NAMEM Conference Sept 2010 Cardiff, Wales. Welcome to Wales!
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Transcript of NAMEM Conference Sept 2010 Cardiff, Wales. Welcome to Wales!
• My experience..
• Consultant – 16 years
• RC examiner
• Assistant Director Clinical Teaching Swansea, SoM
• Hon Senior Lecturer, Cardiff, SoM
• Associate Dean…
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?
PG major changes ..
• Time served…to competency based
• Mapped to speciality curricula
• Progression via WPBAs
• Annual review
• Formal Exams
• Competitive points
• ‘Central’ application process
White paper
• Putting patients first
• Improving healthcare outcomes
• Autonomy, accountability and democratic legitimacy
• Cutting bureaucracy and improving efficiency
• Conclusion: making it happen
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
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
WalesWrexham
Rhyl
Bangor
Carmarthen
Swansea Singleton Bridgend Royal
Glamorgan
Cardiff UHW
Newport
Abergavenny
Merthyr
Llanelli
Aberystwyth
Haverfordwest
Neath / Port Talbot Cardiff
Llandough
Swansea Morriston
Caerphilly
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)
More importantly…
• NHS Wales
• Major reconfiguration
• 7 Health Boards
• 3 NHS Trusts
• Service reconfiguration
How can we get there?
• Unified undergraduate and postgraduate medical education system
• All Wales approach
• Small enough yet big enough
• Have to move from an institutional to an ‘all Wales’ approach
• Inherent competition
• Winners and losers
Generation theoryGeneration theory
• Career laddersCareer ladders• Work hard, go upWork hard, go up• Work is workWork is work• Stay in one line of workStay in one line of work• Stay put, show loyaltyStay put, show loyalty• Plan for the futurePlan for the future• Employer sorts trainingEmployer sorts training• Expect benefits and Expect benefits and
rewardsrewards• Live to workLive to work
• Career bridgesCareer bridges• Work hard, move acrossWork hard, move across• Work as playWork as play• Change if its not workingChange if its not working• No guarantees, move onNo guarantees, move on• Live in the momentLive in the moment• You organise learningYou organise learning• Want flexible benefits, inner Want flexible benefits, inner
reward (meaning)reward (meaning)• Work to liveWork to live
• Flexible system….
• Needs of the NHS change and constantly changing….
• Greater divergence between NHS Wales and NHS….
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)
The future?
• Unified Undergraduate and PG pathway in Wales
• SIFT and MADEL monies managed jointly
• Flexible career pathway….
• Curricula driven ‘more’ by the NHS
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.)
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
What’s the problem with PG curricula?
• Written by RCs
• Signed of by GMC
• Do all curricula met needs of NHS?
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
Influences on career decisionsInfluences on career decisions• Time - earlier decisions are now requiredTime - earlier decisions are now required• Generation (Boomers, X and Y)Generation (Boomers, X and Y)• Choice left to individual – (UK norm)Choice left to individual – (UK norm)• Prior exposure to a speciality helps inform Prior exposure to a speciality helps inform
choicechoice• Peer influence (what others think)Peer influence (what others think)• Role modelsRole models• Media/new mediaMedia/new media• Positive and negative experiences (“horn Positive and negative experiences (“horn
and halo”)and halo”)• Life style and work life balanceLife style and work life balance
Doctors need to take an evidence-based Doctors need to take an evidence-based approach!approach!
• Lets consider ‘training in Wales’ as a product that we are trying to sell
• Market place that has changed…constantly changing
Total customer solution
• Consider what it is that the customer wants as a total package
• Not just what is in the advert