–2005 he established the College of Medicine at the University of Sharjah in the United Arab Emirates and also played a lead role in the establishment of the Monash Medical School in Malaysia. He established Gippsland Medical School in July 2006 and then in 2010 he took up a position in the office of the Vice-Chancellor working to establish the Southeast University-Monash University Joint Graduate School and Research Institute in China, a position from which he retired in July 2012.

Associate Professor William Hart was recruited by Chris in November 2006 as deputy head to lead the managerial aspects of establishing the new medical school. With a background as a public health physician, William was also involved in establishing various aspects of the Year A curriculum, particularly in the areas of personal and professional development, population health, and problem-based learning. William became head of school in 2010 and then director in 2011 under the new School of Rural Health organisational structure, prior to being recruited by Curtin University in Perth in September 2012 as foundation head and professor of medicine.

The vital task of conversion and contextualisation of the Monash medical curriculum from a five-year course into a four-year rural and outer metropolitan program fell to Associate Professor Robyn Hill, who had worked with Chris previously on the new Monash five-year curriculum and also had experience in the School of Rural Health. Robyn was appointed as Gippsland Medical School director of curriculum. In 2010 she left the medical school and later took up a senior management position at Central Gippsland TAFE.

These three foundation staff recruited a team of professional and academic staff to enable admission of the first cohort of students in 2008.

The directors of the Gippsland-based regional clinical schools of the School of Rural Health – Associate Professors David Campbell and Daryl Pedler were both closely involved in the establishment of Gippsland Medical School and were integral to the executive team. Both made major contributions to the development of the clinical curriculum.

With William Hart’s departure in September 2012, Associate Professor Shane Bullock has been appointed acting director of the medical school to lead and manage the graduate entry medical program as the School of Rural Health moves into its next phase.

Students

No particular prerequisite undergraduate studies are required for application to the graduate entry medical program at Gippsland Medical School. Students have varied academic backgrounds and life experiences – from pharmacy to journalism, arts-law to aerospace engineering. This poses unique pedagogical challenges and opportunities. In the same class might be a student with no background in human biology and a PhD graduate in neuroscience. They learn from each other. For teaching staff, finding the optimal level of depth and breadth of material as well as a balance between didactic and self-directed learning, is an ongoing task. Exit evaluation interviews and feedback from employers indicate that the quality of graduates is high, particularly in the area of clinical skills, irrespective of undergraduate background.

Predictors of return to working in a rural region include the student coming from a rural area, as well as exposure to rural medicine during the course. Gippsland Medical School has strategies to recruit students of rural origin at rates in excess of the Commonwealth’s medical student target of 25 per cent and to ensure that the list of applicants has a sufficient number of potential students of rural and Gippsland origin.

There are major challenges in attracting students who were born and bred in the bush. Gippsland Medical School engages with local secondary schools to improve their students’ health literacy and to raise expectations that rural and Indigenous students can apply to enter the Monash medical degree. With Gippsland Medical School part of the School of Rural Health, a whole-of-school approach is being taken to increase rural admissions into the medical degree across both direct and graduate entry student cohorts.

A large group of students cheering and throwing their hats in the air at their graduation

 

Managing a dispersed rural cohort model

As one of four cohorts of medical students managed by Monash, the challenge for Gippsland Medical School was to contextualise and deliver the Monash medical degree appropriately with respect to the issues of rural and Indigenous health in Gippsland, while achieving equivalent academic outcomes as Monash medical students from Clayton, Malaysia or the Extended Rural Cohort. In the rural cohorts, this challenge is compounded by the community-based teaching model of student attachments to small rural hospitals and general practice clinics, which requires close coordination and academic support. Through a regionalised committee structure and a commitment to communication, staff in the network of hospitals, community centres and private medical clinics collaborate with Monash staff to maintain the integrity of the course.

Monash’s is a generalist medical degree and the learning outcomes achieved are equivalent whether the student is trained in Gippsland, Clayton or Malaysia. In the regional clinical schools in Gippsland a model of training has been developed which contextualises the curriculum around problems and cases which illustrate rural and Indigenous issues.

The first year, Year A, of the curriculum at Gippsland Medical School, is unique. In contrast to the direct entry course offered at Clayton and Malaysia, the graduate entry cohort is significantly smaller and students have a one-year foundation program instead of two. The current Year A program is a mix of problem-based, other small group learning modes, seminar/workshops and didactic teaching. In a one-year program there are some great opportunities for alignment and integration of the curriculum themes and assessment. Much of the learning is contextualised to demonstrate rural and/or Indigenous issues. The social, population health and biomedical components of the program focus on the relevance to clinical practice. Within weeks of commencing Year A, the students participate in significant out-placement in clinics and hospitals. In addition, all students undertake extended placements with community service and support agencies. The feedback from students is that Year A is intensive and challenging for many of them. They value highly clinical skills learning, the rapport they develop with Gippsland Medical School staff and the anatomy program.

The funding for the new medical student places was designed to overcome the medical workforce shortage in Gippsland and, as a consequence, the medical school has high expectations placed upon it by the local community. The very nature of the rural community and its relative closeness to the Gippsland campus necessitates a closer relationship than in the more anonymous metropolitan environment. Gippsland Medical School and the two Gippsland regional clinical schools have retained a high level of public and local political interest since their establishment. Recent developments within Monash aiming to increase the autonomy of the Gippsland campus, including the Gippsland Medical School, will need to be managed very sensitively. The perceived relative merits of its graduates is an important issue for the medical school and its community partners.

