Title: Aspiring to Excellent Medical Practice
1Aspiring to Excellent Medical Practice
- - The role of the doctor the implications for
postgraduate medical education and doctors in
training
Professor David Sowden SRO MMC
2When a man reasoneth, hee does nothing else but
conceive a summe totall, from addition of
parceles or conceive a remainder, from
subtraction of one summe from another.for
reason.is nothing but reckoning.
Thomas Hobbes 1588-1679 Leviathan
3Why are we here there is currently no
strong consensus on the role of the
doctor at various career stages the
policy objective of postgraduate medical
training is unclear.
Sir John Tooke Aspiring to excellence
4And!
- consensus on the role of the doctor needs
to be reached by the end of 2008 (and the
service contribution of trainees better
acknowledged)
5The expert medical clinician
- distilling and dealing with complexity
- ability to make decisions in the face of
(considerable) - uncertainty and/or difficult circumstances
- effective and efficient problem solving
- taking legitimate risk via a process of
professional judgement - capability to lead in clinical settings,
especially in emergency - situations
- capability to demonstrate an intuitive grasp of
clinical situations - based on a deep, tacit, understanding of the
specialist or - generalist areas of practice
- capacity for intellectual leadership
6- a commitment to evidence based innovation in
clinical - care, and to establishing an evidence base
where none - or insufficient evidence exists
- commitment to the health of the population as
well as - the individual patient
- capability to support patients through the
clinical - pathway for example as care navigator and as
an expert - translator
- commitment to patient safety
- technical expert (relevant to some specialties
only) - experience
-
7Current problems with postgraduate medical
education (not exclusive !)
- language and meanings poorly understood
(competence, competences, competency) - trainer preparation and time to train, supervise
and assess - doctors are either trained or not trained
- time (Calman, MMC, EWTD, New Deal etc)
8Current problems continued
- Competence paradigm risks creating an inflexible,
reductionist approach to professional learning. - Does it aspire to produce expert practitioners,
partners and leaders?
9Consequences
- Since assessment drives learning competence
acquisition may become a tick box exercise - Focus moves to ensuring competency but not
proficiency or expertise - Language needs clarifying
- Competences may be acquired but at expense of
confidence and experience
10 The medical professional is ..someone with a
wide range of interventions available and who can
move cleanly and elegantly amongst them. Cleanly
and elegantly I like that we dont see the
joins or hear the machinery creaking. The least
we owe trainees is to keep the possibility of
this delight and elegance alive and to defend
time and space to discover them.
ROGER NEIGHBOUR The Inner Consultation
11Millers Pyramid
Does
Performing
Shows how
Competent
Knows how
Knowledge/understanding
Knows
12Summary of the Dreyfus Model of Skills Acquisition
- Level 1 Novice
- Rigid adherence to taught rules or plans
- Little situational perception
- No discretionary judgement
- Level 2 Advanced Beginner
- Guidelines for action based on attributes or
aspects (aspects are global characteristics of
situations recognisable only after some prior
experience) - Situational perception still limited
- All attributes and aspects are treated separately
and given some equal importance
13- Level 3 Competent
- Coping with crowdedness
- Now sees actions at least partially in terms of
longer-term goals - Conscious deliberate planning
- Standardised and routinised procedures
- Level 4 Proficient
- See situations holistically rather than in terms
of aspects - See what is most important in a situation
- Perceives deviations from the normal pattern
- Decision-making less laboured
- Uses maxims for guidance, whose meaning varies
according to the situation - Level 5 Expert
- No longer relies on rules, guidelines or maxims
- Intuitive grasp of situations based on deep tacit
understanding - Analytic approaches used only in novel situation
or when problems occur - Vision of what is possible
Eraut, M (1994) Developing Professional Knowledge
and Competence
14(No Transcript)