College News - January 2011150 years of Membership PATIENTS TO EXPECT GREATER STANDARDS OF CARE AS RCPE MARKS 150 YEARS OF MEDICAL EXAMININGHistoric papers released to commemorate anniversary One of Scotland’s oldest medical institutions, the Royal College of Physicians of Edinburgh (RCPE), will today (26 January 2011) celebrate 150 years of overseeing the medical examination of doctors – an activity in which Scotland continues to lead the world. The RCPE was founded in 1681 by doctors concerned with improving the public health and many of its Fellows have been at the forefront of international medicine from the Scottish Enlightenment to the present day. Since its inception, the RCPE has been responsible for setting up the Royal Infirmary of Edinburgh, Edinburgh Medical School and, in more recent times, ASH Scotland. During this time, its primary objective has been to improve and maintain national and international standards of medical care in order that patients can access the best treatment available. In pursuit of this objective, its central activity has been developing and overseeing the Member of the Royal College of Physicians (MRCP) postgraduate medical examination for doctors wishing to train as specialists – an examination which the RCPE has run individually, and more recently with its sister Colleges of Physicians in Glasgow and London, for the last 150 years. During this period the MRCP examination has become a leading internationally-recognised standard of clinical excellence and doctors from over 80 countries have travelled to Edinburgh to take the examination. Over 3000 candidates sat the MRCP examination through the RCPE last year alone. To commemorate the anniversary of the RCPE’s examining activities, the RCPE has made a number of its papers to doctors and the public for the first time. The web pages offer a rare insight into the MRCP examination and show how the exam has evolved in order to enable doctors to be qualified to respond to emerging diseases. A range of over 300 historical examination paper questions can be viewed in their original form online and illustrate the topical medical issues of the day and the RCPE’s role in ensuring doctors were qualified to respond to them. Sample questions cover areas including suspected infanticide (1899), scarlet fever (1900), cholera (1906), contentious legislative proposals to sterilise people suffering from mental deficiency (1931), industrial dusts causing chronic lung disease (1932), complications entailed with antibiotic use (1955) and tuberculosis (1955). The exam has continued to evolve and, in addition to setting questions on current clinical areas, has progressed beyond its original written and oral format into two written papers and a Practical Assessment of Clinical Examination Skills including doctors’ communication skills. Most recently, the College has responded to the increasing specialisation within medicine and, along with its sister Colleges, has developed MRCP(UK) Specialty Certificate Examinations (SCEs) in 12 specialty areas (i.e. cardiology, gastroenterology etc) in order to ensure that consultants, across the medical specialties, are adequately qualified to deal with a range of disease areas within their specialties. These SCEs use the latest computer-based testing and have become a mandatory requirement in a number of specialties for doctors wishing to complete their training and progress to consultant positions. The MRCP(UK) and SCE examinations play a fundamental part in ensuring the standards of care provided by today’s doctors along with other NHS activities including workplace based assessments. Upon passing the MRCP(UK) examination, doctors are invited to join one of the 3 UK Colleges of Physicians as a Member. Over 10,000 doctors worldwide are currently Members or Fellows of the RCPE. In addition to providing access to historical documents the web pages also include personal reminiscences and anecdotes from doctors who sat the exam, reflecting on their trepidation at sitting, and joy at passing, what is generally considered to be one of the most challenging medical exams internationally. Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh, said, “The College has a strong tradition of promoting and maintaining medical standards in which the public can be confident and we are proud of the international standing of our examination. In reaching 150 years of examining we have reached a significant milestone and will continue to promote the highest standards of medical care on behalf of patients and to ensure that the examination is responsive to changing needs. “The work involved in running medical examinations is considerable and would not be possible without the voluntary support of the many hundreds of doctors who give their time every year in order to ensure that examination questions are valid and quality-assured, and to oversee the practical assessment of doctors’ examination skills. This also helps to ensure the professional independence and integrity of the examinations. “The recent development of Specialty Certificate Examinations provides a further valuable mark of accreditation of a standard of medical competency and care which the public should come to expect of consultants and increasingly come to recognise, as these examinations are rolled out further.” RCPE Press Release INTERNATIONAL MEDICAL EXPERT URGES ‘STEP CHANGE’ IN SCOTTISH APPROACH TO PATIENT SAFETYAn international medical expert will today urge a step change in Scottish doctors’ approach to patient safety and warn doctors that they must learn to think more critically if wishing to reduce the number of adverse incidents in Scottish hospitals. He will also urge that medical schools in Scotland and internationally need to adapt their curricula in order to ensure that doctors of the future are better placed to make clinical decisions which can have serious adverse implications for patients if incorrect or not fully informed. Prof Pat Croskerry, Nova Scotia, Canada, a leading international expert in patient safety and clinical