Medical Training Review Panel: thirteenth report

Medical Students

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In Australia, initial medical education is provided by university medical schools accredited by the Australian Medical Council (AMC). There are 18 universities with accredited medical schools, of which 14 are currently producing graduates. Four universities have students enrolled in courses of various lengths, but are yet to produce graduates. The first medical students graduate from Bond University in 2009. The University of Wollongong and University of Western Sydney (UWS) commenced teaching in 2007, and Deakin and Notre Dame Sydney commenced in 2008. These universities are expecting their first medical graduates in 2010 and 2011 respectively.

In the past, most medical doctors gained their graduate qualification by completing a six-year Bachelor of Medicine and Bachelor of Surgery (MBBS). Over the years, an increasing number of 5 year and 4 year (graduate entry) programs have been introduced. Recently, some six-year
programs have been replaced by five-year programs and a number of universities have introduced four-year graduate entry medical degrees for applicants with an existing degree. Some universities have both undergraduate and graduate entry programs.

In the past, university medical degrees usually had two stages:

• pre-clinical, which was primarily lecture theatre and laboratory-based; and
• clinical, which incorporated hospital ward and outpatient-based experiences.

Current programs integrate both components and incorporate clinical experience during the early years of the course.

Most significant clinical exposure occurs in the last two years for graduate entry programs, or the last three or four years for undergraduate entry programs of five or six year's duration.

Medical students are usually attached to a number of clinical teams, mostly in hospital settings. The student is part of the team and, under instruction from interns and registrars, learns in an apprenticeship manner how to undertake a range of clinical tasks. This approach aims to
develop their clinical skills to a level that is appropriate for commencing prevocational training as an intern.

Current Data

In 2009, there were 14,521 medical students studying in Australian universities (Table 2.1). Of these, 5,306 (36.5%) were undertaking a six-year course, 3,926 (27.0%) were undertaking a five-year course and 5,289 (36.4%) were undertaking a four-year course.

Table 2.1: Medical students in Australian universities, 2009

	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6	Total
6-year course
Adelaide	179	166	145	122	138	123	873
James Cook	180	166	100	91	103	84	724
Melbourne UG(a)	-	248	224	221	220	213	1,126
UNSW	277	269	258	240	218	209	1,471
Tasmania(b)	-	-	-	-	53	96	149
UWA UG	173	144	124	152	187	183	963
Subtotal	809	993	851	826	919	908	5,306
5-year course
Bond(c)	91	83	80	75	59		388
Melbourne PG(a)(c)	85	77	107	87	83		439
Monash UG	301	294	295	279	233		1,402
Newcastle/UNE	196	192	105	127	107		727
Tasmania(b)	124	127	103	55	..		409
UWA PG(c)	64	58	60	33	15		230
UWS	133	110	88	..	..		331
Subtotal	994	941	838	656	497		3,926
4-year course
ANU	94	82	91	78			345
Deakin	136	112	..	..			248
Flinders	144	132	120	102			498
Griffith	156	142	149	119			566
Monash PG	73	57	..	..			130
Notre Dame Sydney	113	107	..	..			220
Notre Dame WA	109	106	90	80			385
Queensland	429	384	411	347			1,571
Sydney	299	261	264	261			1,085
Wollongong	86	81	74	..			241
Subtotal	1,639	1,464	1,199	987			5,289
Total	3,442	3,398	2,888	2,469	1,416	908	14,521

UG - undergraduate
PG - postgraduate
^(a) UG last intake in 2008, current gradtuate program intake in 2009. Graduate entry in graduate program from 2011.
^(b) Tasmania's six-year course last intake in 2005. Five-year course first intake in 2006.
^(c) These courses are less than 5 years in duration - Bond 4.8 years, Melbourne PG 4.5 years and UWA PG 4.7 years.

Source: Medical Deans Australia and New Zealand

In 2009, 12,097 or 83.3% of all students were domestic students (Table 2.2). Of these, 4,230 (35.0%) were undertaking a six-year course, 3,268 (27.0%) were undertaking a five-year course and 4,599 (38.0%) were undertaking a four-year course.

