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