FUTURE MEDICAL TRAINING: MAKING THE VISION HAPPEN

CDAMS/AMC

9 March 2005

Robert Wells

OVERVIEW

The stakeholders The contexts in which they operate Becoming involved in policy processes Medical education

THE CHALLENGE: SELLING THE VISION

You know what you think needs to be done for the future of medical education

Who else needs to be engaged if change is to happen?

Will they be interested?

WHO ELSE NEEDS TO BE ENGAGED?

Universities & education & training bodies Governments & health providers Regulators The public as consumers Potential students Supervisors (ie those who will actually oversee the

training)

STAKEHOLDERS

For most stakeholders medical education is not primary concern

Each stakeholder has a range of pressures in the context in which they operate

Need to be able to demonstrate to each how your needs/plans for medical education relate to stakeholders’ needs

BROAD CONTEXT

All affected by globalisation, economic environment, social & demographic change

Some concentrate on developments in health: quality improvement; safety concerns; funding & resourcing

Some focused on higher education environment All subjected to workforce imperatives

GLOBALISATION

Trade: Free trade agreements Goods & services International conventions: Human rights Workforce Mobility Shortages

ECONOMICS

Microeconomic reform: National Competition Policy Balanced budgets & economic rationalists Costs: increasing % GDP on health ‘out of control’ items- PBS Intergenerational issues Increasing ‘dependency’

THE DISAPPEARING WORKFORCE

Workforce shortages across the economy & across all health professions

Shorter working hours by choice & decree Longer training time for specialties Increasing specialisation vs generalists Fewer school leavers in longer term Driver for policy & practice changes

THE CHANGING HEALTH CARE SCENE

More complex care & treatment needs More treatment modalities Teamwork Patients are better educated & have access to much

more information about their conditions Patients invest enormous amounts of their own

money in alternative & complementary therapies So what are the challenges for medical education?

AUSTRALIA- EDUCATION

Higher education reforms: Local market in medical school places Greater accountability & control of universties Redefinition of a university Medical education changes Graduate/ mature entry Clinical focus Rural Clinical Schools/ UDRHs

POLICY: CONTEXT

Evidence-based Rational process Balancing of interests Long term perspective Open & accountable Objectively evaluated

Reactive Ad hoc responding to specific

interests Short term horizon Secretive Spin

MEDICAL EDUCATION

Continuum: university- postgraduate- vocational-CPD Takes minumum10 to 15 + years to become an

‘independent’ practitioner Many players along the way: universities; PGMCs;

colleges

MEDICAL EDUCATION- SOME PROBLEMS

Model has not changed significantly in 100 years-but the rest of health care system has changed

Trainee doctors seem to spend a lot of time waiting for the next stage

Increasingly doctors will be working in multidisciplinary teams, but approach to training does not seem to reflect this

A NEW APPROACH TO MEDICAL EDUCATION (1)

Rethink our approach from the ground up: what skills will doctors need at various stages of their career?

Should we continue with the ‘one size fits’ all approach which seems to be time-based rather than accomplishment- based?

How much general knowledge do practitioners need if they are predominantly going to work in a highly specialised field?

NEW APPROACH (2)

Could there be some ‘streaming’ during medical school ?

Could the early postgraduate years be directed to meet requirements for ‘basic’ specialist training?

Could there be common core elements across specialties?

Could there be ‘exit’ points in specialist programs which confer some specialist recognition & allow further progression?

MAKE SOMEONE ACCOUNTABLE

Federal health minister could be responsible for all health worker education & training

Supported by a national education & training authority

Responsible for undergraduate, prevocational, vocational & continuing professional training

Work with and through existing authorities: build on what’s there

Have a training budget

SOME CHALLENGES

Identify the key decision-makers at each step of the way

Understand the context in which they operate, their constraints & their primary concerns

How can your plan help them?

THE WAY AHEAD