OTAGO MEDICAL SCHOOL ‘IN JEOPARDY’

Press, Volume CVIII, Issue 31669, 3 May 1968, Page 1

OTAGO MEDICAL SCHOOL ‘IN JEOPARDY’

Special Report Calls ror Widespread Reforms (New Zealand Press Association)

DUNEPIN, May 2. Drastic changes will be needed if the University of Otago Medical School is not to lose the reputation it has gained over almost a century of endeavour, says a report issued today.

Professor R. V. Christie, formerly dean _ of the faculty of medicine at McGill University, Montreal, says that the future of the Medical School has been placed in jeopardy by economies.

The report suggests the medical faculty at Otago must be one of the most economical in the English-speaking world.

“Rehabilitation will be expensive but this investment will only be effective if it is associated with chances tn administration,” says Professor Christie. The Edinburgh-trained expert in medical education was asked by the university council to report on the problems of curriculum and organisation faring the Medical School. He spent two months in New Zealand making his study, and presented his report to the council on April 23. His suggested remedies include:

The immediate appointment of 20 additional staff. The reduction of clinical classes at Dunedin from 110 to 6065. The establishment of a second clinical school at Christchurch. The lengthening of the teaching year by six weeks and the reduction of the Medical School confab from live to four years, with appropriate staff increases.

The inclusion of four or five university representatives on the Otago Hospital Board. In the preamble to Ms report Professor Christie says: “If my comments appear to be disparaging they must be taken in the context of a medical school which is struggling to maintain its considerable reputation and of a faculty which has become diacounged and despondent because of lack of support and opportunity. “The quality of many of the staff, both tn research medical schools, but unless something is done soon the ranks of what amounts to a

skeleton staff will be depleted and the university may well be faced with a difficult crisis.” He sees the financial problem of the school as being so urgent it cannot wait for the university’s new five-year grant in 1970. He recommends as a first step that extra finance for 20 additional staff positions should be provided now for appointments to be made next year. One of the most important sections of the report deals with the limited facilities for clinical teaching in Dunedin. “It is patently impossible for Dunedin hospitals to continue to train 110 clinical students if the Medical School is to meet the standards expected elsewhere,” says Professor Christie. The Goodenough Committee in 1944, recommended that any medical school admitting about 100 student:, a year to the clinical part of the course should have access to 9501000 beds (not including geriatric and long-stay patients). In 1966 the University of London recommended ta the Royal Commission on EducaDunedin has a total of 632 teaching beds available for an entry of 60 students. Professor Christie suggests there are two workable solutions to this impasse. The first is to reduce the annual intake to the school to 60 or 70 students. This, he says would be politically unpalatable since ! the cojt of a medical school , tills size would be only 10 to 20 per cent less than a school j of double the size.

It might also be undesirable since New-Zealand will require more rather than fewer doctors if its needs are to be satisfied. What he recommends is the establishment of a second clinical school. And he favours Christchurch as the site, and 1973 aw the time to bring it into operation. Ulis school could either take half of the class for the

two clinical years or half for the first year and the other half for the second. He recommends the latter. With Dunedin and Christchurch each handling 60 or 65 clinical students the graduation class could be increased to 120 or 130. -He emphasises all along that the Christchurch (or Wellington) school should be clearly a school of the University of Otago, but with some autonomy. Discussing the length of the academic year (27-weeks in the first three years and 30 weeks in the fourth and fifth years) Professor Christie says it is the shortest he has encountered in any medical school. Longer Year He suggests it could be increased by six weeks and the professional years of the course reduced from five to four.

A 20 per cent increase in staff would be necessary for this, however, or there would be reduced time for research —leading to further difficulties in recruitment

Professor Christie criticises the method of selecting students for professional classes in medicine. Modifications have been made over the years and recently provision has been made. for some admissions direct- from school, but the system is predominantly a selection on the academic results of the first or intermediate year of university study Professor Christie says that about two-thirds of the entry should be selected from school, before the . students begin the intermediate year, and the remaining one-third of the places should be reserved for later entrants. The balance of a suitable pre-clinical curriculum has been altered by recent scientific. advances in medicine, says Professor Christie. He suggests a reorganisation of this part of the course, with the possibility of the equivalent of B.Sc. after three years study.

Earlier Exclusion He points out that it is both more efficient and more humane that students who are unlikely to succeed,or who would take an unreasonably long time to qualify, should be excluded from the course in their early years at the university. He cites cases where students have taken 14 yean to graduate and others where they have had to give up the

struggle after eight years or more. Teaching facilities at Dunedin Hospital in general medicine and surgery are grossly inadequate—worse than in any of the teaching hospitals he has seen in Europe or North America, says Professor Christie. He expressed amazement that facilities for teaching and research in medicine are better in the other major New Zealand hospitals—in Auckland, Wellington and Christchurch—than those provided by the Otago Hospital board in Dunedin. He doubts if the reputation of the Otago Medical School can survive unless there is some effective representation of the school on . the hospital board.

‘Not The Same’ He makes it clear that he does not agree with the Health Department that representation of this sort must be the same in Dunedin as for the new medical school in Auckland. In Auckland the teaching hospitals are a small fraction of the board's responsibilities. In Dunedin they are the Otago Board’s principal commitment “- . . I have always believed that different situations required different treatment” he says. The Otago Medical School is unique in that its teaching hospitals are administered by an elected board which has no university representation, says the report. Direct representation was first requested in 1888. "Today Otago is faced with an unbelievable situation. Its hospital board is anxious to help the Medical School and yet lack of communication between hospital and school remains an obstacle to wellinformed and therefore efficient decisions.”

Low Salaries The report says that recruitment at the Medical School is affected by salaries "far below the rest of the English-speaking world” and the vicious circle of understaffing which means too little time for research. A third factor is the uncertainty and unrest which comes from serving two masters (the university and the Hospital Board under the joint appointment scheme). With their different regulations, questions of study leave and other perquisites become very complicated.