Title: Tooke and the College Professor Dinesh Bhugra Dean The Royal College of Psychiatrists
1Tooke and the CollegeProfessor Dinesh
BhugraDeanThe Royal College of Psychiatrists
2- Professional is some one who can do his/her best
work when he/she does not feel like it - Alistair Cooke
3- Starr P (1982) (a) profession is an occupation
that regulates itself through systematic required
training and collegial disciplines, that has a
base in technical specialised knowledge and that
has a service rather than profit orientation
enshrined in its code of ethics
4Charter of Professionalism (Am Coll Physicians)
- Primacy of patient welfare, patient autonomy and
social justice - Commitment to professional competence, honesty
with patients, patient confidentiality,
appropriate relations, improving quality and
access to care, just distribution of finite
resources, scientific knowledge, maintaining
trust by managing conflicts of interest,
professional responsibilities of being respectful
of one another, maintaining patient care, self
regulation including remediation and disciplining
5- What society expects?
- Services of the healer
- Assured competence
- Altruistic service
- Morality and integrity
- Accountability
- Transparency
- Source of collective advice
- Promotion of the public good
- Creuss 2006
6- What medicine expects?
- Trust
- Autonomy
- Self-regulation
- Health care system value driven
- adequately funded
- Participation in public policy
- Shared responsibility for health
- Monopoly (?)
- Status and rewards respect, financial
- Creuss 2006
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9- Now the threat emerges from perceived equality,
internet and increased ease of availability of
knowledge, broader spread of specialisation,
changes in policy, problems with funding
10Four Core Attributes of Professionalism
- Four Specialised knowledge
- Relative autonomy in practice and privilege of
self regulation - Altruistic service to individuals and society
- Responsibility for maintaining and expanding
- Professional knowledge and skills
11Yesterday
PG Deans
GMC
Service
College
12Tomorrow!!!
Schools
GMC
Postgraduate Deans
MMC
Service
PMETB
College
13Old system
Postgraduate Deans
STA
GMC
Local interview
RITA
Interview
Registration
MRCPsych 1
MRCPsych 2
The Royal College of Psychiatrists
14How does it all link up???
GMC
PMETB Policy, content outcome
Registration
CCT
MRCPsych1 2
RITA
WPBA
Speciality selection
Specialist Schools
RCPsych
Postgraduate Deans
Modernising Medical Careers-framework
Implementation
15PMETB MMC
- Non Statutory
- DH Funded
- Accountable to DH
- Implementation
- Supports others in implementing standards
- Workforce numbers
- 4 separate programmes
- Statutory
- Independent
- Accountable to Parliament
- Policy
- Standard setter
- Workforce shape
- 4 nations integrated
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17Tooke Review major findings
- Deprofessionalisation
- Medical leaders and relationships
- Workforce planning
- Increases in medical students
- Unclear policy objectives
- No consensus on doctors role
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21Assessments
- Fit for purpose
- Purpose specified and available
- Sequence of assessments
- Content based on PG training
- Methods Reliable, valid, feasible, cost
effective - Transparent methods
- Assessments provide feedback
- Assessor selection and training
- Lay input
- Documentation standardised and accessible
- Sufficient resources
22MTAS/MMC Fiasco
- Reasons
- Arrogance
- Ignorance
- Ineptitude
- Inability to listen
- No piloting
23Lessons for the College
- Time to get control back
- Time for medical leadership
- Concerted effort
- United voice
- Deprofessionalisation of medicine
24Tooke Solutions
- Doctors need to develop consensus re their roles
- PMETB merge with GMC
- Reduction in medical students
- Relationship of deaneries with medical schools
25Tooke Solutions
- DOH should appoint Director for Training and
Director for Medical Education - Selection into specialties through examinations
- Split FY1 and FY2
- Merge FY2 with ST1 to ST3. FY2 becomes first
year of core specialty training - Increase of GP training to 5 years
26Tooke Solutions
- Profession should find a way of communicating and
providing coherent advice on matters affecting
the whole profession - There must be clear shared principles for
postgraduate training and an aspiration to
excellence
27Tooke Solutions
- Independency between education, clinical service
and research should strengthen its links with
DOH, NHS providers and other government
departments - Career aspirations and choices should be informed
by accurate data on likely employment prospects - Colleges to develop modulated curricula
-
28Tooke Solutions
- Staff grades to be called Trust Registrars
- Doctors should be allowed to interrupt their
training for up to 1 year (or by agreement
longer) - Selection into higher specialist training will be
informed by the Royal College
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30Professionalism
- Professionalism comes from a large and broad
knowledge base, service provided which is related
to those who benefit from the relationship,
relationship is honest, fair, legal, ethical,
professionals can speak on public policy, are
independent of the state, educated rather than
trained and have legitimate authority. - Downie (1990)
31Professionalism
- Caring is the core business of medicine and
autonomy is part of the professionalism.
