Authenticated user menu

Search
0
Blog
14 September 2017
Total views

A harsh spotlight on the undergraduate curriculum

There was a moment last week, while masquerading as the Finance Director of a beleaguered and fictional (but certainly realistic) Foundation Trust, that my lack of knowledge about NHS governance became painfully obvious. During an enlightening simulation designed to highlight the fractious interactions that can exist between Trusts, CCGs and politicians, I was disheartened at my own naivety about the NHS I have spent the last two years learning and working in. My colleagues were also perplexed that this knowledge hadn’t been presented earlier.

The National Medical Director’s Clinical Fellow Scheme is in its 7th year since inception. I am just one of 35 junior doctors in the 2017/18 intake, embarking on a fellowship designed to better our understanding of country-wide healthcare infrastructure, policy and priorities, whilst cultivating skills in leadership and management which we can take back to the clinical environment. These unique fellowships are placed within prominent healthcare organisations and arms-length bodies. I will be operating across two institutions at the forefront in promoting medical leadership, management and care: the Royal College of Physicians (celebrating its 500th Anniversary in 2018) and the Faculty of Medical Leadership and Management (far the younger, formed in 2011, but no less ambitious and high achieving).

It’s during the early stages of this year that clinical fellows receive an excellent crash-course of learning relevant to all junior doctors, not just those on the scheme. Teaching around how the NHS is funded and run, the fundamentals of leadership and how to influence and engage stakeholders. Enlightening as it all was, it shines a harsh spotlight on the medical undergraduate curriculum. How is it that doctors can qualify from medical school naïve to the local, regional and national management structure that governs their working? Why is it that confidence and ownership in leadership is not instilled in those formative undergraduate years, to allow for effective challenging and shaping of that governance? Maybe these are failures unique to me; the active learning and new understanding taking place amongst the clinical fellows during our induction, leads me to suspect this isn’t the case.

The popular opinion amongst junior doctors, and large swathes of other NHS staff, is that the Health Secretary Jeremy Hunt is wrong. Wrong about working conditions in our hospitals, wrong about student bursaries and wrong about creeping privatisation. In contrast, comments he made in November last year about increasing the number of clinicians in senior leadership and management positions have found more favour. The growing awareness and competitiveness of the clinical fellow scheme reflects the wishes of junior doctors to have greater influence in the national make-up of our NHS.

But, crucial to appreciate, is that leadership skills are not just relevant to those with aspirations to be their trusts next chief executive. Whether they describe themselves as such or not, all doctors are leaders. Leadership is visible on wards and in GP surgeries every day of the week; it needs labelling as such and targeted for reflective practice and betterment like all aspects of clinical practice. By engaging in this fellowship, I am in no doubt I will have opportunities to practice my own skills and improve. But should it be reliant on special experiences like this to provide this knowledge?

Medical schools should be the foundation for this learning. From my own personal experience, it was too easy to leave university with these knowledge gaps. There seemed no attempt at embedding leadership development within the curriculum; no utilisation of clinical rotations to meet trust executives, attend high-level meetings or ‘understand’ the NHS. The Medical Leadership Competency Framework attempted to redress this and gave practical tips to curriculum setters. Have universities taken the time since its publication in 2010 to effect changes? Not that I observed during my undergraduate years.

There must be a shift in culture. In medical school, ideas are formed about career trajectory. Early surgeons, medics and GP’s aspire to those specialities and cultivate CV’s to propel them along that path. No-one I knew at medical school wanted to be a medical director, but students can’t aspire to be what they’re not exposed to. FMLM have done plenty in professionalising medical leadership and highlighting it as a career option; more needs to be done at the undergraduate level to support this.

There was an endless list of learning points from the early days of the clinical fellow scheme. Chief among them for me: that the provision of leadership and management development in medical schools must be improved. It can no longer be the sole realm of excellent ‘out of training’ opportunities such as the National Medical Director’s Clinical Fellow Scheme to deliver this learning. It is vital we inspire our undergraduates to pursue careers in management positions, and equip all with the necessary knowledge and skills to navigate and shape a changing NHS.

Follow Lewis on Twitter

 or  Register to add a comment

Array ( [0] => sitewide [1] => advert_external_leaderboard [2] => not_front_desktop [3] => advert_external_wideskyscraper [4] => comments [5] => comments_login_prompt [6] => jobs_content_pages [7] => node-social-accelerators [8] => node_blog [9] => related_content [10] => advert_internal_desktop )