Some Mayo with that

New approaches to healthcare training will focus on teamwork and individualised medicine, writes Julie Hare. Being named one of the best hospitals in the US is no small feat. But for the accolade to be afforded 20 years straight – as has just happened when the Mayo Clinic made the US News & World Report’s annual list – it’s reasonable to conclude that excellence is the overriding philosophy. Professor Nick Talley, who is currently chair of the Department of Internal Medicine, professor of medicine and professor of epidemiology at Mayo’s Florida campus, says the factors that drive such a level of excellence need to be increasingly incorporated into Australian medical and health training models. And Newcastle University, where he will take up the position of pro vice-chancellor of the Faculty of Health next year, can expect to pioneer Mayo approaches to training. The Mayo Clinic “lives and breathes” a multidisciplinary, team-centred approach to healthcare training and delivery, Talley told this year’s annual David Maddison lecture. “The safest and best care is when it is provided as part of a team and everyone on the team knows what everyone else is doing. That’s how you ensure continuous quality control and continuous improvement,” Talley told CR. “But best practice in a team approach is a learned skill and, as such, the learning must be in early training. “We also need to train people to understand current systems and teach them how to improve those settings – that is, how to influence the system for the maximum benefit of the patient.” In Talley’s view, team-oriented healthcare will inevitably focus on delivering increasingly individualised medicine. Researchers at the Mayo are currently working on unlocking the one tenth of 1 per cent of human genetic make up that holds the key the individuality. As such, the genetic blueprint holds the code to individuals’ risk of illness in the future and how they will respond to disease and treatment. That is, every person who has a disease will react differently to that disease, which in turn means treatment must be equally indvividualised. “Individualised medicine refers to knowing and using the unique characteristics of a patient to determine the exact type of care for the best outcomes. For example, some patients shouldn’t be given certain types of medication if they have a particular genetic makeup,” says Talley. “Individualised medicine is not happening as much we would think. It’s on the crest of a wave, but it is coming in the next 10 to 15 years. So we need to be training people now and thinking about how it will affect us in the future. “The bottom line is that people will carry a portable electronic record of their personal history and information, possibly including some of their risks from their genes – assuming we can get through all the ethical issues. That sort of information will benefit everyone.” Unsurprisingly, there are very significant barriers to such a model – including privacy concerns. “People are worried about sharing of data – and rightly so. There are also barriers around insurance. In the US, if an insurance company knows you have some sort of genetic risk, they won’t touch you. That’s terrible – everyone is at risk of something, we just don’t know what it is most of the time.” Talley says as PVC (health) at Newcastle University he hopes to adopt some of the Mayo Clinic’s approaches, making some dramatic changes to how health professionals are trained along the way. “It’s time for us to think about new ways of doing business and new ways of imparting knowledge. For instance, I’m a great believer in student-led learning, where they help drive the curriculum, based on their knowledge and ability.” This includes moving away from the traditional didactic lecture to shorter, more focused lectures that are used to clarify difficult concepts and stimulate students to be motivated to further their learning on their own or with each other. “Lectures are useful for priming people, but if they remember three for four facts at the end, that is all we can really expect. I want to look at shorter lectures and more small group learning activities with students teaching students. We know if you help others learn, you actually learn more yourself. We have a limited number of teachers. This way can help maximise the utility of our teaching staff in different ways. “Ultimately, we want to produce graduates who are of the highest quality and place the needs of patients first. They need to deliver health care with deep compassion and think creatively to advance their field of expertise.”