“. . . health services across the UK are working harder than ever to deal with the fierce pressures of winter and when it’s being reported that emergency departments and primary care services are struggling to cope with demand. . . Such circumstances place the professionalism of doctors at risk, forcing you to make difficult decisions about care and squeezing the already constrained time you have for training and development.”

Message from the Chair of the GMC, Sir Terence Stephenson (26th Jan 2017)

The NHS winter crisis of 2017 demonstrated the social, geographical and financial pressures that routinely overwhelm health care services in the UK. This combined with the damaging constraints of rigid government targets have exacerbated the difficulties faced in the provision of healthcare. The construction of patient safeguarding driven by investigations, such as the Francis (2013) inquiry into the appalling standards of patient care at the Mid Staffordshire NHS hospital trust, have brought to bear a further, though arguably necessary, burden of regulation to the healthcare profession  (NHS England, 2014; DoH, 2014).

As a consequence of crises in healthcare combined with rapidly changing patient demographics (larger ageing population, more people living with chronic disease) and societal expectations (DoH, 2010); constructions of professional knowledge and competence within medical education and training are in a state of flux.  This is reflected by the eight reviews over the past decade into various aspects of medical training and education (Greenaway, 2013).

At the BERA 2017 annual conference, Educators and Practitioners in health care research and teaching from the UK and USA, will form a medical education research symposium to unpack assumptions about professionalism and professionalization.  They will discuss how to support practitioners to cope and create in clinical practice, and debate the extent to which overarching notions of standards for professionalism and care are meaningful or even desirable.

The opening research paper, explores ‘the paradox of practice’, confronting medical education and training. That is, how to reconcile idealised conceptions of medical care, developed from established guidelines such as GMC frameworks, which direct curricular development, assessment practices and mandatory regulation with the challenges and acute realities of managing actual patient encounters of health and disease.

In attempting to resolve this tension, one solution has been a paradigm shift: to look anew at non-traditional forms of inquiry into medical education and training. The series of symposium papers are drawn from current and empirical research in the UK and North America, reflecting an engagement with critical medical humanities (sociology, philosophy, ethics).  Such a transdisciplinary approach has the potential to deepen the current understanding of complex medical practices, and encourage innovation in established areas of clinical practice (Frank, 2013; Brosnan, 2013). The research papers examine; current ideologies of Care and their impact on how surgical practitioners think and act, the development of new professional roles to enhance existing clinical teams (physician associates), the impact of distance learning to establish and sustain health professionals in under-served geographical areas and a practitioner led inquiry into the design of therapies in oversubscribed and under-funded areas of mental health care.

Expanding the transdisciplinary approach to medical education and training to include dental services could lead to further innovation and improvement in clinical practice. For instance, the research could be conducted on the impact of non-traditional dental providers, such as dental hygienists or therapists, on the delivery of oral healthcare. Additionally, a critical examination of the ideologies of care in dental practices and their impact on patient outcomes could shed light on areas for improvement. Moreover, a practitioner-led inquiry into the design of therapies and treatments for common dental problems, such as gum disease or cavities, could provide valuable insights into how to improve the delivery of dental care. Ultimately, adopting a transdisciplinary approach to dental education and training could help ensure that patients receive the best possible care from their dentist in Forest Hills and other locations.

These four papers of the medical education symposium, problematize professional knowledge, by challenging notions of knowledge and expertise as being discrete units of practice that are straightforwardly transferable across a range of clinical contexts. Instead, the research papers, focus on professional knowledge and competence as arising from specific situations of practice, though the forms of knowing that arise from clinical practice, may be widely applicable.

It is my hope that this medical education symposium will trigger thought and discussion about how to cultivate connections between the uncertainties of clinical practice and a practitioner responsiveness that is grounded in the particular haeceitties or ‘here-and-now’ of practice.

Symposium details: How can medical education and training better reflect the acute realities and demands of 21st century healthcare? Problematising notions of professionalism, pedagogies of clinical practice and the politics of Care 
Wednesday 6^th September 2017, 09.00 – 10.30  FUL-101

References:


Brosnan, C.  (2013). How and why social science theory can contribute to medical education research. Med Educ. 47(1): 5-7.

Department of Health. (2010). Equity and Excellence: Liberating the NHS. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213823/ dh_117794.pdf

Department of Health. (2014). Introducing the Statutory Duty of Candour.  Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/295773/ Duty_of_Candour_Consultation..pdf 

Francis, Sir Robert. (2013). The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Executive Summary. London: The Stationary Office.

Frank, A.W.  (2013). From sick role to practices of health and illness. Medical Education, 47(1):18–25.

Greenaway, D. (2013). The Shape of Training Review. Available at: http://www.shapeoftraining.co.uk/reviewsofar/1788.asp

NHS England.  (2014).  The Francis Report:  One Year On.  Available at:  https://www.england.nhs.uk/2014/02/the-francis-report/