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“Community Competence” and Geography

“Community Competence” and Geography. Can we use GIS and regionalized GME to train doctors who are socially accountable and responsive to community need?. Who am I and how did I get here?. Rule 31 – Review the World Literature Fortnightly* *"Kill as Few Patients as Possible" - Oscar London.

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“Community Competence” and Geography

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  1. “Community Competence” and Geography Can we use GIS and regionalized GME to train doctors who are socially accountable and responsive to community need?

  2. Who am I and how did I get here?

  3. Rule 31 – Review the World Literature Fortnightly**"Kill as Few Patients as Possible" - Oscar London 5,000? per day 1,500 per day 95 per day Medical Articles Per Year

  4. Coping with the growth in trials? MEDLINE 2006/day 1,600 articles 95 trials 4 reviews* *CDSR per day 1 new 1 update It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials. Bastian, Glasziou, Chalmers, PLoS2009)

  5. Le Musée Pasteur sera exceptionnellement fermé le 31 octobre et le 1er novembre 2011.

  6. Australian Academy of Science

  7. Australia’s health care system • Publically funded universal health care system • Patient reimbursement scheme • Subsidized treatment from Medicare practitioners • 75 – 85% of scheduled fee • 70% ‘bulk billing’ • Fully subsidized ("free") treatment in public hospitals

  8. Australia’s health care system • Medibank (1975) • Medicare (1984) • Private Health Insurance Rebate (1999) – 30% premium • PBS – subsidy for listed prescribed pharmaceuticals • Until now… PBAC…

  9. Medical Education in Australia • AMC – national standards and accreditation body • Medical schools • Specialist medical training • Recognition of medical specialties and sub-specialties • Overseas trained medical doctors assessment • Advice on registration

  10. GP Training • Previously standards set and program delivered by RACGP • 1997 – Federal government review • 2000 – GPET created

  11. General Practice Training – the players

  12. Medical Student numbers • 2000 - 11 Australian medical schools • 2011 - 20 The total number of Australian medical 2005 - 1608 medical students 2012 - 2916 medical students • 81%

  13. General Practice trainee numbers The total number of Australian medical 2006 - 600 2014 - 1400 • 133%

  14. Emergent and Emerging issues • No longer going to be a problem of insufficient quantity alone • Quantity and quality training places • Supervisor fatigue and saturation • Corporate practices • Metro – regional/rural divide • Generation Y • Fewer hours • More likely to move practices • Less likely to “buy-in” to a practice • Clinical leadership in employee setting

  15. Emergent and Emerging issues • Increasing multi-morbidity / multi-chronicity • WHO – stewardship • ~ Stagnant financial incentives for teaching • Medicare rebates less than cost of living increases • Multimorbidity and multichronicity • Patient-centeredness in context of information tsunami

  16. Training locations of registrars • SLA data from ABS • Population demographics (age, CALD, • Chronic disease and risk factor estimates • Psychological distress estimates • Medical workforce • Early childhood developmental vulnerability and risk • ReCEnT project - GP trainees record 60 consecutive consultations, three times over ~18 months

  17. Initial Questions • Where are registrars training? • How are they distributed? • Are they distributed differently in different RTPs? • Within an RTP, how variable is health disparity and indicators of chronic disease? • Does this differ between areas that have a trainee and those that don’t? • How might this information be useful in individualising learning plans for registrars?

  18. “The good physician treats the disease; the great physician treats the patient who has the disease.” Sir William Osler …But an exceptional physician also monitors his or her community to anticipate problems and prevent them…

  19. Total health expenditure as a share of GDP (2007) oecd-ilibrary.org

  20. Total Health Expenditure per Capita  and GDP per Capita, US and Selected Countries, 2008 "OECD Health Data", OECD Health Statistics (database)

  21. Generalism: Threats and Opportunities • ~stagnant financial incentives for teaching • Medicare rebates less than cost of living increases • Multimorbidityand multichronicity • Patient-centeredness in context of information tsunami

  22. “Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations.” Cross, 1989

  23. Hypothetical 79 y/o female with COPD, osteoporosis, DM-II, HTN, OA 12+ meds, $406/month Multiple potential drug interactions frictionless universe vs. real life

  24. frictionless universe vs. real life

  25. “The good physician treats the disease; the great physician treats the patient who has the disease.” Sir William Osler

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