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St. Luke’s Symposium hears from Former Head of U.S. Food & Drug Agency
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St. Luke’s Symposium hears from Former Head of U.S. Food & Drug Agency

Each year, RCPI’s St. Luke’s Symposium presents a programme of groundbreaking medical advances.

At No. 6 Kildare Street on 16 October, as part of a panel session titled “Career Pathways in Modern Medicine,” a keynote address was given by Prof Robert Califf - a cardiologist at Duke University Hospital North Carolina, and former head of the U.S. Food and Drug government agency during the Obama and Biden presidencies.

“In the U.S, we’ve seen a percentage-drop in people’s confidence in medicine as an institution,” said Prof Califf, whose keynote address was about delivering clinical leadership in disruptive times.

Prof Califf spoke to the corroding effects of a U.S. culture regarding medicine as foremost a business rather than a service. The incentivising of clinicians to optimise parts of the system they work in has led to “dead zones” elsewhere. He cited a study by the research non-profit Kaiser Family Foundation, which identified counties in the U.S. lacking in high-speed internet and access to healthcare as having the highest percentage of diagnosed diabetes.

“The ideal would be to develop a federated community of healthcare professionals and biomedical scientists working together to foster a connected health science ecosystem that listens to the public and communicates effectively," said Prof Califf, arguing for an evidence-based approach rather than one driven by policy and politics.

He spoke of the importance of adapting to an age of malinformation. “Most of the information our patients are seeing on social media is not reliable information about health,” he said. “If you didn’t want to wage a war, another way of doing harm would be convincing a lot of people not to use medical products that are good for them.”

Prof Califf said that in many ways the profession of doctor is being attacked in the U.S. However, there are encouraging signs of trust. “In the US people trust the people they’re seeing, not the system. That’s an advantage we can use.”

He remains concerned about the path taken by the U.S. “I think the instability in the U.S. will bring us to further collapse in the system,” he said.

Irish perspectives on how to navigate a career in medicine were also given. Prof Edward McKone (dean, RCPI Institute of Medicine) gave a presentation about the reframing of general medicine training to meet an anticipated increase in demand for general internal medicine activities. To meet the needs for a future population, general medicine specialties such as geriatric and respiratory medicine will require expansion.

Under advice from the Medical Council of Ireland, the college’s Institute of Medicine undertook a formal review of Basic Specialist Training (BST) in General Internal Medicine education and training. Following the commissioned report Optimisation and Progression of Training in Internal Medicine – In Search of Excellence (OPTIMISE), which benchmarked practices in Ireland against models abroad, a change has been proposed to change the two-year programme to a three-year programme, comparable to the UK.

Based on feedback from the college’s Higher Specialist Training (HST) trainees, a recommendation was made for a more trainee-centric experience during BST General Internal Medicine, to ensure readiness for transitioning to HST. Concerns from Model 3 hospitals about inadequate numbers of trainees allocated to their sites also fed into proposed changes – which suggest more efficient pairings of Model 2 and 3 hospitals with Model 4 hospitals.

Prof McKone shared draft designs for a three-year BST General Internal Medicine programme wherein Year 1 would involve rotating between eight posts each lasting six weeks, with an emphasis on “dual” specialties involving General Internal Medicine. Rotations would extend to three months in Year 2 and 3, with emphasis on exposure to specific specialties, and a maximum six months posted in a Model 3 hospital.

Prof McKone also mooted potential for a separate Higher Specialist Training in General Internal Medicine programme further down the line.

A Medical Council perspective on a changing healthcare environment was also given by its vice-president, Mary Davoren. Ms Davoren said the Council has introduced changes based on feedback from doctors who find complaints made against them to be difficult to deal with. “We need to acknowledge the psychological consequences of the complaints,” she said.

Ms Davoren said that under new changes: “Complaints that are obviously and clearly vexations, and that are frivolous and not made in good fate, the CEO can deal with directly without having to go to a Preliminary Proceedings Committee, which is a process that can take weeks.”

She also said that doctors wishing to submit new undertakings in response to complaints can now commit those undertakings to the Preliminary Proceedings Committee, which may prevent complaints from proceeding to the fitness-to-practice stage.  

The different paths taken by early-career consultants and non-consultant hospital doctors were also heard. Dr Ellen Cosgrave, a recipient of the RCPI and Health Service Executive’s ASPIRE Fellowship for doctors who recently completed the college’s HST programmes, spoke of her time on the HST Public Health Medicine programme – being posted at HSE Public Health Dublin and South-east offices during the COVID-19 pandemic, and spending her final year training at World Health Organisation headquarters in Geneva.

Others spoke of bringing the skills they learned in Ireland back to their home country. Dr Awadelkareem Mustafa, an internal medicine doctor from Khartoum Sudan, is currently posted in Midland Regional Hospital Tullamore as part of the HSE’s International Medical Graduate Training Initiative (IMGTI). He said he was impressed by the multi-disciplinary healthcare patients receive in Ireland. “That was a new experience for me. In Sudan, if a patient had a stroke, there wouldn’t be a multi-disciplinary team.” The symposium also heard from Dr. Dana Alyaqout, who works as a paediatrician at Jaber Al-Ahmad Hospital in Kuwait City after completing RCPI’s International Clinical Fellowship Programme in Paediatrics. Dr Alyaqout trained in Ireland in order to gain exposure to adolescent health, and now wants to collaborate with Irish peers to build better adolescent health infrastructure in Kuwait.

“Collaboration is the heartbeat of the challenge. Mult-nation collaboration. That will build a better future,” she said.