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This presentation explores the stakeholders in medical education, the challenges in selling the vision, and the need for engagement from universities, governments, regulators, the public, potential students, and supervisors. It discusses the broad context of globalisation, economics, and workforce shortages, and the changing healthcare scene. The challenges for medical education in Australia are also addressed, along with a new approach that includes rethinking the skills needed for different stages of a doctor's career and the possibility of streaming and common core elements. The importance of making someone accountable for health worker education and training is emphasized, as well as the need to understand the concerns of decision-makers and how your plan can help them.
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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
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 POLICY: CONTEXT
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?
