Reimagining Medical Education

imagesWe’ve got a problem (well 4 actually), when it comes to medical education! The first is this: Jeremy Hunt is promising loads of new places at medical school – I know this doesn’t sound like a problem, it sounds like a solution. But the truth is, once you actually do some number crunching, the new places won’t even account for the losses we will have due to retirement over the next 10 years, let alone account for the increased need there is in the system. So…..we’re still going to be short of doctors. Unfortunately – there isn’t a political appetite to increase these numbers further, and with our exit from the EU we’re genuinely facing an ongoing crisis.

 

The next problem is therefore that we need to restructure our workforce in quite aimages.jpg creative way, to work more smartly and differently, with a flexible workforce, but due to the pressures upon the system, there is little room for people to put much time or imagination into this and there is also a huge leap of faith involved. There is simply not the evidence base in place to support the leap we are asking GPs, in particular, to take in restructuring their practices and not replace GPs with GPs, but with combinations of paramedics, advanced practitioners, physician assistants, physics, mental health workers, health coaches and the like. However, the issue is that the system finds itself, like Indiana Jones, at the edge of a cliff, with no way back and the only thing for it is to step into the unknown and hope that God supplies the stepping stones…..Those in leadership positions are going to have be given space and grace to try some things, get it wrong and try again……One of the vital things that will be involved is proper engagement with the communities we serve. Clinicians and the general population need to have a better and deeper understanding of one another. There is a huge language void to be bridged and a collaboration that is needed in understanding how services can be more helpfully redesigned for the benefit of everybody. It also means where there are are difficult decisions to be made, there are no cloak and daggers or suspicion, but honest, open communication in the light of day that builds trust and partnership.

 

Our third issue is that with the vast increase in hyper-specialism and the loss of generalism from training programmes after qualification. Rural and remote places in particular are unable to get the staff mix necessary to run successful and safe services. This is due to a lack of foresight from centralised diktats and various guidance from NICE and the Royal Colleges that favours this approach. Health Education England must be brave enough to allow areas to be innovative in the training they provide. Our needs in Morecambe Bay are utterly different to those of Nottingham or Central London and we need new training programmes that will cater for this.

 

images.jpgFourthly, our medical schools are delivering a curriculum, designed centrally but based on yesterdays NHS. There is not enough creative vision around the curriculum to build the right kind of future doctors. There is still far too much focus on illness and disease and no where near enough thought or teaching about wellness, healthy lifestyles, nutrition and non-pharmacological options. The role of the future doctor is much more population focused and digitally savvy. It is our medical schools more than anywhere else that carry the responsibility to ensure the future NHS is catered for. We need a radical shake up in medical education and some brave people to rewrite the curriculum that will enable medical schools to be more creative and engaging in helping to raise the doctors we need for the future.

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What Lies Beneath?

Do you sometimes wonder what is really going on? As the furore around the planned 5-day strikes by junior doctors unfolds, with all the clamour and the noise, the positioning, the power plays, the arguments and the counter-arguments, I wonder where is the truth amidst the madness? How have we reached a stage in which the government and an army of medics, surgeons and psychiatrists are at such loggerheads? What lies beneath all of this?

 

Theresa May, our Prime Minister tell us that “doctors have never had it so good” – I wonder when she last shadowed a Senior Registrar for Acute Medicine on a Friday night in an understaffed hospital? Jeremy Hunt tells us that he is a modern day Aneurin Bevan (I wonder what AB would think of that?!), whilst his shadow counter-part, Diane Abbott retorts that this is a ridiculous suggestion. The PM and the Secretary of State for Health both agree that the junior doctors are playing politics, something the other side refutes, but all agree that this is a disaster and patients lives may well be put at risk. The right wing press tell us it is all about pay and that the doctors are being greedy, whilst the left wing press tell us it is all about an underlying agenda to privatise the NHS. The Junior Doctors admit that some of this is about pay (who would want a significant pay cut for working long and unsociable hours?) but that it is more about resisting a policy to deliver a 24/7, 7/7 NHS, which they believe to be unaffordable and unstaffable due to shortages in funding and recruitment. Senior colleagues appear to be split down the middle in terms of support for the strikes, patient groups are understandably concerned and yet a solution does not appear to be forthcoming.