Table 2.2: Domestic medical students in Australian universities, 2009

	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6	Total
6 year course
Adelaide	155	145	125	98	97	85	705
James Cook	162	162	96	88	100	82	690
Melbourne UG(a)	-	172	150	148	143	132	745
UNSW	210	209	206	200	162	169	1,156
Tasmania(b)					41	75	116
UWA UG	145	115	105	126	159	168	818
Subtotal	672	803	682	660	702	711	4,230
5 year course
Bond(c)	83	79	80	73	55		370
Melbourne PG(c)	79	72	88	69	68		376
Monash UG	247	228	221	182	159		1,037
Newcastle/UNE	172	166	80	104	85		607
Tasmania	99	109	81	47	..		336
UWA PG(c)	64	58	60	33	15		230
UWS	118	106	88	..	..		312
Subtotal	862	818	698	508	382		3,268
4 year course
ANU	86	78	85	72			321
Deakin	134	112	..	..			246
Flinders	125	114	106	74			419
Griffith	156	142	149	117			564
Monash PG	67	52	..	..			119
Notre Dame Sydney	113	107	..	..			220
Notre Dame WA	109	106	90	80			385
Queensland	306	300	328	272			1,206
Sydney	251	222	228	206			907
Wollongong	74	70	68	..			212
Subtotal	1,421	1,303	1,054	821			4,599
Total	2,955	2,924	2,434	1,989	1,084	711	12,097

UG - undergraduate
PG - postgraduate
^(a) UG last intake in 2008, current gradtuate program intake in 2009. Graduate entry in graduate program from 2011.
^(b) Tasmania's six-year course last intake in 2005. Five-year course first intake in 2006.
^(c) These courses are less than 5 years in duration - Bond 4.8 years, Melbourne PG 4.5 years and UWA PG 4.7 years.

Source: Medical Deans Australia and New Zealand

Types of Student Places

A student undertaking medical studies in Australia may occupy either a full fee-paying undergraduate place, funded entirely through the tuition fees paid by the student, or a Commonwealth-supported university place where, through the Higher Education Contribution Scheme (HECS), the student is required to pay for only part of the cost of his or her degree.

Some medical students occupying Commonwealth-supported university places are participating in the Bonded Medical Places Scheme (BMPS) or have received scholarships through the Medical Rural Bonded Scholarship Scheme (MRBSS).

Students participating in the BMPS have a return of service obligation to work in an Area of Workforce Shortage, identified by the Commonwealth, for a period of time equal to the length of the medical degree. However, up to half the return of service obligation can be met while completing prevocational training and vocational training.

Recipients of the MRBSS scholarship are required to work for six continuous years in a rural or remote area of Australia. MRBSS doctors start their six-year commitment to work in rural Australia after completing their vocational training.

In 2009, three quarters of students (75.3%) were in Commonwealth Supported Places (Table 2.3). From 2009, new full fee-paying domestic undergraduate medical places were no longer available.

Table 2.3: Medical students by type of student place: Number and proportion of places, 2005-2009

	2005	2006	2007	2008	2009
	Number
Commonwealth supported
HECS(a)	6,983	7,144	7,317	7,642	8,177.5
BMPS	434	688	1,212	1,747	2,279
MRBSS	452	486	488	489	481.5
Fee paying
Domestic	160	415	678	932	949
International	1,919	2,081	2,153	2,309	2,424
Other(b)	na	35	101	218	210
Total	9,948	10,849	11,949	13,337	14,521
	Proportion of places (%)
Commonwealth supported
HECS(a)	70.2	65.9	61.2	57.3	56.3
BMPS	4.4	6.3	10.1	13.1	15.7
MRBSS	4.5	4.5	4.1	3.7	3.3
Fee paying
Domestic	1.6	3.8	5.7	7.0	6.5
International	19.3	19.2	18	17.3	16.7
Other(b)	na	0.3	0.9	1.6	1.4
Total	100.0	100.0	100.0	100.0	100.0

^(a) ANU offers their research component part time in exceptional circumstances.
^(b) Other includes medical students on state health department bonded medical scholarships.

Source: Medical Deans Australia and New Zealand.

In 2009, 8,178 students were in Higher Education Contribution Scheme (HECS) places. This was an increase of 1,195 (17.1%) places in total from 2005. However, HECS places significantly decreased as a proportion of all places from 70.2% in 2005 to 56.3% in 2009.

