FUTURE MEDICAL TRAINING MAKING THE VISION HAPPEN CDAMSAMC

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: Ø Free trade agreements Ø Goods & services § International conventions: Ø Human rights § Workforce Ø Mobility Ø Shortages

ECONOMICS § Microeconomic reform: National Competition Policy § Balanced budgets & economic rationalists § Costs: Ø increasing % GDP on health Ø ‘out of control’ items- PBS § Intergenerational issues Ø 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

AUSTRALIA- EDUCATION § Higher education reforms: Ø Local market in medical school places Ø Greater accountability & control of universties Ø Redefinition of a university § Medical education changes Ø Graduate/ mature entry Ø Clinical focus Ø 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- postgraduatevocational-CPD § Takes minumum 10 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