The cost of teaching an intern in New South Wales.

OBJECTIVE: To determine the cost of formal and informal teaching specifically provided for interns and to determine how much of an intern's time is spent in these activities. DESIGN, SETTING AND PARTICIPANTS: Costs of formal teaching for 2012 were obtained from the New South Wales Health Education and Training Institute (HETI) and costs of informal teaching by a survey of all interns in a random sample of prevocational networks. MAIN OUTCOME MEASURES: The cost of formal intern education provided by HETI; the number of hours of formal teaching provided to interns in hospital; intern estimates of the amount of non-timetabled teaching received in a typical week. RESULTS: The cost of formal teaching was $11 892 per intern per year and the cost of informal teaching was $2965 per intern per year (survey response rate, 63%) - a total of $14 857. Interns spent 2 hours per week in formal teaching and 28 minutes per week in informal teaching, representing 6.2% of a 40-hour week. CONCLUSION: The time of professionals paid by NSW Health represents most of the expenditure on teaching interns. An increase in time spent on intern teaching beyond the current 6.2% of an intern's 40-hour week would be an investment in better health care.

The hidden cost of medical student education: an exploratory study.

OBJECTIVE: To examine the hidden cost of medical education at the Sydney Medical School, for which the University of Sydney does not pay. METHODS: All face-to-face teaching provided for students in the Sydney University Postgraduate Medical Program was listed under two headings: teaching by university employed staff; and teaching by other health providers not paid by the university. All teaching hours in 2010 were extracted from detailed timetables and categorised under these headings. Time spent in lecture preparation and exam marking was included. Students were sampled to obtain information about additional teaching that was not timetabled. RESULTS: Teaching by university paid staff accounted for 59 and 61% of face-to-face teaching costs in years 1 and 2 of the 4-year Graduate Program, but only 8% in the final 2 years. The cost of medical education provided by the university, including infrastructure costs was $56250 per student per year in 2010. An additional $34326 worth of teaching per student per year was provided by teachers not paid by the university. CONCLUSION: The true cost of medical education is the cost of education met by the university plus the value of teaching currently provided by government funded health providers and honorary teachers. In 2010, 38% of the medical education cost at Sydney University was provided at no cost to the University. As government health departments seek to trim rising health expenditure, there is no guarantee that they will continue to contribute to medical education without passing this cost on to universities. WHAT IS KNOWN ABOUT THIS TOPIC? Some medical student teaching is provided by teachers who may be employed by a government health provider or who are honorary teachers. There is no cost to the university for this teaching. WHAT DOES THIS PAPER ADD? An estimate of the total value of teaching provided to students at Sydney Medical School, for which the university does not pay, is approximately $34000 per student per year, compared with the total cost of approximately $56000 per student per year incurred by the university. WHAT ARE THE IMPLICATIONS? Medical education is a partnership between the university, the government health sector and honorary teachers. Without contributions by non-university paid staff, the cost of medical education would be unsustainable.

Reforming New South Wales public hospitals: an assessment of the Garling inquiry.

The final report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals was published on 27 November 2008. The report acknowledges the challenges facing the New South Wales health system, including increasing numbers of patients, rising treatment costs, workforce pressures, and the breakdown of working relations between clinicians and management. Many of Commissioner Garling's 139 recommendations formalise aspects of clinical care that should and could be happening now if the system were better managed, including better supervision and training of junior staff. Commissioner Garling recommends that change should be driven by clinicians "from the bottom up", but does not adequately describe how this should happen. Implementation of the report's recommendations that will require strong leadership and continuing consultation with clinicians and the community.

Changes to the University of Sydney medical curriculum.

In 1997, the University of Sydney replaced its undergraduate medical course with a new 4-year graduate medical program. The course was reaccredited by the Australian Medical Council (AMC) in 2005. Suggestions for further development by the AMC led to a comprehensive review of the course, commencing in July 2006. This article describes the review process and outlines key recommendations that came out of the review that have been or are being implemented.

The challenge of locum working arrangements in New South Wales public hospitals.

Use of locum medical officers is increasing in the NSW hospital system. Locums are expensive, and have highly variable expertise and experience. Locum employment arrangements are ambiguous. Locum work may divert junior doctors from participation in specialist training. Attempts to regulate the locum workforce must be accompanied by measures that increase the appeal of public hospital work and vocational training positions.