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From: Rescuing Medical Education Conference
Stamford Sydney Airport
O'Riordan St (cnr Robey St), Mascot
18 February 2005
Dr Anne Kolbe
President, Royal Australasian College of Surgeons
Thank you, Bill. Thank you Bruce and Lindsay, for inviting the Colleges to partake in what is shaping up to be an excellent day.
Like Guy, I'd like to take a slightly different tack. I'd like to encourage you to remember that medical education is a large and complex process and it basically involves undergraduate, graduate and pre-vocational and vocational training. It is the vocational aspects of training that I have any qualification to address, and it is those aspects of training that involve the medical colleges.
I'd also like you to understand that, although this seems like a surgical take-over, what I have to say applies equally to the 12 medical colleges in Australia.
And finally, I'd like to ask you to focus on the solutions. It's always important to identify the problems but it is much more important to focus on identifying the creative, sustainable solutions to manage those problems.
This is the Direction Statement of the RACS. It could be a Direction Statement for a university, for any other medical college, for any academic institution. It is an association of professionals. It is an organisation that is committed to ensuring the high standard of safe and comprehensive surgical care for the communities that we serve, through excellence in surgical education, training and on-going continuing professional development.
As I stressed, it is an organisation made up of professionals, and we need to remember the significance of being a professional. We need to remember that the community entrusts us with an opportunity to practice our skills, knowledge and expertise. And in return we have a fiduciary responsibility to ensure that the standards of that profession are maintained so that the service that is provided is appropriate to those we serve.
I'd also like to remind you that values are important. This set of values happen to apply to the RACS but again, they could apply to any organisation. And I draw your attention to service and professionalism and collaboration and teamwork.
I also draw your attention to this piece of work, and this has received enormous exposure this morning from various people. These are the outcomes, with slight Australasian modification, of the CANMED study. Those of you who are not familiar with that study, it was a large federally funded Canadian study conducted through the late 1990's to enable the Canadian community to determine what their medical practitioners of the future should look like.
These are the domains of competence against which we now train, against which the Australian Medical Council accredits us to train, and hopefully against which it accredits universities to train the next generation of medical professionals. Central to this set of competencies are obviously the medical and technical expertise, but there are other areas of competency that lie outside - communication, and what I've heard today as the soft sciences. We need to train across all of these competencies, not just some of them.
What of the past? This country and other countries around the world have a very proud history in vocational education. For my college that history spans some 75 years. We have been entrusted by the community with setting the standards and we have been the sole providers of surgical vocational education. However, in the recent past things have changed, and there have been a large number of factors that have been the drivers in those changes.
Patient expectations have changed enormously, and probably rightly so, and those of you who read Richard Smith, who was the previous editor of the British Medical Journal, will be aware of those changes.
In addition to that, there have been huge failures in our ability to self regulate ourselves and our ability as a profession to deliver a consistent standard of safe care. Look at Alderhay, look at Bristol, look at Shepman. We cannot step back from those failures. They have led to a loss of trust in us by all sorts of groups of people, perhaps with some justification, and to erosion of our professionalism. And therefore to less understanding of who we are as professionals and of our professional bodies such as colleges and the work that they undertake. We have an enormous amount of work to do to profile the activities of our universities and our professional bodies.
In addition, there are a whole flurry of other problems in health care. You are aware of all of them. We work in difficult environments. There are some problems in the culture of health care, and those of you who read the recent writings of John Ells, who I am sure is well known to each person in this room, will be aware that he speaks a lot about behaviours and culture, and those drivers to how we move forward.
I draw your attention particularly to the contrast between the value statement of team work and collaboration and what I'm sure you see constantly in a lot of your workplaces, and that is an inward looking profession engaged in silo behaviour, turf protection - and we could state that there are issues in turf protection around medical education - and a limited recognition and acceptance of what diversity has to offer to medical education.
So what's going to happen? What does the future hold at least for the medical colleges and vocational education? I think it holds change. Change in meeting community needs and expectations; change in being more objective in what we do; change in working in a more collaborative and partnership and teamwork way; change in opening ourselves even further to public scrutiny and being more transparent in what we do; and change in us being more accountable.
However, I would suggest to you that these changes are not threatening. Quite differently, they provide us with enormous opportunity, and we should capitalise collectively on that opportunity.