Therefore self-regulation becomes essential. The
attacks on self regulation and guidelines turn
doctors into technicians.
32Professionalism
- Medical Professionalism has
- Principles of primacy of patient welfare
- Patient autonomy
- Social justice
- Professional responsibilities related to this are
the key
33Components
- These are
- Commitment to Professional Competence
- Honesty with patient
- Improving quality and access of care
- Just distribution of finite resources
- Scientific knowledge
- Maintaining trust
34Factors in deprofessionalisation
- Political climate
- ? Patient knowledge
- Alteration of roles
- Nurse prescribing? Psychologist prescribing
- Prescriptive policies
- Increased regulation
- Reduced autonomy
- New ways of working in England
35- 66 attendees at the AGM
- 5 questions
- Semi Qualitative
- Themes
- Contents
- Not scientific
361. What do you understand by professionalism?
- This question caused some difficulties as a wide
range of components were described. These
included professionalism being a vocation, or a
group identity, having a clear emphasis on
skills, training, ethics, autonomy,
responsibility, accountability, competency,
expertise, integrity, maintaining standards, self
governance, and evidence base of practice among
others. Two common themes to emerge were
knowledge and skills and standards. Training to
achieve and maintain these was considered to be
significant part of professionalism.
372. Definition included additional factors
- (not mentioned in the above as was code of
practice)
383. Defined by whom and owned by whom?
- An overwhelming majority (45, 68) acknowledged
that professional bodies define whereas the
remaining responses were split between the
society and the individual. Interestingly 8 (12)
indicated that we (assuming professionals)
define it.
394. Is professionalism important?
- Two respondents said it was probably important
whereas one was negative. One respondent thought
it was more important than before and one felt
it to be less so. The rest ( 59 out of 66 who had
responded to this, 89) gave an unequivocal yes.
405. What are the threats to professionalism
- Among over 20 threats identified, three major
threats were the government, media and other
disciplines and specialties. Both external and
internal threats were noted. Loss of autonomy and
self regulation was reported to be an important
threat. Among other factors the mental health
czar, pharmaceutical companies, scientology, New
Ways of Working, MMC and MTAS, learned
helplessness were identified.
416. What should be done?
- The college was seen as a significant factor in
challenging the threat through training,
education, unity, working with others to raise
standards and increased awareness through
expertise, guidance and peer support.
42- As one respondent put it succinctly,
professionalism is an individual response to the
highest demands of the chosen profession.
Another respondent suggested, Professionalism
involves conducting ones self in the practice of
ones knowledge, skills and training with
integrity, respect for others and expert
competence. Professionalism involves putting
others needs and good before ones own needs and
it involves keeping up to date in ones
knowledge, skills and practice. Professionalism
implies wisdom in practice!
43Solutions
- Out of the chaos come solutions define the role
clearly - Doctors take control back
- Take patients and carers with us
- Work with allies without giving professionalism
away - Strategies to deal with policy makers must change
44- 2-day seminar scheduled 22ND 23rd October
- One day open meeting- January 21st
- A two day open meeting in July
- Give feedback now and later
45- To accumulate authority a group must first agree
speaking with one voice conveying authority - Sox 2007
46- They think theyve beaten us at our own game
- Poor simple minds
- Every chess master knows in the quest for victory
- he will concede minor defeats
- They may have won at the roundabout
- The game is far from over
- They think they've beaten us
- We smile and say
- Welcome to the Next Level
- Hoag (1995)
47 - There needs to be a common shared understanding
of the roles of the doctor in the contemporary
health care team. Such clarity must extend to the
service contribution of the doctor in training,
the certified specialist, the GP and the
Consultant. Such issues need to be urgently
considered by key stakeholders and public
consensus reached before the end of 2008.
Education and training need to support the
development of the redefined roles.
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