TRANSFORMATION IN MEDICAL EDUCATION

1. TRANSFORMATION IN MEDICAL EDUCATION LONDON DEANERY CONFERENCE Fiona Moss June 9th 2010

2. What is the aim of medical education?

3. Improve the quality and safety of care for • today’s and for tomorrow’s patients

4. “Medicine used to be simple, ineffective and • relatively safe. Now it is complex, effective and • potentially dangerous” • Cyril Chantler: Lancet 1999 • “The role and education of doctors in the delivery of health care”

5. “Every system is perfectly designed to • achieve precisely the results that it produces” • Paul Bataldan and Donald Berwick • Institute of Health Care Improvement, Boston c1997

6. London Deanery Educational Supervision Score from the National Survey for Trainee Doctors 80 78 76 74 72 Indicator Score 70 68 66 64 62 Educational Supervision Score 2007 (N = 6,153) Educational Supervision Score 2009 (N = 8,016) London: Educational Supervision

7. London: Educational Induction

8. London: Educational Feedback

9. INSERT HEADLINES ONONE OR TWO LINES

10. Transformation in Medical Education in London • Faculty development • Educational supervision • Simulation and Technology enhanced Learning Initiative • Academic GP programmes • Darzi Fellowships • Education Fellowships • Frontier • e Wisdom • Mednet

11. Transformation in medical education • Synapse • Leadership training: Nucleus • Career support • Mentoring • Revalidation pilot • Schools conferences • Celebrations of achievement

12. Changes to process of medical education • Modernising medical careers • Curriculums, assessments • PMETB, regulation and survey • Revision of curriculums • Leadership Framework • Academy of Royal Colleges Core Competencies Framework

13. Changes to structure of training: London • Speciality Schools aligned to Royal Colleges • Heads of Schools : clinicians leading change and transformation • Boards to provide educational governance: lay chairs • Targeted investment in education • London SHA support for development of Medical Education

14. London’s resources: • 350+ GP teaching practices • 110+ Dental teaching practices • 10 “old style” teaching hospitals • 5 medical schools • 44 acute and mental health trusts • 3 AHSCs • Most important: many, many people

15. With resources: responsibility • London very important for PGME in the UK • 12,000 trainees • 25%: greater proportion of higher speciality trainees • Some truly excellent areas of PGME • Some departments do not meet acceptable standards • Aim is to push up the quality of training • Not just about pulling “curve to the right” • Want to remove the “tail”

16. Changes to context of education and training: • Rise and rise of co-morbidities • Increasing life expectancy • Public health challenges • Reduction in duration of hospital stay • New medical technologies • Improvements in delivery of care • Service provision moving from secondary to primary care • Changing public and patient expectations • Information technologies • Recognition of the importance and impact of clinical leadership

17. Training must be in step with service • Huge changes in service: not just planned but happening • Development of networks and integrated pathways of care • Place of training needs to be appropriate and modern • Today’s trainees must be fully equipped to lead tomorrow’s changes • Specialists: need more understanding of the skills of the generalist • Generalists: need more understanding of the skills of the specialist

18. Preparing trainees: for a different future • Modern burden of clinical responsibilities: old approach to training • Increasing complexity and uncertainty • Old fashioned division between generalists and specialists • Kaiser good outcomes: primary and secondary care working together • Better outcomes with different approaches to getting specialist input • Intelligent conversations between generalist and specialist • Showcasing the best of our NHS care for all our trainees.

19. We are very good at training clinicians to look after • individual patients but we do not train them well • enough to understand, work in, look after and be • able to change the system of care

20. The future we are working towards: • Training more GPs and fewer specialists • Change in consultant: trainee ratio • More care delivered in community settings • Doctors with the skills to lead and manage change • Doctors working and training well in integrated health settings • Better “read across” between specialties & between settings

21. The future we are working towards • Training is a privilege and not a right • Not all Trusts train in all specialties • Training more GPs and fewer specialists • Training in health networks: “two years in one place” for all trainees • Competition ratios for GP are higher than for surgery • GPs and specialist trainees: co-learning: “intelligent conversations” • Education pressing for the best in service delivery across care • London leading PGME across primary and secondary care

22. “Every system is perfectly designed to • achieve precisely the results that it produces” • Paul Bataldan and Donald Berwick • Institute of Health Care Improvement, Boston c1997

23. INSERT HEADLINES ONONE OR TWO LINES • Obor sit luptate tuerostis ad dolenit vel ulla alis niat, quiscing elis eugait dionullut nullumsan veriliquisim diat atie tincidunt alisciduis nonulputpat. • Guer atue et, qui ex ex et dunt eum iurem zzrillamet lorperatet vel irit iriure • Er sit wiscing ex ese venim ilisl ea at aliquismod dit augait augait prat autatum voluptat ex et, vulla am alis augait aliquisisit lutet nonulluptat • Lestionse magna augait nosto ea consecte tie mod dion euisit er ipis ex exer ilisci eu facidui psuscillaore consed volorpe riametum quip ex ea con hent ut laorper aessi. • It ver aciduis modolore magna faci exeraestio elit nos nit, sit adipit praestrud min eu facipit alit lore dignis ad euguero consent nullam. • Exer alissectem zzriuscil dignisim vel ut nim delesenim veril ulla commod magnim quipit accum iure tie delenibh eu faci blaorero core.

24. Commissioning medical education • Enhance our commissioning function • Clarity of what is required • Link commissions to markers of good quality education and service • Commission only where training & service meet explicit standards • Encourage and support innovation in training • Will include undergraduate and CPD • Revalidation - including junior doctors

25. Commissioning: opportunities • Training in all aspects of the curriculum: clinical and organisational • Opportunity to include quality improvement work in training • Training that reaches across primary:secondary care interface • Time for trainers with trainees • Intelligent conversations between GP and specialist trainees • Intelligent conversations between trainers in different settings • Spread the good practices across London • Innovative; evaluate; aim for excellence; become the model

26. Commissioning medical education: so far • Steady approach • Clinically led: expert commissioning • Develop the skills needed for commissioning • 15% of secondary care training • Core medicine; core surgery; core psychiatry • Dental foundation 2 • Single GP pilot of 12 trainees

27. INSERT HEADLINES ONONE OR TWO LINES • Obor sit luptate tuerostis ad dolenit vel ulla alis niat, quiscing elis eugait dionullut nullumsan veriliquisim diat atie tincidunt alisciduis nonulputpat. • Guer atue et, qui ex ex et dunt eum iurem zzrillamet lorperatet vel irit iriure • Er sit wiscing ex ese venim ilisl ea at aliquismod dit augait augait prat autatum voluptat ex et, vulla am alis augait aliquisisit lutet nonulluptat • Lestionse magna augait nosto ea consecte tie mod dion euisit er ipis ex exer ilisci eu facidui psuscillaore consed volorpe riametum quip ex ea con hent ut laorper aessi. • It ver aciduis modolore magna faci exeraestio elit nos nit, sit adipit praestrud min eu facipit alit lore dignis ad euguero consent nullam. • Exer alissectem zzriuscil dignisim vel ut nim delesenim veril ulla commod magnim quipit accum iure tie delenibh eu faci blaorero core.

30. Ministerial priorities • Public health • Autonomy and accountability • Patient led care • Long term conditions • Outcomes

32. Change: Transition Transition Burden Now Transformed Time

33. How future proof is our training? What changes do we need to be making now?

34. The best in training and education must extend across the NHS care community

35. The quality and safety of today’s and tomorrow’s patients is our business

36. Training and education is everyone’s business