In 2009, there were 2,279 students in BMPS places, an increase of 1,845 (425.1%) from 2005, when there were only 434 students in BMPS places. The proportion of students in BMPS places also increased significantly between 2005 and 2009 from 4.4% to 15.7% of all places.

Over this same period, the proportion of students in MRBSS places decreased from 4.5% in 2005 to 3.3% in 2009.

Since full fee-paying positions were first made available to Australian students in 2005, the proportion of fee-paying domestic students has risen from 1.6% to 6.5% in 2009.The number of fee-paying international students decreased from 19.3% in 2005 to 16.7% in 2009.

Rural Exposure

Exposure to rural and remote settings, whether through living, being schooled and/or undertaking medical studies or training there, is considered to have a positive impact on the likelihood of medical professionals practising in rural and remote areas.

Data on students who have a rural background is collected by medical schools. In 2009, 20.7% of first-year domestic students reported that they had lived in a rural or remote area prior to commencing their medical studies (Table 2.4).

Table 2.4: First-year domestic students with a rural background^(a), 2009

	Males	Females	Total	Proportion domestic students (%)
Adelaide	6	5	11	7.1
ANU	7	9	16	18.6
Bond	na	na	na	na
Deakin	17	16	33	24.6
Flinders	12	23	35	28.0
Griffith	13	14	27	17.3
James Cook	18	38	56	34.6
Melbourne PG entry	5	13	18	22.8
Monash PG	6	13	19	28.4
Monash UG	30	31	61	24.7
Newcastle/UNE	21	42	63	36.6
Notre Dame Sydney	na	na	21	18.6
Notre Dame WA	na	na	32	29.4
UNSW	17	34	51	24.3
Queensland	23	21	44	14.4
Sydney	12	10	22	8.8
Tasmania	11	12	23	23.2
UWA PG	7	6	13	20.3
UWA UG	16	25	41	28.3
UWS	1	1	2	1.7
Wollongong	10	14	24	32.4
Total	232	327	612	20.7

UG - undergraduate
^(a) Based on RRMA classification in which RRMAs 3-7 are categorised as rural and remote regions.
Source: Medical Deans Australia and New Zealand

No other data is currently available and the MTRP has identified this as an area in which it hopes to improve data in future years.

Trends

Between 2005 and 2009, the total number of first-year medical students increased by 47.7% (Table 2.5).

Over this same period, domestic first-year student numbers increased by 1,084 (57.9%), whilst international first-year student numbers increased by just 27 (5.9%).

The proportion of females in first-year medical studies has remained relatively stable over the last five years (Table 2.5).

Table 2.5: First-year medical students: Domestic and international and proportion of females^(a), 2005-2009

	2005	2006	2007	2008	2009
Domestic	1,871	2,071	2,560	2,934	2,955
Proportion females (%)	55.2	55.1	54.4	54.0	54.8
International(b)	460	426	436.0	499	487
Proportion females (%)	57.2	53.1	49.8	50.9	47.0
Total	2,331	2,497	2,996	3,433	3,442

^(a) Based on commencing year of graduate course.
^(b) International students are those studying as private or sponsored students who are not Australian citizens, permanent residents or New Zealand citizens.
Source: Medical Deans Australia and New Zealand.

Between 2005 and 2009, there was an increase of 4,586 (46.2%) in the overall number of medical students studying in Australian universities (Table 2.6). Over this same period, the total number of domestic students increased by 4,071 (50.7%).

Table 2.6: Medical students: Domestic, international and proportions of females^(a), 2005-2009

	2005	2006	2007	2008	2009
Domestic	8,026	8,768	9,796	11,028	12,097
Proportion female(%)	55.2	55.7	55.8	55.3	54.6
International(b)	1,909	2,081	2,153	2,309	2,424
Proportion females(%)	53.4	53.9	52.3	52.5	51.4
Total	9,935	10,849	11,949	13,337	14,521

^(a) Data covers all years of study.
^(b) International students are those studying as private or sponsored students who are not Australian citizens, permanent residents or New Zealand citizens.
Source: Medical Deans Australia and New Zealand.

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