What is the MSOD Project
The Medical Schools Outcomes Database (MSOD) and Longitudinal Tracking Project is the Australian Government’s main data collection tool for medical student information. Through Medical Deans Australia and New Zealand, the 19 existing medical schools in Australia have agreed on a minimum data set to be collected about medical students commencing a medical program from 2006 onwards.

This project has initiated a national process to collect reliable demographic, educational and career intention data on medical students across all medical schools, and to store the data in a national database. Data is collected longitudinally on entry to medical school, during the medical course, on exit from the course and will be collected in the postgraduate years. The Project is a collaboration of a number of key stakeholder organisations representing students, postgraduate education and training, rural and indigenous health, and workforce planning.

Schematic Representation of MSOD Longitudinal Study and Linkages

Longitudinal Tracking
A recent feasibility study has investigated different methodological approaches to longitudinal studies, to ensure that the data collected as part of the MSOD can be of most value to workforce planning. A recommendation for the most efficient, cost-effective and non-intrusive approach has been submitted to DoHA (‘The MSOD Project Feasibility Study Report July 2008’).

There is continuing discussion with Stakeholders on the implementation but this approach will combine repeat questionnaire surveys in early postgraduate years supplemented by data linkage with a national registration database. Questionnaire surveys will be sent to participants at one, three and five years after completing their basic medical studies to enable the tracking of graduates through prevocational and vocational training. This is a key time at which career choice is often finalised.

After five years it is assumed that most will have selected a specialty for future practice.

Significance of MSOD
The MSOD & Longitudinal Tracking Project is one of the most ambitious and important projects in this field, and is of national and international significance. The Project is the world’s first study to longitudinally track medical students throughout their medical education, training and practice continuum across all medical schools at a national level.  Its importance as the foundation for evaluating outcomes of medical education programs with specified workforce objectives (including rural and areas of workforce need), assisting in medical workforce planning, and providing a national research resource, cannot be underestimated. The MSOD has developed an agreed stringent and robust dataset adopted by all medical schools and underpinned by nationally consistent definitions. The database is a rich source of recent data and currently contains records of approximately 11000 medical students.

The MSOD data is useful for medical schools, the Commonwealth and stakeholders as an educational tool and even more valuable if linked beyond medical school to the future workforce, incorporating national registration as a tracking tool. Such a landmark project is not without significant challenges and is faced with the issues of ongoing resourcing, privacy and access of data and the logistics of data linkage.   Despite its challenges, there is no doubt that such a landmark initiative will yield invaluable dividends for all key stakeholders - governments, universities, professional organisations and communities.

Application to Health Workforce Planning
The quantitative, research-driven approach of the MSOD Project has direct application to the needs of medical workforce planning.  The release in 2004 of the National Health Workforce Strategy Framework focussed attention across the health and health education sectors on the need for a nationally consistent and collaborative approach to workforce planning underpinned by the best available evidence.  In a recent press release by the Minister for Health Nicola Roxon (30th April 2008), an audit of Australia’s rural and regional health workforce has revealed the previous Government relied on 17-year-old population figures - from 1991 Census figures - in developing incentives for doctors and other rural workforce policies. The Rudd Government aims to reform this system to base incentives on current population figures and real need. Hence, there is an immediate need for current and robust data for medical workforce planning in order to reduce politicking and guesswork. The MSOD data is able to contribute.

More recently, the MSOD Project is directly relevant to the work of the National Health Workforce Taskforce (NHWT) established in late 2007. In particular, the key objectives of the Research, Planning and Data portfolio have clearly been influenced by the need to improve national health workforce information through data collections and establishing consistent and common minimum data sets. The MSOD has developed a nationally agreed process and minimum data set which links in with the objectives of the NHWT and is able to contribute to the improvement of national health workforce and training information.

Medical Education
The MSOD Project provides invaluable information to medical schools about the educational experiences of their students benchmarked against all other schools in Australia and about the impact on career intentions.

It also provides the basis for enabling the tracking and quantitative evolution of the effectiveness of Commonwealth funded medical education initiatives in achieving improved medical workforce recruitment and retention.

Clinical Placements
The evidence for the impact of clinical placements on career intention is another area of priority and interest to Government. Medical education studies acknowledge that the evidence for the impact of duration and location of clinical placements on career outcomes is sporadic and inconsistent. In addition, attempts to collect clinical placement information at universities have been relatively unsuccessful previously. The MSOD Project conducted through Medical Deans involves a close working relationship with medical schools to enable collection of this information cost effectively and accurately. The NHWT Clinical Education and Training project has expressed an interest in using the MSOD clinical placements data to inform their recommendations on effective, sustainable approaches to the delivery and organisation of clinical training.