decision-making, will be speaking at a conference in Edinburgh organised jointly by the Royal College of Physicians of Edinburgh, Scottish Intensive Care Society and NHS Quality Improvement Scotland [1] aimed at improving patient safety in Scotland. During his presentation Prof Croskerry will highlight that whilst patient safety has improved in recent decades as a result of the development of evidence-based medicine (in which doctors practise medicine based upon the best available scientific evidence), doctors are not thinking sufficiently critically to inform their clinical decision-making and ensure the best outcome for patients. In some cases, this could have serious consequences for patients including the risk of permanent disability or death. Critical thinking is a learned process which benefits from teaching and includes conceptualisation, analysis and evaluation of information gathered from medical history or records or generated by physical examination or laboratory investigation. Prof Pat Croskerry, Department of Emergency Medicine, Dalhousie University, Nova Scotia, Canada, said, “Doctors are required to make clinical decisions on a daily basis which can literally have life or death implications for patients, not only in emergency situations but also in the daily routine of general practice. The development of evidence-based medicine has greatly helped to ensure that patients receive the most appropriate treatment based upon the available scientific evidence, but in so doing we have put less emphasis on the human element and this has been undervalued. By focussing solely on the available evidence, doctors can easily miss warning signs or indicators of more serious disease which can be learned through experience. They may also encounter the patient’s complications in an entirely different context or setting to that in the evidence and there is also an important need to take into account the patient’s individual circumstances, values and preferences. “The key to improving clinical decision-making, and improving patient safety further, is to shift the emphasis in medical practice and teaching in order that doctors can be trained to not just assess the available evidence, but, of equal importance, to also reflect on their own thinking in their approach to dealing with clinical problems. In essence, it is now time for a further step change in our approach to patient safety which will combine the benefits of evidence-based medicine with critical thinking and well-calibrated decision-making. Effective critical thinking needs to be learned and greater prominence needs to be given to training doctors to think more critically in their early years at medical school and throughout their medical careers”. In addition to Prof Croskerry, the event will feature presentations from a range of speakers providing updates in developments in patient safety, including Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing, Olivia Giles MBE and Dr Ross Paterson, Scottish Patient Safety Programme. Dr Graham Nimmo, Royal College of Physicians of Edinburgh, and a Consultant in Intensive Care Medicine, said, “The safety of patients is of paramount importance and our first priority. It is for this reason that we have convened this conference in order to increase awareness amongst doctors and other healthcare staff in Scotland about the latest developments and international thinking in patient safety. It is recognised that there are many pressures on the system when patients are admitted to hospital and this can result in different forms of adverse incidents including drug errors, both in terms of prescribing and administration, and errors in diagnosis. When such incidents do occur they, understandably, dent public confidence and trust. As doctors, we are keen to ensure the quality and reliability of the healthcare provided and are continually developing safer systems in which we believe patients in Scotland can have confidence”. Dr Brian Robson, Medical Director, NHS Quality Improvement Scotland, said, “Scotland has developed an international reputation for its commitment to improving the quality and safety of care for patients. NHS Quality Improvement Scotland plays a key role in supporting these improvements involving changes from the bedside to the Boardroom through engaging professionals, patients, carers and the wider public. We are delighted to support the Royal College of Physicians of Edinburgh at this important conference which will explore how the reliability of healthcare can be even further improved. The conference yet again proves that Scotland punches above its weight in bringing international experts and Scottish clinicians together to share and learn together to improve our care and services for patients”. Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing, Scottish Government, said, "International experts tell me that the safety work in Scotland's NHS is unique in the world. "The collaboration of senior policy leaders, clinicians, managers and, most importantly, patients and families in the Scottish Patient Safety Programme has so far delivered unprecedented changes in Scotland's hospitals. This includes infection reductions, improved drug safety and mortality reductions. "Patient safety is a top priority in NHS Scotland's Quality Strategy. Building on the groundbreaking work of the Scottish Patient Safety Programme we have recently launched the first country-wide paediatric safety programme and are moving into primary care and mental health. "I am proud of the work being done to make care in Scotland's NHS even safer and I am delighted this conference will help share best practice." Contact: Graeme McAlister on 0131-247-3693 or 07733-263453 ENDS Notes for Editors [1] RCPE/SICS/NHS QIS Hot Topic Symposium on Patient Safety and Clinical Decision Making, 19 January 2011, 9.00am – 4.30pm, Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh. Programme - http://events.rcpe.ac.uk/events/124/patient-safety-and-clinical-decision-making
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