The Demand for Continuing Medical Education

The establishment of the Goodfellow Unit met an important demand for continuing medical education for GPs. From the early-1970s, leaders in general practice had started to agitate for further training opportunities for medical graduates. They visited international medical schools for inspiration for what they could achieve in New Zealand.

In 1971, Dr (Sydney) Rae West, who became the second Associate Professor of General Practice at the University of Auckland in 1977, received a Nuffield Fellowship to spend three months surveying international approaches to continuing medical education in Canada, the United States, the UK, and Europe. Dr West’s emphasis on enhancing training opportunities for qualified GPs reflected both his academic interest in medical education and his experiences of trying to access further training while working as the sole GP in his country town.

Dr Rae West (1925-2015) became the second Associate Professor of General Practice in 1977. 

Dr West reported that after twenty-five years of working in general practice, ‘my medical knowledge in many fields was becoming obsolete’. He acknowledged that he was certainly ‘not alone in this situation’. High patient loads had left West, like many of his colleagues across New Zealand, with little time to pursue further training. Many doctors’ geographical isolation made it even more difficult to ‘obtain the education necessary to keep up to date in a world of rapidly increasing medical knowledge’.1

Upon his return to New Zealand, Dr West urged the medical schools in Auckland and Dunedin to provide continuing medical education for GPs in the form of lectures, seminars and discussions groups. He also recommended they establish an Organisation for Continuing Medical Education to both assess doctors’ educational needs and to facilitate further education, and proposed the New Zealand Government provide the facilities needed to encourage continuing medical education.2

The Royal New Zealand College of General Practitioners, members of Council, 1992-3.

Back Row: L. Quennell, P. Moodie, C. Botting, S. Rawstron, L. Revell, N. Terpsta, G. Coster, I. Griffiths, O. Wiles, T. Fletcher, D J Crook. Front Row: F Millard, W. Wilson, J. Simon, T. Turnbull, R. West (president), P. Robinson, J. Tracey, N. Soysa, A. Townsend.

Dr Campbell Maclaurin, a surgeon and the Associate Dean of Graduate Studies in Medicine at the University of Auckland, made similar efforts to introduce continuing medical education for GPs in New Zealand. In the early-1970s, he had received funding from the Butland Foundation to explore international developments in continuing medical education for practicing doctors. He was particularly inspired by a meeting he attended in Halifax, Canada, whereby GPs invited specialists to teach courses based on the topics the GPs had selected, rather than vice versa. He felt the model could be applied in New Zealand.

In December 1975, Campbell Maclaurin appealed to the University of Auckland to appoint a Director of Postgraduate Medical Education. He reasoned that ‘the almost explosive growth in medical knowledge and specialisation that has occurred throughout the world since World War II’ had led to an ‘increasing realisation of the need for adequate postgraduate education in general practice.’3

While the Royal New Zealand College of General Practitioners, with assistance from the Health Department, had established training programmes in Auckland, Wellington, and at the University of Otago, Campbell Maclaurin argued that the College was not an administering body and could not organise and manage the education programmes. Rather, it was responsible for determining professional requirements for GPs, developing training guidelines, and examining candidates for membership of the College. Alternatively, his proposed senior academic appointment attached to the University of Auckland would ‘provide the postgraduate leadership and direction that is now needed’.4

Nevertheless, in response to Campbell Maclaurin’s query about whether the University would finance the position, ‘the short answer was “no”’.5 The University of Auckland focused on undergraduate teaching. It was reportedly advised to offer limited support to postgraduate studies and only in psychiatry, venereology, and geriatrics. Funds were not to be used for continuing medical education for GPs.6 His idea lay dormant until his timely discussion with Douglas Goodfellow in July 1977 that led to the establishment of the Goodfellow Unit.

In the meantime, concerns about the lack of continuing education for GPs gained momentum across the late-1970s.  In 1976, the Medical Council of New Zealand deemed the resources dedicated to medical education for general practice as ‘woefully inadequate’.7

The following year in June 1977, the New Zealand Family Physician reprinted an extract from an Australian doctor’s report on the lack of continuing medical education that had featured in the Medical Journal of Australia. The author, Dr Wilson, argued that the ‘rate at which knowledge is being made available renders previous levels of educational achievement rapidly obsolete’, and that any further learning that occurred was unintentional and without conscious direction. Wilson concluded that keeping up-to-date on such developments ‘cannot be left to chance’. Rather, ‘continuous learning is a responsibility that must be shared by both individuals and by society’.8

The New Zealand Council for Postgraduate Medical Education shared Dr Wilson’s vision. That same month in June 1977, the Council recommended the Royal New Zealand College of General Practitioners ‘play a leading role in the development of a climate of greater quality of practice’ and adopt ongoing education as a requirement for continued membership.9

They also recommended the College provide further training opportunities for GPs and proposed the Government offer financial incentives for attendance.

Nevertheless, for the most part, regional postgraduate medical societies took primary responsibility for arranging weekend and afternoon courses for GPs. Hospitals in Hamilton, Napier, Palmerston North, Wellington, Christchurch, and Invercargill also arranged seminars for GPs in their respective areas, and some doctors organised independent sessions with their colleagues or read updates published in medical journals.

As Campbell Maclaurin explained: ‘the amount of assistance for continuing education was only informal, only provided within the profession, and not a single dollar was committed to it’.10

  1. 1. Sydney Rae West, Continuing Medical Education, Report on a Nuffield Fellowship in General Practice (Waiuku, 1971), 1.
  2. 2. Ibid., 24-6.
  3. 3. Letter from Campbell Maclaurin to the Postgraduate Medical Committee in the University of Auckland, 23 December 1975.
  4. 4. Ibid.
  5. 5. Interview with Campbell Maclaurin, 11 September 2018.
  6. 6. Letter from Campbell Maclaurin to the Postgraduate Medical Committee.
  7. 7. Medical Council of New Zealand, Medical Manpower in New Zealand, Report on a Planning Workshop held at Wairakei 19-23 April 1976, 42.
  8. 8. Dr Wilson, ‘Continuing Education’, Medical Journal of Australia, 1977, reprinted in the New Zealand Family Physician, June 1977.
  9. 9. The New Zealand Council for Post-Graduate Medical Education, ‘Continuing Medical Education for General Practitioners’, Working Party Paper, June 1977.
  10. 10. Interview with Campbell Maclaurin.