Rural Workforce
The creation of Commonwealth-funded programs aimed at increasing the rural medical workforce has generally occurred without reference to the evaluation of long-term outcomes. Assessments of these programs are usually structured as cross-sectional studies, such as the RUSC review and the reviews of the Rural Clinical Schools and UDRH programs. While these reviews provide useful retrospective overviews or ‘snapshots’ of various programs’ development and operation, they are not necessarily as effective in assessing long-term outcomes.

This issue becomes more pertinent in the context of the government’s announcement in April 2008 of an extra $6.3 million funding for a number of existing rural clinical schools and university departments of rural health to expand their capacity to provide rural education and training support. The government’s strong commitment to improving health outcomes for rural and indigenous communities also includes initiatives to double the number of John Flynn scholarships for undergraduate medical students and to increase the Indigenous health workforce.

Education initiatives specially designed to encourage more medical graduates to take up practice in rural and remote communities must have an evaluation phase as an integral and expected part of their operations. In this, medical schools and the Commonwealth government have joint responsibility for evaluating the outcomes of educational initiatives aimed at influencing the career decision-making of medical students. The MSOD data is able to provide reliable evidence for the long term outcomes of medical education programs with particular reference to medical workforce outcomes.

The Government has established an Office of Rural Health within the Primary and Ambulatory Care Division of the Department of Health and Ageing, to drive reform in the rural health sector through a number of reviews, which will help to ensure that programs and incentives can respond more effectively to the needs of rural health professionals and rural and remote communities. The Minister for Health Nicola Roxon has stated that changes in rural health will have to be tackled in a measured way to be sustainable. These reviews can benefit from the long-term outcomes data that the MSOD Project collects through the undergraduate, prevocational and vocational stages of medical training.

Collaborative
The MSOD Project has brought together key stakeholder organisations from across the medical education/training/practice continuum, including student and postgraduate education and training, rural and indigenous health, and workforce planning organisations, thus representing collaboration between education and health. It is highly commendable that medical schools, traditionally rivals, can demonstrate their collaboration in establishing a Project which can benefit all schools and the community. Medical Deans Australia and New Zealand are in a unique position to ensure that this collaboration continues, and remain the most feasible option to auspice the Project. The MSOD Project has been an important investment and has real potential value, but this can only be fully realised with long term vision and continued resources to progress the task.

What MSOD Will Provide
By the end of 2009, the MSOD Project will have achieved the following:

• Implemented a landmark medical education and workforce project of national and international significance;
  
  
• Established a national process that fully engages all key interest and stakeholder groups, consolidated and overseen by Medical Deans Australia & New Zealand, an organisation with an independent  agenda;
  
  
• Developed a nationally accepted approach across all Australian medical schools for the collection of student data;
  
  
• Attained an ethically approved process for data collection, linkage and research;
  
  
• Developed an agreed minimum data set to be adopted by all medical schools, underpinned by nationally consistent definitions for key terms and concepts.
  
  
• Maintained a stringent, robust and rich data set which will include data from the:
  
  
• 2005, 2006, 2007, 2008 and 2009 Commencing Medical Students Questionnaires
• 2005 cohort (Years 1-4), 2006 cohort (Years 1-3), 2007 cohort (Year 1-2) and 2008 cohort (Year 1) Medical Schools Data and
• 2008 and 2009 Exit Questionnaires
  
  
• Developed a comprehensive and rigorous national database that can be used for evaluating Government initiatives, provide an information resource for researchers, track medical students longitudinally and has the potential for linkage for the purpose of ongoing workforce planning.
  
  
• Completed a feasibility study investigating different methodological approaches to longitudinal studies, to ensure that the data collected as part of the MSOD can be of most value to workforce planning.
  
  
• Formulated a data collection model that has the ability to be transferred to other contexts, particularly where these have the potential to impact on the Australian medical workforce, such as medical schools in New Zealand, PNG and Fiji and for tracking students in other allied health professions in Australia.

The proposed methodology for longitudinal tracking will provide a substantial amount of information by the end of 2013 (on the basis of a hypothetical five year project).  Expected available data will include:

• Exit Questionnaire data for all 4, 5 and 6 year medical programs for the 2005, 2006, 2007 and 2008 commencing cohorts; 4 and 5 years programs for the 2009 commencing cohort; and 4 year programs for the 2010 commencing cohort;
  
  
• Year 1 Postgraduate Survey data for all 4, 5 and 6 year programs for the 2005, 2006 and 2007 commencing cohorts; 4 and 5 years programs for the 2008 commencing cohort; and 4 year programs for the 2009 commencing cohort;
  
  
• Year 3 Postgraduate Survey data for all 4, 5 and 6 year programs for the 2005 commencing cohorts; 4 and 5 years programs for the 2006 commencing cohort; and 4 year programs for the 2007 commencing cohort;
  
  
• Year 5 Postgraduate Survey data for all 4 year programs for the 2005 commencing cohort;
  
  
• Data from linkage with the National Registration Database for all 4 year programs for the 2005 commencing cohort.
  
  
• Unique data from linkage with other training and workforce database.
  

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