News

Changing role of doctors

[ The University of Melbourne Voice Vol. 6, No. 5  3 May - 13 June 2010 ]

Geoff McColl (MB,BS, BMedSc, MEd, PhD, FRACP), Professor of Medical Education and Training and Director of the Medical Education Unit, reflects on the changing nature of our health system and the doctors of the future.

It is quarter of a century since I graduated from the University of Melbourne Medical School and started a career which has led to me being responsible for directing the University’s Medical Education Unit.

I am acutely aware of the importance of training doctors today so they have the skills and attributes that will equip them to be the best doctors both now and in 25 years. What will the health landscape look like in 2035? How will the role of the doctor change?

I could not have anticipated when I was training that there would be a such a significant shift to the use of evidence-based practice, the recognition that the patient should always be at the centre of decision-making, a focus on excellent communication and better patient outcomes because of new targeted drug therapy.

We are currently experiencing more significant changes to the health landscape. An ageing population, chronic health workforce shortages, increasing rates of chronic disease, rapidly changing new technology and escalating health costs are all impacting on the expectations of doctors nationwide.

This pace of change is more likely to escalate than diminish and the doctor of the future will need not just advanced clinical skills, but a broad view of medicine and the flexibility to deal with complexity and uncertainty. We may not be able to predict the future exactly, but we can ensure that our doctors have the skills, aptitude and attitude to survive and thrive however the health system changes.

When I studied medicine, the focus was on the acquisition of knowledge. In 2010, medical information is relatively accessible; ask the many GPs who see patients who have already googled every possible cause of their symptoms.

The issue today is how to use that knowledge to get the best outcomes for the patient within the context of a changing health care environment.

It is clear that, in the future, there will be a multi-disciplinary, team-based approach to healthcare delivery, where doctors will play a more strategic role working in close collaboration with nurses and allied health professionals. Doctors will be focused on the application of knowledge and leading teams to provide good health outcomes in the most cost-effective way.

The doctor of the future needs not only great medical skills but leadership ability, strong communication skills and management capacity.

It has therefore been a privilege to have the opportunity to reframe the way medicine is taught at the University and to be involved in designing the new Doctor of Medicine (MD), which takes its first intake of students in 2011. The MD builds on the strengths of nearly 150 years of University of Melbourne medical education, but then takes a fresh approach to what needs to be achieved in a medical program.

It was developed over two years through a process that involved a scholarly review of the medical education literature, examination of the medical education ‘best practice’ at bench mark Universities including Harvard, Cambridge and Stanford, a review of current course performance and, most significantly, consultation with those who are involved in the health care system – including students, patients, bioscientists, doctors, health professionals, medical educators, senior faculty members and health administrators – who helped us paint a picture of what was needed to produce the doctors of the future.

This innovative process identified the characteristics that form the framework of the new curriculum in six broad areas – self, knowledge, patient, medical profession, systems of health care and society. Of these, self and society particularly require something quite different of our students.

In developing self, students will be expected to understand and demonstrate empathy, compassion, honesty, integrity, altruism, resilience and lifelong curiosity; to recognise when clinical problems exceed their knowledge and skill and evidence a willingness to seek help; to identify and address their own learning needs; to manage uncertainty and to apply effective time management and organisational skills amongst other key skills and attributes.

In society, students will develop, for example, an understanding of the determinants of a well society and the economic, political, psychological, social and cultural factors that contribute to the development and persistence of health and illness; an understanding of the burden of disease in differing populations and geographic locations; knowledge of the principles of health promotion including primary and secondary preventions and the differing requirements of health care systems in a culturally diverse society.

Combined with opportunities to develop advanced clinical skills and to generate new knowledge through research in a field of their choice, these course characteristics drive a new approach to medical education designed to inspire and enable world class doctors to lead in the changing global health care environment.

www.medicine.unimelb.edu.au