training of in house doctors at KFSH Buraidah

1. Do Doctors Ned
Training?
Dr. Shad Salim Akhtar
MBBS, MD, MRCP, FRCP (UK), FACP(USA), Member UICC
Fellows
Consultant Medical Oncologist
Medical Director

2. Quality of care
• >500 pages published daily in English
language
• Guidelines developed for most of the
common conditions
• Protocols created for the management of
many acute and chronic conditions
• How and Why should a doctor know
all this?

3. Why do we need to train
doctors?
• Quality of care implementation
–Standard care
–Guidelines
–Audit
–Outcome measures etc..
• Need a change of behavior

4. Factors affecting doctors’ behavior
• Educational
• Personal
• Patient based
• Economic
• Environment
Cantellon P et al: BMJ 1999;318;1276-1279

5. How can we change the
educational aspect?
• External audit
• Punitive actions
• Or may be better is
•CME/CPD

6. CME - Definition
•Education after
certification and
licensure
Davis D et al. BMJ 2003; 327:33

7. CME or CPD
• Lifelong learning process
• Develop skills needed which include
– Education
– Management
– Training
– IT
– Audit
– Communication
– Team building
– Learner centered and self directed
Editorial BMJ 2000; 320:393

8. Saudi council for health specialization recertification
needs collection of CME hours

9. Reasons for Information Seeking
• Varies from stage to stage
• Complex changes in practice
• Specific patient problem
• Higher qualifications
• Higher remuneration
• Peer challenge
Journal of Med Internet Res 2003; 5:e20

10. Why Do Physicians Learn?
• Revalidation
• Recertification
• Ego
• Juniors ask questions
• Patients’ demands (internet)
• Pharmaceutical agencies
Shannon S. The Lancet 2003; 361:266

11. Why CME BMJ August 2001

13. 1160 7285
1328 9899
1264 11297
1354 8858
0 5000 10000 15000
1420
1421
1422
1423
Major Minor
1241423
1141422
1171421
1211420
Code Yellow/Year
KFSH Trauma Care-Load

14. Trauma care how could we
improve it?
• A specific training course for all those
involved in
– KFSH initially and then
– Al-Qassim region as a whole

15. ATLS
•Justifies the need for
Advanced Trauma Life
Support Courses and
certification of concerned
physicians at KFSH

16. Research states that
physicians have 3 to 5 clinical
questions per day that remain
unanswered.
The answers are out there,
…..

17. Changing Practice
• Physicians becoming aware of a gap in
knowledge or skill
• Learning changes the practice not
teaching
Shannon S The Lancet 2003; 361:618

18. Variation in Support

19. New Equipments Added
• Radiological department
– Dexa
– Angio suite
– Sophisticated ultrasound
• Blood bank
– Aphareis
• OR
– Laparoscopic towers
• Laboratory
– PCR
– Immunocytochemistry

20. Physicians or allied staff trained
• Apharesis
– Cob spectra
• Immunocytochemistry
• Angiography
– Machine idle for 1 yr now
– One of our radiologists on his way
We are independent now

21. KFSH Workload-Number of Pts Seen
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
1412 1415 1418 1421 1422 1423 1424
ER
OPD
SS Akhtar Data from Statistics Dept

22. KFSH Workload - Referrals In
0
100
200
300
400
500
1 2 3 4 5 6 7 8 9 10 11 12
1423
1422
Month
No of pts
Data from Therapeutics DeptSS Akhtar

23. KFSH Workload - Referrals Out -1422
106
89
5946
38
29
23
21
16
12
11 9 8 8 8 16
Neuro Surg Cardiology Oncology Ortho Gen Surg Ophthal
ENT Dental Vas Surg Nephro Gastro Pneumo
Neuro Urol Endo Misc
SS Akhtar Data from Therapeutics DeptTotal No=499

24. Intervention
• Training of doctors
– Consultants
– Residents
• Training of nurses
• Training of technicians
• Other ancillary staff
• Subsequently when funds became
available new staff recruited

25. ~350 km

26. Referrals Out - 1422 - Indications
331
94
12
62
Lack of Facility Request 2nd Op Unkn
Neurosurgery 66
Radiotherapy 51
Angiography 49
Arthroscopy 29
EPS 18
Spinal Unit 16
YAG Laser 15
Isotope Scan 12
Irregular supply
PSCC

27. Staff Recruitment
• Direct from the outsource contractor
– Within the stipulated terms of contract
• MOH
– Selection team
• No on site accreditation system to judge
the need
– This is changing now
• From different countries with different
qualifications

28. • Variation in
– Level of training and qualifications
– Previous type of exposure
• Lack of knowledge of policy and
procedures
• Many lack in the technological know how
• Some lack the skills required
Staff characteristics

29. KFSH Doctors Status- MOH
SS Akhtar MD Office
43
46
35
26
40
38
41
45
30
24
2828
0
5
10
15
20
25
30
35
40
45
50
Consultants Residents
1418
1420
1422
1423
Training
Remuneration
Incentives
Job security
Quality!!!

30. Staff Turn Over-1998-2003
0 100 200 300 400 500
1998
1999
2000
2001
2002
2003a
2003
Total New MOH New SHS EOC
SS Akhtar Nursing Office

31. Years of Experience at KFSH-
Nursing Staff
SS Akhtar Data from Nursing Office
142
112
59
28
No of Nurses
>=10 yrs
6-9 yrs
1-5 yrs
<=1 yr
<=1 year
Incentives
Stagnation
In job training
Salaries

32. Resources-Staff Contractor MOH
• Consultants 58 38
• Specialists 13 57
• Residents 40 69

33. Our Production
• More than twenty consultants working in
our hospital or the region
• More than 70% specialists locally trained
graduates
• About 30 residents enrolled in national and
international postgraduate programs
• More than twenty original articles published
from our institution

34. Postgraduate Programs
• Internship
• Accredited for postgraduate training
– Saudi board
– Arab board
– Royal college of physicians
– Royal college of surgeons
– College of physicians and surgeons of Pakistan
• Publications by the faculty

35. Academic Activities-Hospital Based
• Intensive courses
– ACLS
– ATLS
– FCCS
– Review course with RCP Edinburgh
• Training courses/workshops
– Suturing technique
– Conscious sedation
– Bronchial asthma management
– Critical care workshop

36. Educational Activities 1425
11 27
41
744
108
11
Club meetings Courses Grand rounds
Lectures out Symposia Telemedicine
Workshops

37. Academic atmosphere-Impact
Paramedical staff Nursing staff
Consultant
Resident Specialist
External teams
Quality of care improvement

38. What does all this need
• Financial resources
– Remuneration for teaching activities
– Remuneration for acquiring a skill
• Library
– Books
– Journals
• Other teaching aids
– Mannequins
– Skill labs
• Internet