Deans of Health: Three reasons why universities should be involved in future medical specialist training

Each year, the Danish Patient Safety Authority authorises approximately 1,300 new medical graduates.

And the universities are no longer involved with the continuing education of medical doctors once they graduate. Instead, this is managed by another player: the medical societies.

The regions and general practice work closely with the universities on the medical degree programme, just as they play a key role in any continuing education.

The medical societies represent the different specialties, and they therefore have the necessary prerequisites to take charge of the specialisation of doctors.

Now, after a long and thorough process involving a wide range of stakeholders, the Danish Health Authority has presented twenty recommendations for changes to the further education and training of medical doctors.

One recommendation stands out: The Danish Health Authority wants broader-based doctors who are not only specialists but who are also capable of seeing the whole person.

The Danish Health Authority also wants newly qualified doctors to be better equipped to take responsibility from day one. This means that the involved actors should consider how the tasks and responsibilities best can be shared between them.

In a joint consultation response, the four health sciences faculties in Denmark have proposed a division of roles. The three main points of the consultation response are covered in the following:

1. Improved collaboration on the transition from medical student to life as a doctor

At present, there is no widely recognised, international – or national, for that matter – standard for the content and clinical educational objectives of medical degree programmes.

We therefore support the Danish Health Authority's proposal to formulate a joint national clinical qualification profile for newly qualified medical doctors.

Historically, there has been close collaboration between the four health sciences faculties in Denmark. We are familiar with each other's programmes and know that all of them train highly competent doctors.

We also have a positive ongoing dialogue with the employers of our graduates, including hospitals, general practice and government agencies, about their wishes for the programme. A joint national clinical qualification profile would be a natural next step in our collaboration, and we have already started the process.

The qualification profile would ensure a clear foundation for newly qualified medical doctors' journey towards becoming medical specialists – while simultaneously clarifying expectations and requirements so there is a consensus on what is required when transitioning from the university to medical further education in the regions. We owe this to the new graduates from the study programmes in medicine.

There are many opportunities to better prepare newly qualified doctors for working life. At the University of Southern Denmark's new medical degree programme in Esbjerg, the Master’s students are assigned to a hospital department for two years. They spend two days a week at the department and take part in its daily operations.

The other medical degree programmes also make an effort to ensure that doctors are ready to take responsibility from day one on the job.

It makes sense to have common minimum requirements that can be adapted to the different degree programmes. We are of course open to discussing this with the Danish Health Authority, the regions and other employers of our graduates.

That being said, even the best medical degree programme cannot remove the pressure that comes with being responsible for patient lives as part of a busy workday. New graduates quickly learn this during their clinical basic education, which is typically their first job as doctors.

The programme takes one year: six months spent at a hospital department and six months spent in general practice. As universities, we are very pleased to hear that the clinical basic education programme will continue. This has been one of our key issues.

We would like to play a bigger role in the clinical basic education programme so that we, together with the regions, can create the best possible transition between student life and life as a medical doctor.

2. The universities can help realise the ambitions of the new medical specialist training programme

We fully endorse the Danish Health Authority's goal of educating broad-based medical doctors and strengthening the seven roles of medical doctors in the medical specialist training programme of the future.

The roles of medical doctors are used to understand every aspect of a medical doctor’s work, so it is not reduced to strictly professional knowledge and expertise. It requires much more than fingertip knowledge and clinical skills to be a doctor these days. Patient involvement,  prevention, management and collaboration across specialist groups are also necessary skills.

The medical societies have traditionally focused on the role of the medical expert and the narrower skills within the individual specialist areas. The expert role will naturally continue to be a core task in medical specialist training.

On the other hand, we have more focus on educating broad-based doctors at the universities.

Over the past number of years, we have done away with the tradition of training 'small medical specialists' by adjusting courses and exams and by increasing familiarity with all the roles of medical doctors.

For example, Aarhus University has incorporated a professional track into all clinical courses. The track includes career guidance and instruction in communication, ethics and law.

We are therefore ready to take on the task of increasing the breadth of continuing education for medical doctors.

Furthermore, we at the universities have relevant research-based knowledge and teaching competencies within a number of areas relevant to the Danish Health Authority's recommendations, e.g. artificial intelligence, health literacy, sustainability, social inequality in the healthcare system, diversity competencies, gerontology, prevention, digital health and medical pedagogy. 

Involving the universities in a collaboration on medical specialist training is an opportunity to break with the logic of the past and to create new continuing and further education courses that future-proof the competencies and roles of medical specialists in a changed healthcare system.

We would thereby also be contributing to the goals of the political agreement on the reform of university degree programmes, which intends for the universities to play a significant role in the field of continuing education.

The idea is to think beyond traditional, professional Master's degree programmes or single subject courses, which the universities have had positive experiences with, and instead look at universities as lifelong learning partners.

The universities can contribute to broad and highly specialised continuing education in constructive collaboration with the medical societies, regions, Danish Health Authority and other actors.

3. Medical research and innovation are essential to maintaining the quality of healthcare

The Danish Health Authority's proposal has a strong focus on the running of hospitals, patient pathways and resource utilisation. This is important at a time when the healthcare system needs to find solutions while being under a great deal of pressure, as is also made clear in the new report by the Robustness Commission.

One result of this focus is that the proposal on further education does not explicitly highlight the importance of health science research. All other things being equal, health science research drives the development of diagnostics, treatment and prevention.

This lack of focus is unfortunate, because there is solid evidence that research-active clinics help improve patient treatment. A few years of deteriorated research could lead to our healthcare system falling behind other countries.

As universities, we consider research one of the cornerstones of a modern healthcare system - despite the challenge posed by day-to-day operations. It is also important that research is carried out across the healthcare sector and not just in highly specialised research units.

Universities have a broad approach to research with an obvious focus on clinical research in the healthcare system, while also having an eye to other strengths within basic research, public health, digitalisation and data, including AI, medical technology and sustainability.

We also want to stress the importance of innovation as a prerequisite for solving the challenges of the healthcare system. We have excellent and close collaborations with regions, companies and organisations on the areas mentioned above, and it is important for Danish society that we maintain this position of strength.

In short: We want the universities to be a learning partner throughout the career of a medical doctor. We want to do so by entering into a strong collaboration on the transition between medical studies and the basic clinical training programme, so we can help graduates progress towards their specialist authorisation.

We are interested in taking an active role in the further and continuing education of medical doctors. And we cannot stress enough how important research and innovation is to solving the major challenges facing society.

Thank you to the Danish Health Authority for an inspiring and ambitious proposal, which we believe the universities should play an important role in realising.

The opinion piece was published in Altinget on 3 October 2023

Contact

Dean Anne-Mette Hvas
Aarhus University, Health
Phone: 87 15 20 07
Email: dean.health@au.dk