NAMEM Conference Sept 2010

1. NAMEM Conference Sept 2010 Cardiff, Wales

2. Welcome to Wales!

3. The changing face of medical education Professor Peter Donnelly, Deputy Postgraduate Dean, Wales

4. Disclaimer • The views expressed here are my personal views

5. My experience.. • Consultant – 16 years • RC examiner • Assistant Director Clinical Teaching Swansea, SoM • Hon Senior Lecturer, Cardiff, SoM • Associate Dean…

6. The changing face………

8. Where are we? • In UK • 33 Medical Schools • 21 PG Deaneries • Numerous Foundation Schools….UKFPO • PG Curricula… • Immigration Rules • EWTD • GMC single UK regulator • MMC…fast track?

10. PG major changes .. • Time served…to competency based • Mapped to speciality curricula • Progression via WPBAs • Annual review • Formal Exams • Competitive points • ‘Central’ application process

11. White paper • Putting patients first • Improving healthcare outcomes • Autonomy, accountability and democratic legitimacy • Cutting bureaucracy and improving efficiency • Conclusion: making it happen

12. Tooke Report • NHS and Universities forge functional links.. • Links between health and education providers should be appraisal targets for SHA CEOs • Harmonisation of final year with F1 • NHS MDs…explicit responsibility for the delivery of medical education and training

13. Temple Report • Implement a consultant delivered service • Service delivery must explicitly support training • Make every moment count • Recognise, develop and reward trainers • Training excellence requires regular planning and monitoring

14. We are in Wales…………..

17. Wales Population: 3 million Acute hospital admissions

18. Wales Rhyl Wrexham Bangor Merthyr Aberystwyth Abergavenny Caerphilly Carmarthen Newport Haverfordwest Llanelli Cardiff UHW Swansea Morriston Swansea Singleton Royal Glamorgan Neath / Port Talbot Bridgend Cardiff Llandough

19. Where are we in Wales? • Two Medical Schools • Cardiff, est 1893 • National Student Survey • Swansea…est 2009 GEP • Two Clinical Schools • Uniglam • One PG Deanery, Wales • 59 speciality curricula written by R Colleges and ratified by PMETB (GMC)

20. More importantly… • NHS Wales • Major reconfiguration • 7 Health Boards • 3 NHS Trusts • Service reconfiguration

21. Where do we want to be?

22. Excellent learning producing excellent services to patients

23. How can we get there? • Unified undergraduate and postgraduate medical education system • All Wales approach • Small enough yet big enough

24. Have to move from an institutional to an ‘all Wales’ approach • Inherent competition • Winners and losers

25. Pathway • ‘I want to be a doctor’

28. The future of medical education in Wales means radical rethinking…

29. Generation theory Career ladders Work hard, go up Work is work Stay in one line of work Stay put, show loyalty Plan for the future Employer sorts training Expect benefits and rewards Live to work Career bridges Work hard, move across Work as play Change if its not working No guarantees, move on Live in the moment You organise learning Want flexible benefits, inner reward (meaning) Work to live

30. Flexible system…. • Needs of the NHS change and constantly changing…. • Greater divergence between NHS Wales and NHS….

32. Challenges ahead • UG…emerging Swansea GEP and changes to Cardiff SoM curriculum • F1s fit for purpose? • PG curricula • Temple report • NHS service reconfiguration • Reconfiguration of training • Returners to training • (financial constraints)

33. The future? • Unified Undergraduate and PG pathway in Wales • SIFT and MADEL monies managed jointly • Flexible career pathway…. • Curricula driven ‘more’ by the NHS

34. THE END

35. Aberaeron

38. What is the essence of being a doctor?

39. Doctors make decisions • (Clinical context varies)

40. Science of decision making • Tim de Dombal • Aids to decision making • Processes in decision making • Decision psychology in surgical setting • (Surgical Decision Making. FT de Dombal. Hodder.)

42. What is the product of Medical Schools? • 60 %....GPs • Less than 5%..….researchers

43. How many UG curricula teach decision making?????

44. What the problem with Medical Schools?

45. What’s the problem with Medical Schools? • Research focused • Research driven • Sit in Universities • Academic • Curricula driven by …. • Selection process? • Less NHS input than they should have

46. What’s the problem with PG curricula?

47. What’s the problem with PG curricula? • Written by RCs • Signed of by GMC • Do all curricula met needs of NHS?

48. Principles of an ideal model of training Balance of lower to higher grades Breath of experience (appropriate on-call) Volume of cases Tiers of support Consultant trainers Health Board supporting the training agenda

49. Influences on career decisions Time - earlier decisions are now required Generation (Boomers, X and Y) Choice left to individual – (UK norm) Prior exposure to a speciality helps inform choice Peer influence (what others think) Role models Media/new media Positive and negative experiences (“horn and halo”) Life style and work life balance Doctors need to take an evidence-based approach!

50. Lets consider ‘training in Wales’ as a product that we are trying to sell Market place that has changed…constantly changing