NAMEM Conference Sept 2010

Cardiff, Wales

• Welcome to Wales!

The changing face of medical education

Professor Peter Donnelly, Deputy Postgraduate Dean, Wales

Disclaimer

• The views expressed here are my personal views

• My experience..

• Consultant – 16 years

• RC examiner

• Assistant Director Clinical Teaching Swansea, SoM

• Hon Senior Lecturer, Cardiff, SoM

• Associate Dean…

• The changing face………

Where are we?

• In UK• 33 Medical Schools• 21 PG Deaneries• Numerous Foundation Schools….UKFPO• PG Curricula…• Immigration Rules• EWTD• GMC single UK regulator • MMC…fast track?

PG major changes ..

• Time served…to competency based

• Mapped to speciality curricula

• Progression via WPBAs

• Annual review

• Formal Exams

• Competitive points

• ‘Central’ application process

White paper

• Putting patients first

• Improving healthcare outcomes

• Autonomy, accountability and democratic legitimacy

• Cutting bureaucracy and improving efficiency

• Conclusion: making it happen

Tooke Report

• NHS and Universities forge functional links..

• Links between health and education providers should be appraisal targets for SHA CEOs

• Harmonisation of final year with F1

• NHS MDs…explicit responsibility for the delivery of medical education and training

Temple Report

• Implement a consultant delivered service

• Service delivery must explicitly support training

• Make every moment count

• Recognise, develop and reward trainers

• Training excellence requires regular planning and monitoring

• We are in Wales…………..

Wales

Population: 3 millionAcute hospital

admissions

WalesWrexham

Rhyl

Bangor

Carmarthen

Swansea Singleton Bridgend Royal

Glamorgan

Cardiff UHW

Newport

Abergavenny

Merthyr

Llanelli

Aberystwyth

Haverfordwest

Neath / Port Talbot Cardiff

Llandough

Swansea Morriston

Caerphilly

Where are we in Wales?

• Two Medical Schools• Cardiff, est 1893• National Student Survey• Swansea…est 2009 GEP• Two Clinical Schools• Uniglam• One PG Deanery, Wales• 59 speciality curricula written by R Colleges and

ratified by PMETB (GMC)

More importantly…

• NHS Wales

• Major reconfiguration

• 7 Health Boards

• 3 NHS Trusts

• Service reconfiguration

Where do we want to be?

• Excellent learning producing excellent services to patients

How can we get there?

• Unified undergraduate and postgraduate medical education system

• All Wales approach

• Small enough yet big enough

• Have to move from an institutional to an ‘all Wales’ approach

• Inherent competition

• Winners and losers

• Pathway

• ‘I want to be a doctor’

• The future of medical education in Wales means radical rethinking…

Generation theoryGeneration theory

• Career laddersCareer ladders• Work hard, go upWork hard, go up• Work is workWork is work• Stay in one line of workStay in one line of work• Stay put, show loyaltyStay put, show loyalty• Plan for the futurePlan for the future• Employer sorts trainingEmployer sorts training• Expect benefits and Expect benefits and

rewardsrewards• Live to workLive to work

• Career bridgesCareer bridges• Work hard, move acrossWork hard, move across• Work as playWork as play• Change if its not workingChange if its not working• No guarantees, move onNo guarantees, move on• Live in the momentLive in the moment• You organise learningYou organise learning• Want flexible benefits, inner Want flexible benefits, inner

reward (meaning)reward (meaning)• Work to liveWork to live

• Flexible system….

• Needs of the NHS change and constantly changing….

• Greater divergence between NHS Wales and NHS….

Challenges ahead

• UG…emerging Swansea GEP and changes to Cardiff SoM curriculum

• F1s fit for purpose?• PG curricula• Temple report• NHS service reconfiguration• Reconfiguration of training• Returners to training• (financial constraints)

The future?

• Unified Undergraduate and PG pathway in Wales

• SIFT and MADEL monies managed jointly

• Flexible career pathway….

• Curricula driven ‘more’ by the NHS

•

• THE END

Aberaeron

• What is the essence of being a doctor?

• Doctors make decisions

• (Clinical context varies)

Science of decision making

• Tim de Dombal• Aids to decision making• Processes in decision making• Decision psychology in surgical setting

• (Surgical Decision Making. FT de Dombal. Hodder.)

• What is the product of Medical Schools?

• 60 %....GPs

• Less than 5%..….researchers

• How many UG curricula teach decision making?????

What the problem with Medical Schools?

What’s the problem with Medical Schools?

• Research focused

• Research driven

• Sit in Universities

• Academic

• Curricula driven by ….

• Selection process?

• Less NHS input than they should have

What’s the problem with PG curricula?

What’s the problem with PG curricula?

• Written by RCs

• Signed of by GMC

• Do all curricula met needs of NHS?

Principles of an ideal model of training

• Balance of lower to higher grades

• Breath of experience (appropriate on-call)

• Volume of cases

• Tiers of support

• Consultant trainers

• Health Board supporting the training agenda

Influences on career decisionsInfluences on career decisions• Time - earlier decisions are now requiredTime - earlier decisions are now required• Generation (Boomers, X and Y)Generation (Boomers, X and Y)• Choice left to individual – (UK norm)Choice left to individual – (UK norm)• Prior exposure to a speciality helps inform Prior exposure to a speciality helps inform

choicechoice• Peer influence (what others think)Peer influence (what others think)• Role modelsRole models• Media/new mediaMedia/new media• Positive and negative experiences (“horn Positive and negative experiences (“horn

and halo”)and halo”)• Life style and work life balanceLife style and work life balance

Doctors need to take an evidence-based Doctors need to take an evidence-based approach!approach!

• Lets consider ‘training in Wales’ as a product that we are trying to sell

• Market place that has changed…constantly changing

Total customer solution

• Consider what it is that the customer wants as a total package

• Not just what is in the advert

Perception of Quality of (PQ)

Learning xLifestylex Service Marketingx

=

Recruitment (Retention)Recruitment (Retention)