Evans, Zara

Evans, Zara
Start date:
October 2018
Research Topic:
Medical Education
Research pathway:
Research Supervisor:
Prof Alison Bollock
Supervising school:
Primary funding source:

Research Proposal – The Training of Doctors for the Future in Wales

Current modes of organisation in healthcare provision based on discipline-based specialisation are not ideally calibrated to caring for patients with complex needs (Vera and Kunz, 2007). This has lead Healthcare providers globally to consider alternative arrangements (Baker et al, 2006). There are calls for a shift away from single-disease frameworks to enhance efficiency, safety and effective health coverage (Smith, et al. 2012; KPMG International: 2013). Doctors who acquire inter-specialty expertise can help address these challenges by bridging gaps in existing provision (Muddiman et al, 2016).

The NHS Future Forum (England), in its report to the Government on education and training in January 2012, re-emphasised the need to develop a more flexible career pathway for doctors and a means of fostering generalism in the community and the hospital. These issues were core to the Shape of Training Review (Greenaway, 2013). There was consensus that change should deliver greater feasibility, better preparation for working in multi-professional teams and more generalists (Greenaway, 2013: 3). The report calls for a new approach to postgraduate training in the UK. There is a growing body of evidence to support this new approach, and it is timely to explore current initiatives that have been developed in response to the report.

Although it is widely argued that a more generalist approach is needed to deliver healthcare services that meet the demands of multi-morbidity and complex care needs, there is little consnsus on what constitutes generalism and a range of different definitions exist (Imrie et al, 2011). One Royal College defines generalism as:
a philosophy of care with acknowledgement by the physician that broad based comprehensive care is provided and the generalist physician is prepared and willing to reach across the existing gaps in the healthcare delivery system. A generalist specialist works directly with primary care providers, Family Physicians particularly. Generalists are able to develop their clinical practice to meet community needs and refrain from narrowing their practice (Royal College of Physicians and Surgeons of Canada, 2011).
There is no single Welsh policy document on integrated care, but aspects of the concept appear in many policy documents. Indeed, the creation of the unified Local Health Board’s in 2009 was intended to provide a vehicle for bringing all elements of local health services into alignment.

The integrated NHS Bodies will accelerate the development of new simplified, integrated services. Confusing, disconnected services fail people and do not make best use of scare resources. (Welsh Government, 2011).
With sustainability now at the core of the current agenda for the NHS in Wales, making reality of this unified system for health is identified as one of seven major areas requiring change (Lewis, 2015).

2. Research Aims and Objectives
My principal research question is: how does current training need to develop to address healthcare demands arising from demographic and social change in the nation? The objectives are to:

  1. critically analyse what constitutes generalism.
  2. identify innovative practice in medical postgraduate training in Wales, from the perspective of senior clinicians in NHS Wales.
  3. explore views and experiences of medical trainees in innovative programmes.
  4. seek to understand innovative practice in the context of wider healthcare agendas and theoretical perspectives.
  5. identify the obstacles and enablers of wider roll-out of innovative practice.

3. Methodology

The research will be exploratory in nature as it seeks to investigate innovative approaches to postgraduate medical training and practice. My methodological approach will be informed by engagement with the literature and discussion with my supervisors. I anticipate adopting a mixed methods approach including data collected from desk-based research, observation from site visits, focus groups and one-to-one interviews. Other methods maybe included depending on the outcomes of initial research. In determining ‘what’ and ‘how’ to research, I will also make explicit my views on ‘why’ research, as suggested by Remenyi et al. (1998).

Appropriate research ethics and governance approvals will be sought.

4. Concluding remarks
A contemporary research study is required, that crosses disciplinary boundaries and researches the training of new hospital doctors in the context of increasingly complex patient care cognisant of holistic approaches. As applied research, the study would achieve interest from practitioners and Health Board Leaders who are aware of innovative practice worthy of study.