A number of overarching themes emerged from the Medical professionalism matters events, as outlined in this report.
Among the most frequently raised issues were the lack of time and support to make a reality of reflective practice. This applied at every stage of a doctor’s career.
Doctors also returned again and again to problems around professional isolation, fragmentation and poor communication. Improved leadership, teamwork and stronger patient partnerships were seen as ways forward.
Of course, many of the solutions to these issues are the responsibility of local leaders. There is a need to build the right cultures of compassionate care that support NHS staff to deliver their best, working in partnership with patients.
There are also implications for national leaders and organisations, especially in continuing the debate and supporting the kinds of changes doctors at the Medical professionalism matters events wanted to see.
Here we outline some key recommendations that the organisations represented on the Advisory Group – including the GMC – could take responsibility for beginning to implement.
Undergraduate medical education
- The GMC and Medical Schools Council should work with medical schools to make sure there is a stronger focus on understanding medical professionalism within the undergraduate curriculum. This should help students reflect on the realities of practice and the complex human interactions involved. It should promote self-awareness, wellbeing, safe ways to challenge aspects of care-giving and an understanding of the medical humanities and applied ethics.
- Together, they should also complement their Achieving good medical practice guidance with practical training and toolkits, focused on some of the key areas new doctors find most challenging, including caring for people at the end of their lives. Medical schools should strengthen their efforts to prepare students for the transition to practice. The principles set out in the GMC’s Generic Professional Capabilities Framework could be translated into undergraduate medicine.
The foundation stage and postgraduate medical education
- Foundation and postgraduate medical education programmes should place greater emphasis on the doctor’s role in leadership and quality improvement. This could be based on the standards of the Faculty of Medical Leadership Management, which focuses on the leader as an individual, the leader in the multidisciplinary team, and the leader in the system.
Lifelong learning and leadership
- The medical royal colleges and the GMC should work together to reinvigorate continuing professional development, with an emphasis on reflection and changing practice rather than ticking boxes. They should focus on the most challenging aspects of practice, including having difficult conversations and effective team working.
- There should be more focus on leadership development for doctors.
- The GMC and employers should support a greater emphasis in appraisal and revalidation on in-depth reflection, personal development and the doctor’s contribution to quality improvement.
Partnerships with patients
- Medical education and training should be more focused on meaningful patient involvement, including in-service design.
- In reviewing its guidance on consent, the GMC should work with partner organisations to enhance the materials available to help doctors make decisions in partnership with patients.
- Future Medical professionalism matters events should involve more individual patients and patient organisations.
A supportive culture
- The GMC, alongside other systems regulators and improvement bodies, should intensify their efforts to promote a culture of openness, learning and candour, recognising that the professional may be the ‘second victim’ when things go wrong in healthcare.
- All education and training organisations should increase their focus on interprofessional learning and challenging professionalism tribalism.
- All organisations can do more to recognise the intense pressures on the profession and make it more acceptable for people to ask for help when they are struggling. The GMC should continue to implement its programme of reforms to take account of doctors’ mental health when facing fitness to practise procedures and to minimise their negative impact.
- NHS Employers and the GMC should work together, and with systems regulators and partners across the UK, to provide further advice on how doctors can contribute to create well-led organisations.
Continue the conversation into 2017 and beyond
- All the organisations involved in this series of events should hold further discussions to make sure this important conversation continues.
- The organisations represented on the Advisory Group should come together again at the end of 2017 to review progress and take stock.
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