Medical education at the University of Sydney the last 40 years

Medical education in Sydney was initiated in 1883. Designed for undergraduates and based on the highly regarded Scottish system of medical education, it was scientifically rigorous, progressing from basic science to clinical work. Those fundamental principles of the curriculum did not change substantially in 90 years. Changes introduced in the 1970s (reducing six years to five) and 1980s (returning to six years) were designed to enhance and integrate the scientific and clinical content, but the basic structure remained similar. New subject areas were progressively included, but teaching methods were basically didactic, with few exceptions. Clinical contact was delayed. Departmental budgets were based on contact hours, leading to competition for curriculum time. The consequence was an overloaded curriculum, punctuated by largely written examinations; students had only a limited sense of a progression in knowledge, understanding and skills. One medal-winning student characterised the program as "doing the Higher School Certificate six times". Radical change was instituted during the 1990s, with the development of a four-year, graduate-entry program that is integrated and problem-based. The role of the Australasian and New Zealand Association for Medical Education is discussed.