Transcript Document

FUTURE MEDICAL TRAINING:
MAKING THE VISION HAPPEN
CDAMS/AMC
9 March 2005
Robert Wells
OVERVIEW
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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?
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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?
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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
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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