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To perform, and to be seen to perform

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Medical Board of Australia Chair Dr Joanna Flynn has raised the possibility that doctors be required to undertake communication skills training as part of their on-going professional development.

An AMA National Conference policy session on medical self-regulation was told that most complaints made about medical practitioners revolved around behavioural issues rather than technical performance, prompting discussion about ways to improve the communications skills of doctors.

Panellist Associate Professor Matthew Thomas, a specialist in human factors and safety management, said that for too long technical and communication skills had been viewed separately, and he welcomed the move in recent decades to include interviews as part of the selection process for admission to medical school.

Dr Flynn raised the possibility that training in communication skills could be made a mandatory component of Continuing Professional Development (CPD) requirements, though she qualified this by adding that there was “no point in creating something meaningless”.

But A/Professor Thomas said communication skills could be learned like any other, and should be a focus of training.

The discussion formed part of a broader debate about the regulation of the medical profession and assurance about the quality of care it provides.

In particular, the panellist discussed the implications of extended working lives, and the growing number of practitioners.

Dr Flynn said official figures showed that an increasing number of procedures were being performed by doctors over the age of 70, and the number of complaints per hours worked increased as practitioners got older.

The MBA Chair said cognitive decline and a loss of physical agility were aspects of ageing that could affect performance.

The Medical Board is currently considering the introduction of a revalidation process to ensure practitioners remain fit to practice medicine, and Dr Flynn said one of the aspects under consideration was whether revalidation should be “stratified” to address particular characteristics such as age, volume of work, and sole versus group practice.

Increases in the medical workforce also have implications for quality.

One of the concerns about sole practitioners is that there is not the informal safety net of colleagues who can pick up problems in the way they practice.

By contrast, working in a group environment increases the ability to share workload, reducing the likelihood of errors caused by fatigue and pressures of time, and it also reduces the pressure on individual doctors to ensure continuity of care.

A/Professor Thomas said the development of a team-based approach to continuity of care was welcome: “The world is not going to end if there is an end to the ‘one doctor, one patient’ model of care”.

He said working in a team could also provide an extra layer of assurance around performance, because any shortcomings in the performance of one practitioner would be extrapolated to the team – meaning all had a vested interest in holding up standards.

Adrian Rollins

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