The Future of the Medical Colleges Anne Kolbe Royal Australasian College of Surgeons

Direction statement As a fellowship based organisation, RACS commits to ensuring the highest standard of safe and comprehensive surgical care for the community we serve through excellence in surgical education, training, professional development and support. As a fellowship based organisation, RACS commits to ensuring the highest standard of safe and comprehensive surgical care for the community we serve through excellence in surgical education, training, professional development and support.

Professionals and Professionalism Professional work is: Professional work is: Complex, requiring special knowledge, skills and judgment Complex, requiring special knowledge, skills and judgment Especially important for the well-being of individuals or societies Especially important for the well-being of individuals or societies Basic elements of professionalism: Basic elements of professionalism: Commitment to practising a body of knowledge and skill Commitment to practising a body of knowledge and skill Maintaining a fiduciary relationship with clients, patients and communities Maintaining a fiduciary relationship with clients, patients and communities Freidson E. Nourishing Professionalism, 1991

Values Service and Professionalism Service and Professionalism performing to and upholding the highest standards Integrity Integrity honesty, humility, upholding professional values Respect and Compassion Respect and Compassion being sympathetic and empathetic Commitment and Diligence Commitment and Diligence being dedicated, doing one’s best to deliver Collaboration and Teamwork Collaboration and Teamwork working together to achieve the best outcome

Domains of Competence Medical Expertise - Clinical Decision Maker Medical Expertise - Clinical Decision Maker Technical Expertise Technical Expertise Communication Communication Collaboration Collaboration Management Management Health Advocacy Health Advocacy Scholarship and Teaching Scholarship and Teaching Professionalism Professionalism CanMEDS 2000 Project; Royal College of Physicians and Surgeons of Canada. Societal Needs Working Group; “Skills for the new millennium”.

The past! Over the last 75 years medical colleges have been entrusted with the responsibility for vocational medical education programmes Over the last 75 years medical colleges have been entrusted with the responsibility for vocational medical education programmes Set the standards Set the standards Sole providers Sole providers

However in the recent past… Things have changed! Patient expectations Patient expectations Failures in regulation and in the provision of safe medical services Failures in regulation and in the provision of safe medical services Loss of trust Loss of trust Erosion of professionalism Erosion of professionalism Less understanding of professional models and less tolerance for professions autonomy Less understanding of professional models and less tolerance for professions autonomy

and in addition…  Aging population  Rapid advances in knowledge and technologies  Practitioner expectations  Workforce shortages  Scopes of practice, HPCAA  Budget constraints, rationed healthcare

and in addition… Cultural change; Inward looking, limited vision Inward looking, limited vision Silo behaviour, turf protection Silo behaviour, turf protection Over dependence on hierarchical structures Over dependence on hierarchical structures Limited recognition and acceptance of diversity Limited recognition and acceptance of diversity Culture of blame and “buck passing” Culture of blame and “buck passing” Culture of bullying Culture of bullying Health professionals are disillusioned Health professionals are disillusioned

So what can we expect in the future? Change… Community needs Community needs Objectivity Objectivity Collaboration and partnerships Collaboration and partnerships Public scrutiny and transparency Public scrutiny and transparency Accountability Accountability …Challenges and opportunities …Challenges and opportunities

In the future we can expect Increasing regulation; AMC: educational capacity AMC: educational capacity ACCC: processes and probity ACCC: processes and probity ACHS: credentialing of hospital environment ACHS: credentialing of hospital environment Medical registration bodies: re-certification Medical registration bodies: re-certification Jurisdictions: greater involvement Jurisdictions: greater involvement

In the future we can expect Relationships with key stakeholders will be crucial: Relationships with key stakeholders will be crucial: Fellows, trainees, staff Fellows, trainees, staff Specialist Societies and Associations Specialist Societies and Associations National and State Committees National and State Committees External bodies: AMC, ACCC, governments, DoH, AMWAC, medical registration boards, MDOs, AMA, External bodies: AMC, ACCC, governments, DoH, AMWAC, medical registration boards, MDOs, AMA,

In the future we can expect Training, Education and CPD: Training, Education and CPD: Will still be our core business although models of delivery may change Will still be our core business although models of delivery may change Need to define the components of competent professional, document training through robust curricula and assessment through valid tools Need to define the components of competent professional, document training through robust curricula and assessment through valid tools Criteria need to be objective, defensible and available for public scrutiny Criteria need to be objective, defensible and available for public scrutiny Partnerships/ collaboration with universities would be beneficial Partnerships/ collaboration with universities would be beneficial

In the future we can expect Standards: Standards: Need to reflect community need Need to reflect community need Training and assessment; defined, objective, justified Training and assessment; defined, objective, justified Demonstrably maintained for re-certification Demonstrably maintained for re-certification Unless the Colleges work to this, then others will fill the void! Unless the Colleges work to this, then others will fill the void!

In the future we can expect Workforce: Workforce: The “ownership” of workforce data will be important The “ownership” of workforce data will be important Sustainable Australasian workforce is the best option Sustainable Australasian workforce is the best option Efficient use of resources will be vital Efficient use of resources will be vital Governments will not allow shortages to be sustained, they will change practice scopes, patterns and standards by legislation if forced Governments will not allow shortages to be sustained, they will change practice scopes, patterns and standards by legislation if forced

In the future we will need to Provide support for our colleagues: Provide support for our colleagues: The pace of change is increasing and the demands of practice are more stringent with less “true enjoyment” The pace of change is increasing and the demands of practice are more stringent with less “true enjoyment” Our fellows and trainees will need support and advice in establishing and sustaining a career, career transitioning and retirement Our fellows and trainees will need support and advice in establishing and sustaining a career, career transitioning and retirement Aggressive, pro-active advocacy Aggressive, pro-active advocacy

About leaders and leadership… Knowledge the business Knowledge the business Vision Vision Ability to horizon scan Ability to horizon scan Ability to manage complexity Ability to manage complexity Flexibility Flexibility Ability to listen Ability to listen Team building and team nurturing skills Team building and team nurturing skills Ability to recognize and celebrate success Ability to recognize and celebrate success

Astute leaders foster co-operation, collaboration, networks and partnerships

“We choose to do this thing not because it is easy but because it is hard” Ric Charlesworth Coach Australian Hockeyroos,