Phase 2 Review Implementation Across Health Care Settings and Higher Education Institutions J Paul Dilworth and Jean R McEwan

Consultative participants –Robert Allan (UCL) –Indran Balakrishnan (Pathology /RF) –Celia Ingham Clark (Whittington (and NCC) –Lucy Etheridge (ACME/ACF) –John Hurst (Division of Medicine /RF) –Dale Ojutiku (DGH Basildon) –Joe Rosenthal (General Practice) –Anna Storrs (student rep)

Generic issues (1) (those changes which face all aspects of the profession and all teaching and training in medicine) Precision Medicine. (Accurate diagnosis and the recognition of definable pathways and guidelines moves treatment away from specialist doctor treatment and follow up) –Care in the community for chronic diseases (COPD, DM) –Short hospital admissions (day cases, pre-admission assessment, MAU/AAU) –Hospital doctors’ increased specialisation –Delegation of traditional roles to other health care professionals –Early (GP requested) use of imaging –Electronic communications

Generic 2 Manpower (teaching faculty) –Time Shift working of junior doctors, EWTD Consultant Job Planning –Recognition of the need for experiential/apprenticeship learning –Experience/knowledge Team working (less direct continuity of care and teaching) Changing roles of other professionals Reduced experience of junior doctors (need teaching also) –Consultants may not be familiar with the curriculum and the modern aims and objectives in teaching medicine in the 21 st century

Local changes in our main provider Trusts Reconfiguration of services in North Central Sector of London Darzi-London –Polyclinics –Independent treatment centres –Private Hospitals UCL Medical School has not been considered/consulted in the first discussions currently reaching conclusion on the reconfiguration.

Implementing change (phase 2 review) 1 Environment Balance the need for generic skills and bread and butter medicine (common conditions) and the requirement to consider and recognise the rare and deal with uncertainty –Teaching in the community extended to new areas (cost implications) –New models of teaching in the hospital (ambulatory care, OP, Day unit) –Integrate simulation wherever feasible –Apprenticeship to include working patterns following those junior doctors –Longer tracking of patients from community to hospital and back to community

Implementing change (phase 2 review) 2, Faculty NHS Faculty development is key as 75% of teaching will still be delivered by NHS staff unless major reorganisation of funding. –Transparent and accountable funding and payment to organisations (and tracked to individuals) for teaching –Improve medical school communications with those delivering the clinical teaching (two way ) –Develop champions of teaching in specific areas –Link NHS teachers to resources in UCL, eg CALT –Consider scheduling the teaching to marry with the service rota (particularly for teaching from junior doctors) –Multi-professional input to teaching, –Specific early specialisation in education/teaching (Teaching Fellows)

Implementing change (phase 2 review) 3 Money! Funding and accountability –The commissioning of clinical teaching must set standards of quantity and quality Specific minimum requirements of a placement for clinical teaching must be explicit –Funding must be flexible as well as transparent and accountable unless there exists a threat of moving students (and money) when a Trust changes its service and ability to deliver the learning experience, the Medical School will remain peripheral to the debates –Numbers of students must be reflected upon honestly consideration should be given to the development of further main teaching hospital sites. –The London Deanery should be asked to define the teaching responsibilities of trainees. A teaching contract should be developed with junior doctors and outcomes assessed at appraisal

Anticipating and Managing Change The Medical School must lobby for inclusion in all discussions on service reconfiguration now and in the future, in order to represent the interests of the Medical School and students. –Financial transparency is essential in the modern climate. Relationships with other organisations must be strengthened and stress mutual advantages of co-operative approaches to teaching and learning in new environments –SHA, Trusts, including primary care Trusts and Commissioners, London Deanery (HIECs), Polyclinics (eg Hornsea Central, Haverstock Health Centre) UCLs experience with commissioning work placements in the private sector and outside institutions should be explored further. –Earth Sciences with Birkbeck, –Bartlett School of Architecture with commercial organisations This chapter of the Phase 2 curriculum review should be discussed in draft form with the main Teaching Trusts, a polyclinic, UCL and the SHA/NHS London.