The new year of 2013 has begun for the Faculty with the same focus of activity as 2012 finished. The agenda for the year has been firmly established with 2013 shaping as the year of the curriculum redesign. The planned introduction of our revised curriculum, commencing in 2015, will entail great commitment and sustained efforts over the coming two years.
The guiding principles of the curriculum redesign have their basis in the outcomes of our “blueprinting” process conducted over the last two years. The blueprinting process documented the core skills and attributes, unique and essential to a specialist pain medicine physician. Having identified these core themes of our vocation, the revised training scheme will ensure our trainees are taught and examined in a curriculum which will deliver the quality specialist we need for the future.
This year has begun with a successful series of face to face meetings across New Zealand and all the states of Australia. The information evenings allowed for the early proposals for the new curriculum to be explained and an opportunity for critical and constructive feedback.
The rigorous debate which occurred during these visits has strengthened the basis of the new curriculum.
This project is the most significant and ambitious undertaking of the Faculty since the initial curriculum was developed fifteen years ago. The process will require active input from fellows to be successful, especially those with direct contact with trainees. The proposed changes will affect all FPM Fellows in teaching hospitals and all future trainees. An early, accurate and thorough understanding of the proposed new curriculum, associated fee structures and training implications is essential.
In the most basic sense, a profession is defined by the sacrifices required, during training and examinations performed to obtain the qualifications of that profession. The introduction of training and examinations for pain medicine in the late nineties gave definition to the Faculty and to the qualification of FFPMANZCA. This qualification has grown in prestige over fifteen years to the current state of recognition as a standalone speciality in Australia and New Zealand. In the same way, the review and redesign of our training curriculum will continue to define our speciality and to maintain the quality of our fellowship.
The recent publication of a report into the administration of National Health Service (NHS) in a regional of the United Kingdom serves to remind us of the importance of the third pillar of our 5 year Strategic Plan: “Build Advocacy and Access”.
An alarming but recurring theme over recent years is the vulnerability of health care to the competing political agenda of cost savings.
Eminent American opinion leader Dr Daniel Carr has previously published his foreboding insights on this topic, in a series of articles and addresses themed “When bad evidence happens to good medicine”. In his writings, he warns of the increasing political misrepresentation of medical statistics and meta-analysis, to improperly justify, often drastic limitations on health expenditure. He warned that the ambitious, clinical agenda to achieve an “evidence based medicine” approach is frequently being improperly represented, to limit health funding where politically convenient.
In today’s political context of necessary austerity, we need to be, more than ever, aware of misrepresentation of evidence and deliberate undermining of our professional and clinical requirements, to justify politically driven cost cutting.
In this regard our plight is an international one. The recent “report of the Mid Staffordshire NHS Foundation Trust Public Inquiry” released in February 2013 was damming in its condemnation of the “saving at all costs agenda of the Mid Staffordshire NHS Foundation Trust”.
The inquiry was empowered to investigate the serious failings of the foundation trust, whose mandate was delivery of healthcare in that region of the UK.
In the words of the report;
“the story it tells is first and foremost of appalling suffering of many patients. This was primarily caused by a serious failure on the part of a provider trust board”. It makes further reference to,
“tolerance of poor standards and disengagement from managerial and leadership responsibilities. This failure was in part the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care”.
We in Australia and New Zealand must all be vigilant and firm in our advocacy for patient care, when the motives of hospital administrators may lead them to be reckless with the interest of good health care, in order to meet targets based solely, or primarily, on their fiscal performance.
We can look forward optimistically to both the challenges and potential achievements of the year ahead.
Associate Professor Brendan Moore,
Dean, Faculty of Pain Medicine