Education for Deprivation Medicine

Professor Jacky Hayden CBE

“I desire no other epitaph… than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.”

– Sir William Osler,

There should be in every school of medicine one or more teachers who have

been in general practice for 10-20 years...he would have had the opportunity

for knowing how to assess the value of symptoms

Mackenzie 1919

The role of the doctor

• Leadership • Dealing with complexity and managing uncertainty • Effective and efficient problem solving • Working with patients to take legitimate risks and

effectively managing risk by providing information alongside professional judgement to maximise patient independence and choice

• Grasping clinical situations intuitively based on a deep, tacit understanding of their area of practice

Changing patient needs• 42% have a long-term

condition • 23% have multiple conditions • Onset 10-15 years earlier if

socioeconomic deprivation

Changing Technologies

The constants• Ability to:

– work in teams and lead them – manage risk and explain risk to our patients – measure and improve quality – explain treatment options clearly and fairly – empower patients to take responsibility for their

own health – motivate and inspire the next generation

The constants

The educational framework• Knowledge • Skills • Values and beliefs • Assessments

Knowledge• Population medicine • Determinants of health and well being • Healthy communities

Skills• Making a diagnosis in context • Agreeing management plans in context • Giving autonomy to the patient to manage their own

condition – Negotiation – Listening – Empathy

Values and beliefs

The workforce will have adaptable skills responsive to evidence and innovation to

enable ‘whole person’ care, with specialisation driven by patient rather than

professional needs.

Respect and dignity We value every person – whether patient, their families or carers, or staff – as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. We take what others have to say seriously. We are honest and open about our point of view and what we can and cannot do.

Learning professional values and qualities

• Patient based narrative • Peers • Mentors • Discussion and testing of ethical principles • Culture and learning environment

Living our valuesIf we tolerate •unfairness •rudeness •inequity

how will our juniors learn our professional value of respect?

Living our valuesIf seniors are •hierarchical and aloof •disrespectful of others’ opinions and contributions

how will our trainees learn the importance of valuing the opinion of patients and carers?

Good decision makingDecision making is hampered when we are: •Tired •Stressed •Treated unfairly •Working in an environment where the culture is hostile

Heffernan

Doctors who consult effectively reduce antibiotic prescribing

Paul Little

Patient Preferences Matter – The silent misdiagnosis. Mulley Trimble Elwyn

Supporting learners• Time and space to explore with the patient what

impact their illness has on their life and their life on their illness.

• Time for trainees to share and discuss with teachers their thoughts about the patient and their illness

• Clinical placements/posts which offer a full range of patient encounters

Supporting learners

Working patterns that allow for deep thought

Supporting educators• Support and challenge

– Time and willingness to seek and value trainees’ opinions

– Skills in critical listening – Skills in delegating (not dumping) – Enthusiasm – Skills in delivering difficult messages clearly and

kindly with a plan to move on

Generic Professional Capabilities

…and finally

Assessment drives learning.

Learn from the mistakes of others. You can never live long enough to make

them all yourself.

Groucho Marx

Resources

• Five Year Forward View • HEE Mandate • GMC Developing a framework for generic

professional capabilites • Margaret Heffernan - Willful Blindness • Wendy Levinson - Understanding Medical

Professionalism • Mulley Trimble Elwyn - Patient Preferences

matter