Do Doctors Ned Training?

Dr. Shad Salim AkhtarMBBS, MD, MRCP, FRCP (UK), FACP(USA), Member UICC Fellows

Consultant Medical OncologistMedical Director

Quality of care

• >500 pages published daily in English language

• Guidelines developed for most of the common conditions

• Protocols created for the management of many acute and chronic conditions

• How and Why should a doctor know all this?

Why do we need to train doctors?

• Quality of care implementation–Standard care–Guidelines–Audit–Outcome measures etc..

• Need a change of behavior

Factors affecting doctors’ behavior

• Educational• Personal• Patient based• Economic• EnvironmentCantellon P et al: BMJ 1999;318;1276-1279

How can we change the educational aspect?

• External audit• Punitive actions• Or may be better is

•CME/CPD

CME - Definition

•Education after certification and licensure

Davis D et al. BMJ 2003; 327:33

CME or CPD• Lifelong learning process• Develop skills needed which include

– Education– Management– Training– IT– Audit– Communication– Team building– Learner centered and self directed

Editorial BMJ 2000; 320:393

Saudi council for health specialization recertification needs collection of CME hours

Reasons for Information Seeking

• Varies from stage to stage• Complex changes in practice• Specific patient problem• Higher qualifications• Higher remuneration• Peer challenge

Journal of Med Internet Res 2003; 5:e20

Why Do Physicians Learn?

• Revalidation• Recertification• Ego• Juniors ask questions• Patients’ demands (internet)• Pharmaceutical agencies

Shannon S. The Lancet 2003; 361:266

Why CME BMJ August 2001

1160 7285

1328 9899

1264 11297

1354 8858

0 5000 10000 15000

1420

1421

1422

1423

Major Minor

1241423

1141422

1171421

1211420

Code Yellow/Year

KFSH Trauma Care-Load

Trauma care how could we improve it?

• A specific training course for all those involved in– KFSH initially and then– Al-Qassim region as a whole

ATLS• Justifies the need for Advanced Trauma Life Support Courses and certification of concerned physicians at KFSH

Research states that physicians have 3 to 5 clinicalquestions per day that remain unanswered.The answers are out there,…..

Changing Practice

• Physicians becoming aware of a gap in knowledge or skill

• Learning changes the practice not teaching

Shannon S The Lancet 2003; 361:618

Variation in Support

New Equipments Added• Radiological department

– Dexa– Angio suite– Sophisticated ultrasound

• Blood bank– Aphareis

• OR– Laparoscopic towers

• Laboratory– PCR– Immunocytochemistry

Physicians or allied staff trained

• Apharesis– Cob spectra

• Immunocytochemistry• Angiography

– Machine idle for 1 yr now– One of our radiologists on his way

We are independent now

KFSH Workload-Number of Pts Seen

020000400006000080000

100000120000140000160000180000

1412 1415 1418 1421 1422 1423 1424

EROPD

SS Akhtar Data from Statistics Dept

KFSH Workload - Referrals In

0

100

200

300

400

500

1 2 3 4 5 6 7 8 9 10 11 12

14231422

Month

No of pts

Data from Therapeutics DeptSS Akhtar

KFSH Workload - Referrals Out -1422

106

89

594638

29

2321

1612 11 9 8 8 8 16

Neuro Surg Cardiology Oncology Ortho Gen Surg OphthalENT Dental Vas Surg Nephro Gastro PneumoNeuro Urol Endo Misc

SS Akhtar Data from Therapeutics DeptTotal No=499

Intervention• Training of doctors

– Consultants– Residents

• Training of nurses• Training of technicians• Other ancillary staff• Subsequently when funds became

available new staff recruited

~350 km

Referrals Out - 1422 - Indications

331

94

1262

Lack of Facility Request 2nd Op Unkn

Neurosurgery 66

Radiotherapy 51

Angiography 49

Arthroscopy 29

EPS 18

Spinal Unit 16

YAG Laser 15

Isotope Scan 12

Irregular supply

PSCC

Staff Recruitment

• Direct from the outsource contractor– Within the stipulated terms of contract

• MOH– Selection team

• No on site accreditation system to judge the need– This is changing now

• From different countries with different qualifications

• Variation in– Level of training and qualifications– Previous type of exposure

• Lack of knowledge of policy and procedures

• Many lack in the technological know how• Some lack the skills required

Staff characteristics

KFSH Doctors Status- MOH

SS Akhtar MD Office

4346

35

26

403841

45

3024

2828

05

101520253035404550

Consultants Residents

1418142014221423

TrainingRemunerationIncentivesJob security Quality!!!

Staff Turn Over-1998-2003

0 100 200 300 400 500

1998

1999

2000

2001

2002

2003a

2003

Total New MOH New SHS EOC

SS Akhtar Nursing Office

Years of Experience at KFSH-Nursing Staff

SS Akhtar Data from Nursing Office

142

112

5928

No of Nurses

>=10 yrs6-9 yrs1-5 yrs<=1 yr

<=1 year

IncentivesStagnationIn job trainingSalaries

Resources-Staff Contractor MOH

• Consultants 58 38• Specialists 13 57• Residents 40 69

Our Production• More than twenty consultants working in our

hospital or the region• More than 70% specialists locally trained

graduates• About 30 residents enrolled in national and

international postgraduate programs• More than twenty original articles published

from our institution

Postgraduate Programs• Internship• Accredited for postgraduate training

– Saudi board– Arab board– Royal college of physicians – Royal college of surgeons– College of physicians and surgeons of Pakistan

• Publications by the faculty

Academic Activities-Hospital Based• Intensive courses

– ACLS– ATLS– FCCS– Review course with RCP Edinburgh

• Training courses/workshops– Suturing technique– Conscious sedation– Bronchial asthma management– Critical care workshop

Educational Activities 142511 27

41

744

108

11

Club meetings Courses Grand roundsLectures out Symposia TelemedicineWorkshops

Academic atmosphere-Impact

Paramedical staff Nursing staff

Consultant

Resident Specialist

External teams

Quality of care improvement

What does all this need• Financial resources

– Remuneration for teaching activities– Remuneration for acquiring a skill

• Library– Books– Journals

• Other teaching aids– Mannequins– Skill labs

• Internet