Clinician Hyphens

I was interested to read a debate on Twitter today, started by @welsh_gas_doc, discussing the major gaps were in medical undergraduate education. Some argued that basic science was missing, or that their course was too heavy on that, but did not show the clinical relevance of it. Of course, it is difficult to know what skills a doctor should have, especially once they take on additional non-clinical roles, as is the norm. Some training in non-clinical areas related to medicine already occurs in undergraduate and post-graduate medical education. Indeed, @welsh_gas_doc mentioned that management was now part of the course for Fellowship of the Royal College of Anaesthetists.

This is not new, because basic science is not strictly clinically-relevant all of the time. But there is a new professionalisation. For a decade, the MRC has been running the National Clinician Scientist Award Scheme, which is a prestigious scheme to fund research by top-rate scientists who also are clinicians, recognising that having a cadre of people who work as clinicians and as scientists is a boon to both fields. Of course, most doctors do (or have done) some audit or research work at some point, and the clinical academic is a common sight in any hospital or GP surgery. But in the past decades, things have been greatly formalised and, for want of a better word, professionalised. There are now distinct clinical academic career pathways. There are even academic foundation programmes, so that the most junior medical staff - none of whom will have passed membership exams - can now be involved in clinical or clinically-relevant research.

But it is not just basic science that can influence healthcare outcomes, and perhaps we should build cadres of clinicians with well-defined post-graduate training in other non-clinical areas. The clinician-educator, for example, is now a distinct breed, with many opting to do clinical fellowships in medical education.

Infection control teams have input into hospital design, and there are some doctors-turned-architect, like the American George Tingwald. But could there be future professional training in design for some clinicians, so that they can make informed input into design that encourages safe medical practice? Or future professional training in management for those whose interests lie way? Policemen and army officers being promoted to command roles go on courses to train them in management, so why not make a cadre of clinician-managers, whose training in management theory and background in clinical work would both be of benefit. Perhaps we should not rely on a small number of doctors to get themselves MBAs or pick up management on the job, but instead recognise their value and train them for it.