Knowledge Transfer and Human Resource Development in Medicine

CME and beyond

Alexander v Smekal

Alexander v Smekal

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HR development could play a key role in providing quality healthcare. Care providers need to dedicate more resources to devise their HR policies and strategies.

The ongoing developments in medicine and healthcare present a continuous challenge for all stakeholders. Besides technical and structural changes, adequate education and training of employees, supply of medicine and healthcare are critical factors for growth. Educational and training programmes need to be adapted to regional and global healthcare requirements. The industry is facing high demand for training due to new markets and modernised equipment and technology. Hospitals are desperately searching for well-trained staff, while the healthcare professionals are looking for suitable opportunities to enhance their knowledge and skills.

The concept of Continuing Medical Education (CME) has been introduced to help physicians update their knowledge and develop skills. Apart from the USA, Europe (European Accreditation Council for Continuing Medical Education (EACCME) and other countries have taken to CME and developed their interpretation of it. In some states, CME is mandatory for physicians. However, it is unstructured and limited to medical content and the main focus of the system is to raise awareness of the need for lifelong learning. For individuals, the term Continuing Professional Development (CPD) better describes a structural approach from the point-of-view of a professional. Both programmes do not address the needs either of the healthcare system or of the employers and employing institutions.

To understand the actual needs and optimise medical education and training, one has to look at the present situation in terms of the requirements of the market and the demographic changes.

Varying healthcare conditions from one country to another mandates healthcare providers to take a global view, which ultimately leads to medical tourism. The success of medical tourism depends upon the terms of mobility of all involved stakeholders. Mobility and flexibility in global market place in reality are affected due to various ethnic, cultural, social, religious, individual, political and monetary factors. Possible changes of these factors may highly affect business models. Hence, all these factors have to be considered seriously while planning to develop healthcare structures and Human Resources (HR).

To meet the growing demands of healthcare due to demographic changes, the countries need to either attract foreign healthcare professionals and services, or send their people who need healthcare abroad. However, it appears that they have not come up with any definite plan to deal with the situation.

The ongoing speed of technical and structural development is faster than the duration of studies and training programmes in medicine and healthcare. Therefore, continuous or lifelong learning is mandatory in these fields. The development of trained medical personnel is much slower than the construction of hospitals and getting technical infrastructure in place.

Medical education and training is mostly focussed on the medical key competences. Knowledge and skills in the different specific medical domains dominate education and training. Especially in Europe, training in communication, leadership, service orientation and business skills is not part of the medical education process. However, consolidation of the hospital and healthcare service market necessitates the need for medical professionals with broadened key competences. Hospital administration in the past was often divided into medical and administrative branches and competences, which worked in two parallel worlds. Modern hospitals, however, are led by an overall united administration with a clear strategy. This change is not reflected in education and training of healthcare professionals. There is, in most cases, no sustainable policy or strategy for HR development in hospitals or hospital groups.

As stated above, both CME and CPD approaches have limited themselves to lifelong medical learning that focuses solely on the medical domain and the individual physician's needs. The aspects and needs of a regional or global healthcare market are not reflected through these approaches. These aspects have to be addressed by the employer or employing organisation. It sounds curious, but HR development is rarely applied to medicine. Therefore, understanding structures and tools for HR development in medicine are underestimated and underdeveloped.

A close look at two major healthcare markets reveals the problems they face in the development of HR in medicine.

• Due to the increasing growth in the hospital buildings and infrastructure in Middle East, there is great need for well-trained healthcare professionals. The strategy to overcome the shortage was to engage foreign specialists. Rarely was a sustainable training programme organised in the region. As a result, the specialists stayed only for a short period of time. When they leave the place, they take their skills and know-how with them. The structures they build do not survive and therefore no sustainability is given

• In Eastern Europe, healthcare infrastructure is growing, supported by partnering programmes. Advanced medical technologies, as in diagnostics or therapy, are being installed but there is no tradition to buy know-how or soft skills. Regional healthcare professionals seek to enhance their knowledge and skills abroad. The knowledge transfer back home is limited.

In both situations, the desperate need for strategic HR development in medicine and healthcare is evident. But what are the consequences?

Implementing HR development in healthcare

First step is to increase the awareness and understanding of the specific situation, the needs and the possibilities. This also includes the possibility of training the staff. In most cases, change management helps to understand and value soft skills, workforce and communication. Untrained teachers who are not aware of modern learning and technology will not succeed if they are not carefully guided and trained. An overall policy and strategy has to be developed to create a sustainable solid base for training. The transfer of information, knowledge, skills, and finally competence requires training in a face-to-face setting, and technology-enhanced learning. Blended learning, combination of Self Directed Learning (SDL) and face-to-face training, including Information and Communication Technologies (ICT) is the way to build up structural and strategic education.

The scenario of e-learning has to be based on a modern learning environment. Modern in this sense includes technical and learning aspects. Web 2.0 and 3.0 inspire technology-enhanced learning in terms of flexibility, interactivity, community aspects, knowledge management, open interfaces and mobile learning. New technology opens new ways of learning, but all the stakeholders have to learn how to make best use of it. Our learning approach at Meditrainment is very much influenced by 'microlearning'. Based on the ideas of Theo Hug, Professor, Department of Educational Sciences, University Innsbruck/Austria, we developed a concept of small learning units as the base of individualised strategic learning scenarios in a personalised learning environment. We believe that each has his own way to learn. Therefore, technology has to be utilised to empower the individual. Learning is always driven by personal reasons and motivation, never by technology. Technology can, however, act by different means as a motivator. We experience this right now in mobile learning. An overwhelming number of possibilities are offered, but only a few are accepted by the user. The technology can be used to make the learning unit interesting, easy and interactive.

Based on a learning environment, all aspects of learning have to be addressed to the learner. The learner should be able to acquire and share knowledge, skills and competence. All of this needs to be evaluated and tested. In learning scenarios, simulation in learning as in testing is an essential feature.

In medicine, some simulators already exist to train skills. Sharing of competence in the sense of developing problem-based solution utilising knowledge and

skills is the Holy Grail of educational transfer. A combination of face-to-face training and self-directed learning with interactive media and simulators can help to reach this goal. Important and essential for the success of such an approach is the interactivity, the amount of repetitions made by the user, and most of all, the persistent motivation. Community and game-based learning will also play an important role in such scenarios.

For strategic and policy-driven approaches to learning, all of the above mentioned aspects have to be addressed in a technical as well as structural way. Therefore, moderation and change management are the key to success. An external consultant should have a broad experience and understanding of the domains of medicine, healthcare, human resource development, management and interdisciplinary development. A person or team is rarely found speaking the same language as an IT-specialist, healthcare professional, administration, constructor, politician and patient.

In the growing market, device makers, universities, IT-Industry, and national agencies try to gain market share. So far though, collaboration or moderation for the sake of a regional problem has not been seen. Most of them have very specific key competences and underestimate the interdisciplinary aspects. Mediating and consulting roles have to be given to specialised companies in the field of education and training in medicine and healthcare.

HR development in medicine and healthcare will play an increasingly important role in the development of regional and global healthcare. More attention needs to be paid and more resources have to be all cated to devise policies and strategy in this field. HR development is the key to continuously providing healthcare for all.


Alexander v Smekal is the Cofounder and CEO of Meditrainment GmbH, Germany. He is a board member in radiology and nuclear medicine, emergency care and sports medicine, studies of healthcare science, occupational activities in medicine, research and lecturing in universities in Germany, Austria, witzerland, Netherlands and USA. He is trainer and consultant for human resource development in medicine and healthcare.