Louie Fooks discusses how a new report by Oxford University’s Healthcare Values Partnership and the Royal College of Physicians on ‘advancing medical professionalism’ can help address some of the problems faced by doctors and the NHS
Louie Fooks is the Humanities and Healthcare Policy Officer for Oxford Healthcare Values Partnership
The government’s Long Term Plani for the NHS, published earlier this month, sets out its vision for a quality health service able to cope with an ageing and expanding population. But, as many commentators point out, without the workforce it needs to support it, the plan will not meet its objectives.
The healthcare challenge
More than 100,000 healthcare posts are currently vacant across the NHS and the number is likely to rise after Brexit. Indeed, the difficulty of recruiting, retaining, and ensuring the well-being of doctors has recently been described as a ‘crisis’ – with health organisations warning it’s a greater threat to the NHS than lack of funding.ii
Nationally, a quarter of doctors in training say they feel burnt out by high workloads and many are planning to reduce their hours or leave the profession early.iii And doctors report working in a culture of blame and fear which is jeopardising patient safety and discouraging learning and reflectioniv.
Yet all this is set against a background of an ageing population with complex health needs – increasing the demands we put on doctors and making it even more important that they can operate at their best. Healthy life expectancy at birth is currently 63 yearsv (against overall life expectancy of well over 80), with nearly half the population living much of their older years managing one or more chronic health conditionvi.
Medical professionalism – part of the solution
How then should we prepare and educate students and junior doctors for modern medical practice – and enable doctors to maintain professional satisfaction throughout their careers? Advancing Medical Professionalism (AMP), argues that enabling and supporting doctors to develop their professional identities is an important part of the answer.
AMP took as its starting point the RCP’s 2005 definition of professionalism as the ‘set of values, behaviours and relationships that underpin the trust the public has in doctors’. It built on this with a series of workshops with healthcare staff, patients and other stakeholders to explore what professionalism might mean for doctors in 2018 and beyond.
The RCP’s Dr Jude Tweedie, co-author of AMP, says: “Medical professionalism is extremely hard to define. As doctors, we recognise immediately when it’s absent and instinctively know that it’s essential to great patient care and physician satisfaction – but it can be very hard to quantify. So, we went out to talk not only to doctors, but to patients, academics, practitioners and others to find out what they thought.
The process was really fruitful and helped us identify seven key aspects of doctor’s working lives essential to professionalism, highlighting the many different roles we expect our modern doctors to fulfil. From this we were then able to develop practical strategies and approaches to promote professional values, skills and attributes in each area.”
Seven key aspects of professionalism. Doctor as:
- Patient partner
- Team worker
- Manager and leader
- Patient advocate
- Learner and teacher
Claire Pulford is the incoming Director of Medical Education for Oxford University Hospitals NHS Foundation Trust. She says: “The General Medical Council’s Generic Professional Capabilities have been adopted into the medical curriculum and give a much-needed basis for embedding professionalism in education and training. Advancing Medical Professionalism provides an excellent resource to support this – to start conversations with students, trainees and other colleagues – and help individuals, teams and institutions to reflect on, and develop, their practice. In Oxford University Hospitals NHS Trust we intend to use the AMP report as a toolkit to inform our development programmes for trainees and trainers and to explicitly reference it in our teaching, training, research, and Quality Improvement initiatives.”
Healthcare and Humanities
Professor Joshua Hordern, of Oxford University Theology Faculty and the Oxford Healthcare Values Partnership, sits on the RCP Committee for Ethical Issues in Medicine and co-authored the AMP report. He believes passionately that humanities disciplines can provide vital insights into the modern healthcare challenges we face. Hordern says: “Most doctors go into the profession with a strong sense of vocation and commitment. But heavy workloads and the increasingly complex context in which they practice take their toll. We hope the approaches in AMP can support doctors in sustaining values of compassion, respect and integrity, developing their vocation and professional identity, and refreshing their joy and confidence in the work they do.”
Professor Karen O'Brien, Head of the Humanities Division at Oxford University, has championed the collaboration between humanities and external healthcare organisations and believes the work on advancing medical professionalism is an excellent example of what this can achieve. She says: "The Humanities and Healthcare project embodies our commitment to supporting partnerships between academic departments and healthcare organisations. Humanities researchers bring insights and skills to fields of research and practice that require emotional intelligence, inter-professional understanding, and a deep appreciation of human complexity. The AMP report is an exemplary instance of this multi-disciplinary approach."
Find out more
With fully referenced sources for further information and a practical exercise at the end of each chapter, Advancing Medical Professionalism is available HERE and its short, accessible summary HERE.
About on the report
Advancing Medical Professionalism was authored by Dr Jude Tweedie, research fellow to the president, RCP; Professor Dame Jane Dacre, immediate past president of the RCP; and Professor Joshua Hordern, Associate Professor of Christian Ethics, University of Oxford. Professor Hordern leads the Oxford Healthcare Values Partnership and is a member of the RCP’s Committee for Ethical Issues in Medicine. Dr Richard Smith added to, and extensively edited, the report.
Oxford Healthcare Values Partnership is a partnership of University of Oxford researchers and healthcare staff seeking to understand and improve the ethos of healthcare services. Advancing Medical Professionalism was developed as part of the healthcare and humanities programme, generously supported by the Arts and Humanities Research Council.
[ii] The health care workforce in England make or break? November 2018, The Nuffield Trust, Kings Fund, The Health Foundation
[iii] General Medical Council National Training Survey 2018, published Dec 2018. https://www.gmc-uk.org/education/how-we-quality-assure/national-training...
[iv] Caring, supportive, collaborative? A future vision for the NHS, British Medical Association, September 2018.
[v] Health State Life Expectancies, UK: 2015 to 2017, Office for National Statistics, December 2018
[vi] Projections of multi-morbidity in the older population in England to 2035: Kingston, A, Robinson, L, Booth, H, Knapp, M, Jagger, C, & MODEM project. (2018). Age and ageing, 47(3), 374-380.