Amalgamation with the School of Rural Health

As originally conceived and established, Gippsland Medical School was in a conflicting position in relation to the School of Rural Health’s regional clinical schools in Gippsland. On top of this, an expansive approach to acquisition of staff and other resources led to a financial crisis within four years. This was at a time when Monash was introducing a series of measures aimed at improving its overall cost-effectiveness. In that context, it could not accumulate further debt and ways had to be found for Gippsland Medical School to operate within its means.

The tensions between Gippsland Medical School and the School of Rural Health were further fuelled by differences in approaches to rural medical education and the fact that the regional clinical schools were well funded through the Commonwealth’s Rural Clinical Schools Program. In Gippsland there was increasing competition for clinical places as the regional clinical schools had responsibilities to support Clayton-based direct entry students as well as graduate entry Gippsland Medical School students.

In 2010 an opportunity for a new organisational structure arose when Chris Browne was recruited to lead the Monash China project and a new head – Professor Judi Walker – was recruited to lead the School of Rural Health.

The immediate issue was to define the relationship between the School of Rural Health and Gippsland Medical School. The Gippsland and East Gippsland Regional Clinical Schools, Gippsland Medical School, MUDRIH, the deputy dean MBBS, and the Pro Vice-Chancellor Monash Gippsland broadly agreed that it would benefit the medical program, the future of Gippsland’s rural medical workforce and the Monash Gippsland campus for the Gippsland Medical School to amalgamate with the School of Rural Health.

The agreed goal was to embed, over a five-year period, a consistent, high quality rural medical education and research program for Gippsland that is carefully aligned with the Extended Rural Cohort program in the north-west and the wider Monash medical degree and draws on the education and research capacity of MUDRIH and the School of Rural Health’s research office.

Different approaches to the delivery of the rural medical degree by the East Gippsland and the Gippsland Regional Clinical Schools and Gippsland Medical School are seen as strengths and are based on the principle of responsiveness to the local environment.

The underpinning tenets of the amalgamation included:

  • agreement on the most appropriate model – to complement the Extended Rural Cohort and the central medical degree models – for Gippsland rural medical education with responsibility, incentives and support for both Clayton-based and Gippsland Medical School medical students

  • the heads of the entities that make up the School of Rural Health to be titled ‘directors’ and report directly to the head of school

  • the Gippsland Medical School deficit to be cleared by the faculty prior to amalgamation

  • adoption of a financial model to deliver a sustainable medical program in Gippsland

  • academic and professional staff positions, roles and responsibilities in the south-east region to be reviewed to identify synergies and efficiencies in the context of the School of Rural Health as a whole

  • a Gippsland rural medical education identity to be defined based on the principle of enhanced workforce outcomes spanning student selection policy as a pathway for recruitment of Gippsland-origin students, curriculum interpretation and course delivery

  • agreement on appropriate learning objectives and resources to support a distributed model of rural medical education

  • synergistic and collaborative research initiatives across the entities that make up the School of Rural Health

  • partnership and collaborative initiatives and appointments with Gippsland hospital and health services and clinical training networks at all levels

  • engagement with local communities of interest to support rural medical and health professional training and research.

An amalgamation transition team led by Judi Walker was established to oversee the transition, taking responsibility for both business and academic issues. In June 2011 the amalgamation transition team undertook a six-month review of progress against the broad thematic headings that had guided its activities. They found that the task of managing the transition had been achieved, but a different structure was required to manage longer term developments.

An important goal for the School of Rural Health is to respond to the need for a sustainable medical workforce in Gippsland by developing a high quality rural medical education program that is carefully articulated and aligned with the school’s Extended Rural Cohort program and the wider Monash medical degree. This was named the Gippsland Health Education Program and is managed by the Gippsland health education group.

The Gippsland health education group reports to the head of school and the School of Rural Health executive and is responsible for developing strategies to meet priorities, define and realise benefits, and monitor risks, quality and timeliness.

One of the first innovations under this new structure was for students in the graduate entry stream to have enhanced access to metropolitan clinical placements and for students in the direct entry stream to have access to Gippsland clinical placements. Under this arrangement, the distinction between ‘graduate entry student’ and ‘undergraduate student’ is blurred, after pre-clinical training, into an integrated whole-of-Monash medical cohort.

Towards a regional approach to medical education and training

By the end of 2011 the Gippsland health education group had developed a rural medical education component of the Gippsland health professions education and training model that was:

  • responsive to rural medical workforce needs

  • regionally specific, flexible and simple

  • easily marketed and understood by prospective students, supervisors and stakeholders

  • focused on training in teams and interprofessional learning.

The Gippsland health professions education and training model traverses the continuum of medical training. It is concerned with delivering the medical curriculum across the Gippsland region through contextualised learning objectives that are responsive to the region’s population health needs, and demonstrating consistency in student recruitment, support and assessment across the region. It incorporates the values of innovation, social accountability, collaboration, community engagement, inclusiveness and respect. Above all it aligns with the school’s Northern Victoria Regional Medical Education Network/Extended Rural Cohort program.

This model and its functions were endorsed by the School of Rural Health’s executive at the end of 2011. The business case for a two-year project to implement an appropriate and sustainable structure to support the model was endorsed by the dean, Professor Christina Mitchell, in July 2012.

The School of Rural Health is now embarking on an ambitious project to achieve a regionalised medical education model for Gippsland – the next step in its continuing evolution.

Hart, William, Walker, Judi, and Bullock, Shane. 2012. ‘Gippsland Medical School: Taking advantage of opportunities as they arise’, in From a Broom Cupboard: 20 Years of Rural Health at Monash University, edited by Clough, Robert. Melbourne: Monash University Publishing. Pp. 136–145

From a broom cupboard: 20 years of rural health at Monash University

   by Robert Clough, editor