 

Shouting, anger, fighting, noise, name-calling, power-plays, hate and hollering. So, who will seek the welfare of the people and the nation? Who will make for peace? Both sides tell us this is what they are doing and this is why they stand their ground. The government apparently want to deliver the same standard of service throughout the 7 day week. The Junior Doctors say they are the ones really standing up for the people by resisting that which is unsafe and unfair.

 

So, let us learn from the peacemakers to find a way through. In apartheid South Africa, peace was not reached through hate and vitriol. It took deep courage from men and women to expose lies, to speak truth to power, but most importantly to tell their stories. It was not about the one man, Nelson Mandela, but the many together waking up to an alternative future that was fairer for everybody. In the battle for civil rights in the USA, a nation was awakened to the reality of injustice within its own borders. The story of one woman, Rosa Parks, who refused to be humiliated on a bus became a people movement as numerous as the stars, shining together for an altogether different day. In Rwanda, after the appalling genocide, those who lost everything, found a voice to communicate to their very oppressors, those who had raped and murdered their own families, not only their story, but forgiveness for the atrocities caused and found a way through to a new future. If we want peace and a better future for everybody, then we need to face up to our reality, be willing to really listen and then find that together we can embrace a new future.

 

We have an apartheid of globalisation and free market capitalism across the entire world. Every day, the gap between the rich and the poor is widened. Our entire economic system, founded on the oppression of Empire through expansion (via military violence), the creation of debt (through an errant banking system) and the rule of law (held in place by the state of the exception) is no longer fit for purpose. We see it in the plight of refugees stuck between war and barbed wire fences in a land they cannot call their own. We see it in the disproportionate imprisonment of Black American males in the USA. We see it in the vile island detention centres of Australia. We see it in the slums of New Delhi, the townships of sub-Saharan Africa and the Favelas of South America – in the eyes of children dying from such ridiculous things as diarrhoea and starvation. We encounter it in the streets of Athens and the public squares of Madrid. And yes, we find it in the midst of our NHS and social care system. Our world as we have known it is broken and no matter how much sticky tape or wrapping paper we apply, the centre simply cannot hold. The core is unstable. Everything is shaking. We must have the courage to let go of what we have known and embrace an altogether different future, a future that is fairer for everybody, where things don’t simply trickle down to the poorest, but in which the balances are re-set.

 

We have become slaves of the ‘free market’, fodder of the beast that requires ever more of us. What lies underneath the row over Junior Doctor pay and the forthcoming strikes is a great gaping hole that scares the hell out of many of us. Oh, we can sling mud until the cows come home, but it’s not going to get us anywhere. Top down, pyramidal, heroic leadership that stays its course and demands it’s own way is simply not going to cut the mustard. We must have some brave and difficult conversations about the detrimental effects of making policy from the safety of ivory towers, and learn to really listen to the stories of those affected. We have so much to learn from the Leeds Poverty Truth Challenge, the Homeless Charter in Manchester, the Community Conversations in Morecambe Bay, the Cities of Refuge initiative, the Civil Rights movements, the Mediation work done in Rwanda…..we don’t have the answers right now. The problems facing the NHS are fare more complex than trying to ensure an undeliverable manifesto promise is outworked. We need humility on all sides, collaboration and partnership.

 

It goes deeper than people right across the UK needing to manage their own health and wellbeing more effectively. It is more complex than needing to recognise where there is waste and dealing with it. It isn’t just as straight forward as needing to talk about chronic under-funding and under-recruitment. We face an existential crisis, an ontological question about the future of humanity together. Resting back onto familiar ways of operating or antiquated leadership styles will simply not work for us any more. The black hole we face is either a death or the opportunity for re-birth. A squeeze that will force us into something new. We can’t keep dancing around it forever. We must take the plunge, accept that there is no going back and see what new creation we might just co-create with Love on the other side. Don’t be afraid…….there is light at the other end of the tunnel.

 

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The Junior Doctors And Lady Godiva

Tweet A few months ago I wrote a blog suggesting the right approach for the junior doctors was one of subversion and submission. But I think I was wrong. It’s not that I’ve changed my mind on the power of subversion and submission, it’s just that this entire spectacle surrounding the junior doctors, the ‘7 [Continue Reading …]

Doctors Must Unite Together For the Rising Generation

Tweet This week the health secretary, Jeremy hunt, tweeted this: “Moderate doctors must defeat the militants”. Here is a man I truly admire speaking some (slightly rude) truth to power. Sir Sam Everington knows a thing or two about the power of protest. Share This: