Dr Kenneth McKenzie writes that the role of the medic is becoming increasingly more complex and that medical training must reflect this.
Although it always seems foolhardy to try to predict the healthcare landscape, it seems very unlikely that the role of the medic will not become increasingly more complex.
Traditionally, clinical excellence was the overwhelming criterion for professional advancement, with a period of training abroad often being seen as an additional but worthwhile step in their career. More recently, three roles have been added to this profile, in varying degrees depending on the speciality.
First, the relative part of research has grown substantially. Although numbers taking a PhD remain comparatively small, the undergraduate training component and the amount of research expected to be conducted at registrar level have increased significantly. The existence of a much larger research architecture that informs medical practice is seen in the budget and scope of organisations such as the Health Research Board and Molecular Medicine Ireland.
Second, the administrative side of the medic’s role has swollen. Medics now spend ever longer parts of their working week attending to administrative affairs, from managing clinical teams to overseeing budgets, to negotiating with hospital and HSE management.
Third, medics are now expected to exert influence in a headline-driven healthcare reporting climate. The extent to which even comparatively small or once-off healthcare events are the subject of intense analysis has increased beyond recognition.
Yet the medical training infrastructure, both at undergraduate level and after, has only partly shifted to reflect these intensified role demands. At undergraduate level, fuller coverage of research design and methods is apparent, while there has been an increased number of lecture hours given over to medical humanities with the aim of increasing reflective and patient-centred practice.
However, it would be fair to say that students logically pay less attention to these aspects of the course than the clinical sciences. This is entirely appropriate as the core curriculum is designed around diagnosis and therapy.
h4. Uptake of training
At registrar and consultant level, there is less than comprehensive provision and uptake of training in the domains that now reflect a substantial part of the medic’s role: understanding core financial data; leading and developing a multi-disciplinary team; research grant-winning; achieving the best representation of one’s views in the media; negotiating with senior administrators; and thinking strategically about the healthcare climate.
Anecdotally, it seems to be the case that some senior consultants will pay for interview and media training. More medics take an MBA, either generic or in healthcare, than before (but still in quite small numbers). Expecting medics to devote even more time to substantial blocs of education and training outside of the clinical specialisations is unrealistic and likely to be counterproductive. Integrating short, sharp training that has been demonstrated to develop managers in the business world seems much more promising.
There is a considerable body of research showing that training geared to specific transferable skills has solid learning outcomes. Applied social psychology research has uncovered some of the central parts behind increasing one’s personal impact on others; in better framing difficult arguments to convince people; in better understanding people’s perspectives to better shape dialogue.
Robust data from work psychology inform us of how and why people perform differently, and how to alter performance to the desired level. The use of elegant yet simple models from economic and business analysis improves one’s ability to think more strategically about the relevant operational environment.
Medics should rightly be cautious about giving up more of their day-to-day training that may seem tangential to the central role of being a medical professional. But medicine is simply too complicated and differentiated to be a domain where clinical excellence by itself suffices.
Making training relevant, digestible and convenient are prerequisites. The part to be played by each of the HSE, the professional bodies, the hospitals and the clinical directorates is of course a major question — answering it would presuppose some or all of the transferable skills listed above.
* Dr Kenneth McKenzie is a Business Psychologist with Pearn Kandola. He studied Psychology at Trinity College Dublin (1994-1998), where he was awarded the Graduates’ Prize, and studied for his PhD in Dublin City University (2000-4). He lectured in the School of Medicine, TCD from 2003-6, and then took up a post as a research social psychologist with the UCD Geary Institute (2006-8).
Kenneth is a member of the British Psychological Society, is an adjunct lecturer in the School of Psychology, TCD, and is an honorary research fellow of the UCD Geary Institute.
About Gary Culliton