What will the future hold? I think for the colleges it will hold an increasing regulation, and probably rightly so. The AMC has done a wonderful job, and I have to say that I sat on a committee that put in place the accreditation process for vocational medical training. It has been enormously useful in focusing each of the colleges on what their objectives are, and how they are working to achieving those objectives, in just the same way as it focused the universities on their curricula and training pathways.
I believe that the ACCC process - that my college is nearing the end of, I sincerely hope, but the other eleven colleges are only just entering - has provided us with a huge opportunity to objectively clarify the costs, the organisation and the working relationships that are necessary for vocational education, and it has provided us with an enormous opening to work more collaboratively with governments and jurisdictions to deliver that education in an effective and an efficient way.
The Australian Council of Health Care Standards and its New Zealand counterpart will demand, and continue to demand, changes in the workplace environment. And we have to remember that 80% of vocational training is apprenticeship, it is conducted in the workplace. And whilst those trainees train, they deliver enormous service to the communities of Australia and New Zealand.
We expect to see more involvement - and we have it already by the Medical Registration bodies in New Zealand - with mandatory recertification of our ability to continue to practice, on an annual basis. And we expect to see - and we see already within my college - increasing involvement of jurisdictions in our day to day activities. That involvement needs to be harnessed and used as a channel of important and useful two-way communication.
In the future we can expect as colleges that our relationships, both internally and externally, will be absolutely crucial to our ability to continue to deliver. Our relationships with our own Fellows, our trainees and our staff; our relationship with our associated internal bodies that are very important to us, and that deliver our educational programmes; our specialist societies and associations; and to a lesser extent, our regional and state offices and committees.
And also crucially important will be for us to pro-actively foster and keep open the channels of co-operation and collaboration with external bodies, whether we see them as friend or foe. Lack of information and miscommunication is one of the things that absolutely harnesses and shackles the forward movement of educational systems.
We can expect to see changes - and I hope improvements - in our training, education and continuing professional development - our core business. We can expect to have to objectively quantify, document and publish our curricula, and the tools we use and the standards against which we assess our trainees and, for that matter, our Fellows.
We can also expect to need to foster and work in partnerships with universities and other groups in order to be able to better and more effectively deliver our programmes.
We can expect that the standards we set need to reflect what the community wants. We cannot set these standards in isolation. We do so at our peril.
We can expect that we will need to take ownership - and in ownership is encompassed a responsibility and an accountability - for the medical workforce. We need to understand the numbers and the changing work patterns. Jack Harris showed you some of the numbers today, we have heard about the feminisation of the workplace, and that's true. The number of women in medicine is rising. He also showed you a slide this morning that showed you the current average hours worked by medical practitioners, regardless of gender, across this country. It has fallen, and it has fallen more for men than it has for women. Jeanette Young presented those figures yesterday from ANWAC at the Committee of Presidents of Medical Colleges. We will expect it to fall further, and it is interesting to see that the number of hours - lying between 45 and 50 - fits very closely with the projections of the European Working Time Directive.
We can expect that we will see changes in scopes of practice and, as the President of the College of Radiologists said yesterday, that is role evolution. We can expect to be accountable for the efficient use of our resources.
And the last statement I believe goes without saying. We need to beware, and think carefully and pro-actively, and take responsibility, or the last statement will come to fruition.
We will need to support, advise and educate our Fellows, our trainees and others. The practice of medicine out there has changed. People's careers need to be able to be more flexible. They will need our support.
I wished again to focus you on the solutions. My role today was to say what is the role of the medical colleges, and I believe it is to take - firmly grasp - the role of being one of the groups of leaders in what is going to be a complex problem that will require innovative solutions.
I draw your attention to the competencies that are required for leadership. John Ells calls these enabling, unselfish competencies. They are very values based, and they are very effective in changing culture.
And there is a final, almost overarching competency, that we - if we are to be the leaders in changing this system of education for the better - need to embrace. You have heard this morning from a politician who is a previous doctor. Many of you may not know a lot about Rick Charlesworth and his leadership skills. Rick Charlesworth is a MBBS medical practitioner. For ten years he was the member for the seat of Perth in the Australia Federal House of Representatives. He is probably the world's best ever turf hockey player. He led the Australian men's hockey team for nearly twenty years. He coached the Australian Women's Hockeyroos team to probably being the best sporting team Australia has ever had. They won gold in Atlanta. They won gold in Sydney. This was their mission statement for their campaign to retain their gold medal at the Sydney Olympic Games. I commend it to each of you who is involved in furthering the process of medical education in this country.
Thank you.
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