Current and future paediatric training in the UK

Current and future paediatric training in the UK – adolescent health (training for the 21 st Century) Dr Andrew Long Vice President, Education, RCPCH Head of School of Paediatrics and Child Health, London DATE: 11 October 2013 Consultant Paediatrician, Great Ormond Street Hospital th

Educational Reform August 2002 – “Unfinished Business” February 2003 – “Modernising Medical Careers” July 2003 – “Choice and Opportunity” April 2004 – “MMC – The Next Steps” October 2007 – “The Tooke Report” May 2010 – “The Temple Report” October 2010 – “The Collins Report” November 2013 – “The Shape of Training” NHS Reform (Greenaway Report)

What does the future hold? • changing burden of childhood disease – less infectious disease – more complex care requirements – more social care issues • greater parental (patient) expectation – increased knowledge accessibility • increasing financial austerity – cost-saving measures – primary care initiatives • changes in healthcare delivery

21 ST CENTURY CHILDREN’S HEALTHCARE ISSUES • failures in acute care − mortality − crisis driven approach − 1 in 3 children < 1 yr admitted to hospital • rising burden of non-communicable disease − 36% neuropsychiatric • failure in long term condition management • major public health issues (eg obesity) • social care issues − 60% LAC with emotional and/or mental health problem • safeguarding issues • unacceptable variations in health opportunity

60 50 40 30 20 10 0 2005 -2007 Ingrid Wolfe, Lancet, Mar 2013 2006 -2008 2007 -2009 2008 -2010

60 50 40 30 20 10 0 2005 -2007 Ingrid Wolfe, Lancet, Mar 2013 2006 -2008 2007 -2009 2008 -2010

Asthma mortality and children with wheeze 0. 25 25 0. 2 20 0. 15 15 om n ai Mortality 6 -7 age group 13 -14 age group ni te d K in gd Sp U an m G er us A la Fi n rt ug Po ed y 0 tr ia 0 Ita ly 5 nd 0. 05 al 10 en 0. 1 Percentage wheeze 30 Sw 10 year SDR per 100000 (0 -14 years) 0. 3 Ingrid Wolfe, Lancet, Mar 2013

POLICY PRIORITIES • improving NHS for children and young people − equity to access of healthcare provision • mortality - preventing avoidable child deaths • mental healthcare provision • child protection and social care provision • tackling childhood obesity

CHANGE IN EMPHASIS • fundamental redesign of children’s healthcare models • more community focused models • focus on health promotion • focus on reducing variation • focus of broader determinants of health

Facing the Future (2011) Review of Paediatric Services • reduce inpatient sites (218 to c 170 with 32 new SSPAU’s) • increase number of consultants from 3084 to 4625 WTE • increase number of advanced children’s nurse practitioners, neonatal nurse practitioners and paediatrically trained GPs • reduce number of trainees by approx. one third – reduction offset by expansion in GP • emphasise importance of training in community paediatric settings

• • The doctor of the 21 st century · (in addition to providing excellent medical care) · must be able to lead in complexity, and be expert in systems and team based care · must be able to train other providers to do many tasks we currently do · must be stewards of healthcare resources · must improve care through practice audit and skilled analysis of patient outcome data · ? and more

Modern paediatrics?

Training the 21 st Century paediatrician • curriculum – – core knowledge teamworking/leadership professionalism global health • career paths • credentialling • collaboration • community • continuing professional development

Curriculum

The medical career path * * * The current NHS retirement age is 65 years

PHASED PROFESSIONAL CAREER Time since PHQ (years) 7 -10 17 -20 traditional portfolio crossover change over 27 -30 37 -40 47 -50

Information Technology • By 2020… • New technical information will double every 72 hours • 50% of what you know in first year will be out of date by third year • 5. 6 billion Internet searches will be done every month • 100 trillion bits per second will travel down one strand of optic fiber

• What Happens in an Internet Minute? • • 20 4: 17, 000 • 61, 141 • INkw +Om 01 f Nap clew nlliorls, • liermy +KA • music • • 20 million • 33, 000 • 204 rni II • Email ion Phele Verws • 3, 000 • Phoiruploach • In sales wrir • 320+ • blew T. hif. Fer • 05 ec stobcii 4 8 ota tronsierr 06 (ion: writs • 10131, 0110 New tweets • • 1, 300 100+ • kiwnwl. Aci i. u 4 tr 4 h. Frw linked • "135 • ixcitunr$ • 4 totr'41 ink -004$ • 6 • rieve WRipe 450 articles publnhecl • 277, 000 Lepi nd • 6 million • Fecelzeek views • 2+ million • And Future Growth is Staggering Seert h • • • 30 wide] vpkixled • Today, iha 11. 7 a number of • networized devicef, the global • F. D. pki. Latiec By 2015, the • In 2015, number of networked devices it would take giipbul • if& • 1. 3 million VKleo 7 iews • /74, , • g. Lerios • FIa. ursoi you 5 yours • http: //scoopintel. com/what-happens-in-an-internet- • I P • to view all 1 vide. 0 croni • IP networks 0. 061 second

A New Culture of Learning ? © Catherine Lombardozzi, Ed. D. 2010 What are the components that support learning in organizations? Can we curate or design a culture that will support the learning we want?

Components That Support Learning information databases degree program community of practice intranet resources Share. Point site how-to videos manager twitter feed Google books & journals trial & error tech support webinars discussion board professional organizations © Catherine Lombardozzi, Ed. D. 2010 teammates working with colleagues lessons learned meetings training podcasts procedure manual conferences public seminars job aids mentors industry blogs

Harold Jarche sense-making for the connected workplace

• learning participation Medical Education 2013 practice

Learning Environment Component Categories RCPCH Resources and tools 20% 10% 70% Relationships Formal Work-based In-the-job and networks training and programs and action and education practices reflection Learner Motivation © Catherine Lombardozzi, Ed. D. 2010

• LIFE NE f . com • HOME ABOUT EXAMS FOAMED EDUCATION RESOURCES ECG LIBRARY REVIEWS 'IMF JULY 9, 2013 • LITFL I FOAM • FOAM stands for Free Open Access Meducation • Medical education for anyone, anywhere, anytime. • The term FOAM was coined in June 2012 in a pub in Dublin, over a pint of Guinness during ICEM 2012 [watch the Dublin video] • FOAM is the concept, r. FOAMed is the Twitter hashtag. • FOAM is the movement that has spontaneously emerged from the exploding collection of constantly evolving, collaborative and • teractive open access medical education resources being distributed on the web with one objective — to make the world a better place. M is independent of platform or media — it includes blogs, podcasts, tweets, Google hangouts, online videos, text documents, nhs, facebook groups, and a whole lot more. Mike Cadogan ER Physician W. Australia • http : //1 ifeinth efa st lane. co m/fo

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Enrichment

Summary • 21 st Century problems need ₢ solutions • modern paediatricians need to be trained in a modern fashion • information technology can support learning • training needs to be balanced by good support and supervision • we need to train all paediatricians in generic adolescents skills and competences • some paediatricians may choose to spend more time undertaking this work • adolescent care needs multidisciplinary input