Review calls for greater focus on doctors’ skills rather than on exam performance

A review of the Royal College of Physicians of Ireland’s specialist training programmes has recommended a greater focus on practical skills and on a specialist’s ability to communicate with patients rather than on the accumulation of knowledge for exam purposes.

The college offers postgraduate training in hospitals to more than 1,200 doctors in 26 specialties through its six training bodies. They include obstetrics and gynaecology, pathology, paediatrics and public health.

The review, by Prof Kevin Imrie, president-elect of the Royal College of Physicians and Surgeons of Canada, said the college's current training model had served Ireland well but changes were warranted due to factors such as changing healthcare demands and Ireland's ageing population.

“Historically, we would have depended much more on what people knew, on exams that can measure knowledge, and that’s very important but, beyond knowledge, we need to know that physicians are able to use that knowledge,” Prof Imrie said.

“We all know that you can have physicians who are very bright, but may not be very good communicators or may not be very good at working with other people and the sense is that we like to assess people on those skills as well.”

Prof Imrie said the college was well-positioned to take “an international lead role in the worldwide movement away from a strictly time-based model of medical education to an outcome-based approach organised around competencies”.

His review also encouraged the college to eliminate the time gaps between entering training and working as a specialist. He said the college should strengthen its commitment to training doctors who could provide general care in broad specialties.

Other recommendations include making training structures more predictable for doctors by giving them better information about their next rotations. It also called for flexibility for couples who are both in training or for those with children.

Prof Imrie has outlined his findings to Minister for Health Leo Varadkar and said he believed there was enthusiasm for implementing the 10 recommendations made in the report.

College president Prof John Crowe welcomed the findings and said the college had already began to implement some of Prof Imrie's recommendations. "Rather than being the conclusion of a process, this report will significantly contribute to the ongoing work of the college, faculties and institute," he said.