Australian medicine given some northern exposure

The new James Cook medical school in Northern Queensland is bringingdoctors to under-represented regions and focusing on the health problems of its Aboriginal population. Julia Hinde reports from Australia

Doctors from the far north of Australia are a rare commodity. A school-leaver from northern Queensland who wanted to study medicine had to hike south 2,000km or more to the country's 11 medical schools. Until now.

In February, Australia opened its first new medical school in 24 years, based at James Cook University in the northern Queensland town of Townsville, 1,200km as the crow flies north of the next closest medical school at Brisbane.

The decision to open a new school comes at a time when the outlook for medical education in Australia is very different from the UK. Whereas the UK is expanding trainee doctor numbers by 1,000 a year, paving the way for potential new schools, in Australia the number of new doctors is being held static. So a new medical school has meant other schools seeing their numbers shrink.

But, as Richard Hays, dean of the new James Cook school and a northern Queensland GP, explains: "Northern Queensland is boomsville when it comes to population and economic growth. Our population is growing hugely, these people need doctors."

The town of Mt Isa, for example, 900km inland from Townsville, has a population of 24,000, with 36,000 in the area, yet it has major problems attracting senior specialists to its hospital and experienced GPs to its community. Many of its positions are filled by Britons and South Africans, as well as others from overseas, working in Australia on six to 12-month placements.

The university hopes that by selecting local students and giving them local study options, they will choose to stay and practise in the region. Evidence from such programmes in Norway and the United States suggests they may be right.

Even before the school was up and running, specialist recruitment to Townsville and other area hospitals improved, says Professor Hays.

"There is a big earnings disparity in Australia between hospital doctors and private medicine. But the connection to a university is a bargaining chip, a reason for a doctor to stay in public medicine. Most of the doctors who have come here in the past three years have come because they wanted to work in a university hospital."

As well as teaching the basic requirements of a medical degree, the James Cook course will pay attention to the medical requirements of its region. Its current research strengths are in the issues raised by rural and indigenous health.

"The research is not so much about the health disparities between indigenous and non-indigenous Australians, but how we can intervene," says Professor Hays.

He explains that the school is spending a lot of time with Aboriginal groups to get them involved in research projects.

"Research programmes involving indigenous people do not tend to get going unless people see value in them," he explains, adding that the school is trying to involve indigenous Australians not only in the projects, but also in helping to determine research priorities.

"It's about community empowerment," says Professor Hays.

To put this in context, according to the Australian Bureau of Statistics, between 1991 and 1996, life expectancy at birth was estimated to be 56.9 years for indigenous Australian males and 61.7 years for indigenous females, compared with an all-Australian estimate of 75.2 years for males and 81.1 years for females.

Professor Hays believes the research emphasis on Aboriginal health, rural and remote medicine, as well as tropical disease, makes the James Cook Medical School unique.

"We believe that in these three areas we will be one of the few medical schools in the developed world able to do this well," he says.

"None of our students will be brought up in the huge metropolitan hospitals, but will be working in places like Thursday Island off Cape York, in the Gulf of Carpentaria and at remote towns such as Mt Isa. Our students will have to meet all Australian qualification requirements, but I think at the end of the day, they will be different too."

For one, they are likely to be younger than many of Australia's newly qualifying doctors. James Cook will be a six-year course aimed at school-leavers, as this is seen as the most attractive option for rural Australians and Aborigines, and distinguishes the school from the existing University of Queensland Medical School at Brisbane.

This is in contrast with a recent trend in Australia, which has seen many of the country's medical degrees move to becoming shortened courses aimed at graduates only.

Where the UK is just beginning to introduce such fast-track courses for graduates, Australia this year, through Flinders University in Adelaide, graduated its first cohort of graduate-only medics, trained in four, instead of the traditional six, years.

Sydney University Medical School and Queensland have also become graduate-only, while Melbourne this year admitted a group of graduates on a fast-track programme alongside its longer undergraduate course.

Though it is still early days, with the first Flinders graduates only a few months into internships, Michael Ahern, associate professor in the school of medicine at Flinders, says this year's graduates are "more mature with more life experiences, and appear more empathic, accepting of behaviour and communicative" than their forerunners. Drop-outs due to motivational problems have fallen to almost zero.

There have been criticisms from some who argue that the four-year students know fewer facts than their predecessors, but Professor Ahern is confident that in the long term, his new graduates will make better doctors, with all the tools to continue to acquire knowledge in the fast-changing world of medicine.