Governance and Assessment in a Widely Distributed Medical Education Program in Australia

Abstract

The learning objectives, curriculum content, and assessment standards for distributed medical education programs must be aligned across the health care systems and community contexts in which their students train. In this article, the authors describe their experiences at Monash University implementing a distributed medical education program at metropolitan, regional, and rural Australian sites and an offshore Malaysian site, using four different implementation models. Standardizing learning objectives, curriculum content, and assessment standards across all sites while allowing for site-specific implementation models created challenges for educational alignment. At the same time, this diversity created opportunities to customize the curriculum to fit a variety of settings and for innovations that have enriched the educational system as a whole.Developing these distributed medical education programs required a detailed review of Monash's learning objectives and curriculum content and their relevance to the four different sites. It also required a review of assessment methods to ensure an identical and equitable system of assessment for students at all sites. It additionally demanded changes to the systems of governance and the management of the educational program away from a centrally constructed and mandated curriculum to more collaborative approaches to curriculum design and implementation involving discipline leaders at multiple sites.Distributed medical education programs, like that at Monash, in which cohorts of students undertake the same curriculum in different contexts, provide potentially powerful research platforms to compare different pedagogical approaches to medical education and the impact of context on learning outcomes.

Decentralised training for medical students: a scoping review

“…The timing of the first exposure and how the theoretical input linked with the practical training were important [ 28 ]. An integrated (clinical and public health) approach, educational continuity and equivalence in multiple settings were seen as important [ 52 , 53 , 60 , 61 ]. A need for interprofessional learning to be imbedded in the curriculum [ 3 , 57 , 62 , 63 ] as well as opportunities for developing ethical and cultural competencies was also identified [ 64 ].…”

“…The benefits for a range of stakeholders when clinical training takes place involving immersion in local communities were described in a number of the included studies. These benefits included addressing health workforce issues, changing attitudes and perceptions of students, faculty and community, rich real-life training experiences, closer relationships between faculty and community, and a positive impact on community health outcomes [ 12 , 39 , 61 , 81 , 102 – 107 ]. The challenges of community immersion, however, emerged from poor communication between faculty and community, language barriers and a lack of cultural and religious sensitivity [ 108 ].…”

Challenges, success factors and pitfalls: implementation of distributed medical education

“…Most studies describing establishment of new sites appear to have had well‐orchestrated implementation plans . Work in the ordered domains requires adequate resources and aligned operations for simultaneous movement on multiple fronts.…”

“…Compared with other aspects of DME, the literature on DME implementation itself is somewhat limited . These descriptive reports – some about postgraduate medical education (PGME)– are usually from a senior leadership perspective and variably emphasise site selection criteria, stakeholder partnerships, resources, curriculum development and delivery, assessment, faculty development, management and governance of DME.…”

“…Although DME is more common, there have been challenges in implementation, including the development of student support and administrative systems across multiple sites, educational alignment and temporary disruption of physician networks at new sites …”