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Phase 2 Review Implementation Across Health Care Settings and Higher Education Institutions

Phase 2 Review Implementation Across Health Care Settings and Higher Education Institutions. J Paul Dilworth and Jean R McEwan. Consultative participants Robert Allan (UCL) Indran Balakrishnan (Pathology /RF) Celia Ingham Clark (Whittington (and NCC) Lucy Etheridge (ACME/ACF)

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Phase 2 Review Implementation Across Health Care Settings and Higher Education Institutions

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  1. Phase 2 ReviewImplementation Across Health Care Settings and Higher Education Institutions J Paul Dilworth and Jean R McEwan

  2. Consultative participants • Robert Allan (UCL) • Indran Balakrishnan (Pathology /RF) • Celia Ingham Clark (Whittington (and NCC) • Lucy Etheridge (ACME/ACF) • John Hurst (Division of Medicine /RF) • Dale Ojutiku (DGH Basildon) • Joe Rosenthal (General Practice) • Anna Storrs (student rep)

  3. Generic issues (1)(those changes which face all aspects of the profession and all teaching and training in medicine) • Precision Medicine. (Accurate diagnosis and the recognition of definable pathways and guidelines moves treatment away from specialist doctor treatment and follow up) • Care in the community for chronic diseases (COPD, DM) • Short hospital admissions (day cases, pre-admission assessment, MAU/AAU) • Hospital doctors’ increased specialisation • Delegation of traditional roles to other health care professionals • Early (GP requested) use of imaging • Electronic communications

  4. Generic 2 • Manpower (teaching faculty) • Time • Shift working of junior doctors, EWTD • Consultant Job Planning • Recognition of the need for experiential/apprenticeship learning • Experience/knowledge • Team working (less direct continuity of care and teaching) • Changing roles of other professionals • Reduced experience of junior doctors (need teaching also) • Consultants may not be familiar with the curriculum and the modern aims and objectives in teaching medicine in the 21st century

  5. Local changes in our main provider Trusts • Reconfiguration of services in North Central Sector of London • Darzi-London • Polyclinics • Independent treatment centres • Private Hospitals • UCL Medical School has not been considered/consulted in the first discussions currently reaching conclusion on the reconfiguration.

  6. Implementing change (phase 2 review) 1Environment • Balance the need for generic skills and bread and butter medicine (common conditions) and the requirement to consider and recognise the rare and deal with uncertainty • Teaching in the community extended to new areas (cost implications) • New models of teaching in the hospital (ambulatory care, OP, Day unit) • Integrate simulation wherever feasible • Apprenticeship to include working patterns following those junior doctors • Longer tracking of patients from community to hospital and back to community

  7. Implementing change (phase 2 review) 2, Faculty • NHS Faculty development is key as 75% of teaching will still be delivered by NHS staff unless major reorganisation of funding. • Transparent and accountable funding and payment to organisations (and tracked to individuals) for teaching • Improve medical school communications with those delivering the clinical teaching (two way ) • Develop champions of teaching in specific areas • Link NHS teachers to resources in UCL , eg CALT • Consider scheduling the teaching to marry with the service rota (particularly for teaching from junior doctors) • Multi-professional input to teaching, • Specific early specialisation in education/teaching (Teaching Fellows)

  8. Implementing change (phase 2 review) 3Money! • Funding and accountability • The commissioning of clinical teaching must set standards of quantity and quality • Specific minimum requirements of a placement for clinical teaching must be explicit • Funding must be flexible as well as transparent and accountable • unless there exists a threat of moving students (and money) when a Trust changes its service and ability to deliver the learning experience, the Medical School will remain peripheral to the debates • Numbers of students must be reflected upon honestly • consideration should be given to the development of further main teaching hospital sites. • The London Deanery should be asked to define the teaching responsibilities of trainees. • A teaching contract should be developed with junior doctors and outcomes assessed at appraisal

  9. Anticipating and Managing Change • The Medical School must lobby for inclusion in all discussions on service reconfiguration now and in the future, in order to represent the interests of the Medical School and students. • Financial transparency is essential in the modern climate. • Relationships with other organisations must be strengthened and stress mutual advantages of co-operative approaches to teaching and learning in new environments • SHA, Trusts, including primary care Trusts and Commissioners, London Deanery (HIECs), Polyclinics (eg Hornsea Central, Haverstock Health Centre) • UCLs experience with commissioning work placements in the private sector and outside institutions should be explored further. • Earth Sciences with Birkbeck, • Bartlett School of Architecture with commercial organisations • This chapter of the Phase 2 curriculum review should be discussed in draft form with the main Teaching Trusts, a polyclinic, UCL and the SHA/NHS London.

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