Vision & Strategy for future PGME Dr Jon Bailey Academy of Medical Royal Colleges Trainee Doctors’ Group Chair

What most impacts Post Graduate Medical Education? How much is there to know? How much time do we have to learn it? How many need to learn it? How many can teach it?

“To know your future you must know your past” ― George Santayana Jorge Agustín Nicolás Ruiz de Santayana y Borrás, known as George Santayana (December 16, 1863 – September 26, 1952), was a philosopher, essayist, poet, and novelist. Spanish-born, Santayana was raised and educated in the United States and identified himself as an American, although he always kept a valid Spanish passport.[1] He wrote in English and is generally considered an American man of letters. At the age of forty-eight, Santayana left his position at Harvard and returned to Europe permanently, never to return to the United States. His last wish was to be buried in the Spanish pantheon in Rome.

John Rae 30 September 1813 to 22 July 1893

Studied medicine in Edinburgh Graduated with an Edinburgh University degree Licensed by the Royal College of Surgeons of Edinburgh

In 1836–39 Thomas Simpson sailed along much of the north coast of Canada. Rae was chosen because of his well-known skill in overland travel.

Independently practising general, vascular, urological, plastics, cardiothoracic and T&O surgeon… Consultant Surgeon Aged 23 Total training: 5 years

Consultant Physician Aged 30-34 Total training: 12-16 years

The Journal des sçavans, (later renamed Journal des savants), established by Denis de Sallo, was the earliest academic journal published in Europe. “Content included obituaries of famous men, church history, and legal reports. The first issue appeared as a twelve page quarto pamphlet on Monday, 5 January 1665

Annual scientific publication growth of 9%, equating to a doubling time of approximately 9 years. There are approximately 1 million times the number of scientific papers in 2016 compared to 1836. Medical training time has only increased 3 fold, so its not all bad.

Anatomy Lecture Theatre, at the Old Medical School in the University of Edinburgh. Designed in 1877 by Robert Rowand Anderson. Still in use.

Cardiff University, around 2009 Also still in use…

In 1978, there were 55,000 hospital doctors; in 2014 there were 190,000, of which 74,859 were consultants: a rise of 345%. The UK population has increased from 56,183,000 to 64,597,000 in the same time, a rise of 14.9%.

What most impacts Post Graduate Medical Education? How much is there to know? Far more than we can hope to learn How much time do we have to learn it? 12-16 years (plus CPD) How many need to learn it? More than ever before How many can teach it? More, but fewer teachers per pupil Crawford W. Long used ether as a general anesthetic in 1842. He did not publish an account of his successes with general anesthesia until 1849, however. The first public demonstration of general anesthesia was in 1846 by a Boston dentist named William T.G. Morton at the Massachusetts General Hospital.

How do we learn effectively?

How can we achieve success? Effective use of learning time Know less, know where to look Effective assessment

Know less, know where to look

Know less, know where to look

Know less, know where to look

Effective use of learning time (& resources) Mandatory Emergency Medicine courses for CCT ALS, ATLS, APLS, Level 1 Ultrasound £6,200 Diploma in Mountain Medicine £5,400 MSc £10,640 Total of £22,240 (£3700/year) PPL £7380, Commercial diver £14,700

Effective use of learning time & resources

Effective use of learning time

Effective use of learning time

Effective use of learning time

Effective assessment How can we prove training is effective? What defines competence? What demonstrates competence? What proves competence? What function do exams serve? Do clinicians perform to exam standard reliably? Do they need to? Do we really know what we want to be?

How can we achieve success? Effective use of learning time Maximise active learning, use passive learning as concurrent activity Know less, know where to look Know what you need to know immediately Effective assessment Competence is not exam success Test only what must be tested