Teaching and Learning in non traditional settings Professor Jane Dacre President Royal College of Physicians

Why - Interesting Times As healthcare workers, we live in interesting times Outline of some current challenges General Specific Discuss how we can change Look to the future

2012 Hospitals on the Edge

Brexit Rt Hon Theresa May: “Brexit means Brexit.” Sir Bruce Keogh: ‘It is really important we make them feel welcome. If you are a European doctor or nurse you might not feel too welcome at the moment.’

What future do we want for the NHS 85% of physicians believe that current health service funding is not sufficient to meet demand Seven-tenths of trainee physicians now report working on a rota with a permanent gap

2016 Junior Doctor Contract Dispute

Our education programmes We are educating for the future We are teaching about today’s problems for tomorrows learners We are using curricula that were designed yesterday How can we expect to get it right?

Shape of Training

GMC’s Generic Professional Capabilities

Don Berwick – three eras of medicine Era 1: 'the ascendancy‘ Era 2: 'the present‘ Era 3: 'the moral era' Era 3 for Medicine and Health Care, Donald M. Berwick, MD, MPP1 JAMA. 2016;315(13):1329-1330 http://jama.jamanetwork.com/article.aspx?articleid=2499845 I was recently inspired by Don Berwick who came to speak to the RCP’s annual conference a couple of months ago. His speech centred around the need to reconnect with patients, to rediscover the therapeutic relationship. He believes we have already experienced two eras of medicine – the ascendancy of the profession with its patrician, doctor-centred approach, and the present over-regulated and over-controlled era. We need to move into the third era – the moral era, concentrating on developing those great relationships with patients that motivate and inspire us. If we can all do that, we will be able to overcome some of the present dissatisfaction and poor morale.

The role of the doctor Conducting the orchestra Playing in the orchestra Mastering several instruments Managing the programme Creating harmony

The learning we need is… Interdisciplinary Multidisciplinary Embraces other professional groups PAs ACPs Pharmacy Nurses Social care

New concepts in delivery of care Health and wellbeing Mental and physical health Community focussed Outside hospitals Delivered by teams Shared clinical decision making

Safety and quality of care We have sacrificed our clinical autonomy at the altar of patient safety Doctors in training make fewer clinical decisions Doctors in training take less responsibility Better trained, better educated, but less prepared for independent practice

Solutions found in less traditional settings Communities Care homes Patients homes Policy think tanks Trust Boards NHS England, HEE, CQC

Non traditional settings

We need to educate differently Clinical competence, of course Leadership Team working Shared clinical decision making Flexibility Generalist skills and specialist skills

Curriculum design should be flexible and transportable Future proofed Strategic Scholarly Pragmatic Encourage scholarship Support research and innovation Always conscious of the hidden curriculum

Developing new models of care

Examples National medical directors clinical fellows Chief registrars Teaching fellows Research Fellows Broad based training Calman and MMC stifled our creativity and flexibility.

Trainees are very clever people Knowledge can be aquired anywhere Process can be adapted across different settings Capabilities are transferable Doctors need to learn about safe risk taking Doctors should practice making decisions

Summary The NHS is in trouble, and understaffed, underfunded and overstretched We need to train them to make that better Teaching and learning in different settings is creative and helps Flexibility is key

#medicineisbrilliant Looking to the future #medicineisbrilliant Despite all the challenges, I still believe medicine is a great career choice. Together we can tackle the challenges of the future and promote the best possible health and healthcare for everyone!