Training for the future: from 20th century medicine to 21st century healthcare delivery

The future of the NHS is at stake, or so the media tells us, and medical leaders are raising concerns and asking whether there will be an NHS in the future.

For those in the front line the changes seem inevitable. We therefore need to look at ways we can ensure that quality continues to improve. The key to the future is whether we are able to provide better quality and safer care in the NHS more effectively than we do now.

What we do now is better than in the past, but we have a long way to go. And we clinicians can demonstrate that we really mean what we say when we talk about protecting the NHS for quality and safety. Whatever the outcome, we should make sure that we have trained healthcare professionals who provide quality care and to know how to improve at all times.

I have been asked by a medical student to work on a project with a group of students who are trying to improve care for disabled children. They need to learn the skills that will allow them to understand how to improve outcomes. It is a privileged be asked – teaching how to improve care within the context of a clinical condition only takes a few hours of my time, after all. And it may result in improved care for the children, as the students will learn more than just clinical signs and symptoms.

On reflection, this illustrates where we need to improve the training of the UK's future doctors. Are we still training students and trainees for a 20th century approach in a 21st century world? Surely we should be teaching them how to implement change, improve care and understand the impact of continual change, as well as the usual subject matter required to be doctors?

With the call to modernise the NHS, can we take advantage of the changes imposed on the system to ensure that clinically led quality initiatives will reduce waste, increase efficiency and effectiveness and result in a safe, high quality, patient-centred service?

So, what should we teach our future doctors and nurses? Can we ‘train them for quality and safety’ as well as train them to be good doctors and nurses? Surely a good doctor or health professional is one who improves quality continually? This will require a total rethink on the philosophy of medical education; it is not only the craft of being a doctor or nurse that counts, but the philosophy underlying it.

Lucian Leape recently published the requirements for physicians in the future in terms of patient safety. The report opens by stating:

‘Health care delivery continues to be unsafe despite major patient safety improvement efforts over the past decade. The Roundtable concluded that substantive improvements in patient safety will be difficult to achieve without major medical education reform at the medical school and residency training program levels. Medical schools must not only assure that future physicians have the requisite knowledge, skills, behaviors, and attitudes to practice competently, but also are prepared to play active roles in identifying and resolving patient safety problems. These competencies should become fully developed during the residency-training period. This is not to say that we are not producing good clinicians in terms of the clinical skills and knowledge. We are not producing clinicians who can respond to the new needs of healthcare requires a model of treating the individual patient as well as understanding the wider context.’

In the UK, have the medical schools and deaneries responded to the new needs of healthcare and the changing environment? Can they say they have met the requirements set out by Leape? All one has to do is look at the curricula of medical schools and the websites of the deaneries to see that there is little in the way of patient safety and quality. As the knowledge base has increased, so the amount students need to cram in over the student years has multiplied exponentially. Patient safety is clearly not on the agenda.

Certain trainees are fortunate to benefit from fellowships focused on leadership and sometimes including improvement methodologies (in London, for example). However this is woefully insufficient.

We need incorporate the new way of thinking within the training schedule so that all students, and then trainees, can have this experience. I raised this challenge, to move beyond 20th century medicine to 21st healthcare delivery, at recent Deanery meetings. I fear that by the time there is a response and a change in focus in medical education, another decade will have passed.

Peter is a Consultant Paediatrician at Great Ormond Street Hospital and The Royal Free Hospital, and is a Health Foundation Quality Improvement Fellow.