Health Education and Training Collaboration Professor James Angus AO Honorary Professorial Fellow

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1 Health Education and Training Collaboration Professor James Angus AO Honorary Professorial Fellow 11 August 2015

2 Summary Medical Education History New Technology Challenges for Education The Melbourne Curriculum Australia-China Links Our Partners

Medical Education in 1910 In the 10 years that followed the Flexner report the number of medical schools in the US dropped from 133 to 85. Bioscience learning connected to clinical learning.

3 Medical Education in 1910 In the 10 years that followed the Flexner report the number of medical schools in the US dropped from 133 to 85. Bioscience learning connected to clinical learning. Key Technology: Stethoscope Thermometer Microscope Early x-rays High frequency electric currents in medicine and dentistry, 1910 Source:

4 Medical Education in 1970s Problem based learning (PBL) First implemented at McMaster University in 1969 by Barrows

5 Medical Education in 1980s and 1990s Variations of PBL Case based learning (CBL) Team based learning (TBL) Enquiry-based learning (EBL) Case supported learning (CSL) University of Melbourne

6 Medical Education in 2000s The disruptive effects of technology on health care and health care education MOOCs Remote consultation Just in time information Dr Google Source:

Medical Education in 2015 Google Glass IBM Watson 3D

therapies Must prepare the contemporary learning to be

7 Medical Education in 2015 Google Glass IBM Watson 3D Organ Printing Data Analytics P4 Medicine Targeted therapies Must prepare the contemporary learning to be adaptive to rapidly changing system and environment Source:

Wearable Medical Devices Predicted >$8billion industry by 2018 Revolutionise healthcare delivery and management Reduce the economic burden imposed by growing

8 Wearable Medical Devices Predicted >$8billion industry by 2018 Revolutionise healthcare delivery and management Reduce the economic burden imposed by growing chronic conditions such as diabetes, obesity and hypertension Source:

9 Precision Medicine The process whereby we achieve the Goal of Personalized Medicine Training the next generation of health professionals

10 Can we cope with the information? Source: A. P. Abernethy et. al., J Clin Oncol. Sep 20, 2010; 28(27):

11 The Goal for Healthcare Adapted from:

The Melbourne MD Overview The Melbourne Model Splits from educational norm in Australia, aligning Melbourne s program with European and US systems Is the first truly postgraduate entry-to-practice

12 The Melbourne MD Overview The Melbourne Model Splits from educational norm in Australia, aligning Melbourne s program with European and US systems Is the first truly postgraduate entry-to-practice medicine qualification in Australia Is designed to meet the current and future needs of students, patients and the changing healthcare sector. Goals To supply industry with work-ready professionals To train a higher level of healthcare professional

13 The Melbourne MD Graduate Attributes Attributes that all students will achieve by the end of the Melbourne MD have been defined. These attributes fall into six domains:

14 Research in the Melbourne MD Scholarly selective 1 and 2 Apply research skills in a meaningful project Present and discuss the results of that project Work within in a research team Apply the principles of ethical research (Unique to Melbourne MD)

15 Significant Collaborative Initiatives between China and Australia

16 Asia Australia Mental Health (AAMH) draws on the strength of its core partners to find solutions Commenced 2003 Purpose is to partner with leading local and international organisations to improve mental health in the Asia Pacific region The heart of our work is the deep appreciation of the importance of culture AAMH programs contribute to the WHO Collaborating Centre for Research and Training in Mental Health, Melbourne Department of Psychiatry Cutting edge research Training programs Leadership in mental health across the lifespan Asialink Leaders in Australia Asia engagement Targeted and culturally appropriate programs Networks of influence across sectors and geographies University of Melbourne St. Vincent s Health Expertise in mental health service delivery Best-practice patient-centred care Training for overseas colleagues

17 Initial Target China AAMH - Impact statement: China ( ) 55 unique capacity building programs collaboratively designed 630 days of training programs delivered 2000 people from China directly involved Chinese mental health leaders visiting Australia for sites visits, workshops and meetings 651 people from Australia directly involved 60 + Australia mental health experts have visited China Key partners in the largest global program of mental health reform the 686 Program involving 250 cities, 1800 districts, and covering a population of 940 million. 3.2 million patients are now receiving community services Development of the national protocols protecting the mental health of children in disasters- 100,000 copies distributed post Sichuan earthquake. Establishment of the global first UoMPeking University Joint Centrefor mental health research and training

Working nationally and in the provinces In China, AAMH works to develop patientcentred mental health services and partners with Department of Mental Health, Bureau of Disease Control and Prevention

18 Working nationally and in the provinces In China, AAMH works to develop patientcentred mental health services and partners with Department of Mental Health, Bureau of Disease Control and Prevention National Centre of Mental Health, China CDC Peking University Institute of Mental Health Guangdong Mental Health Centre Shantou University Mental Health Centre Chinese University of Hong Kong AAMH OFFERS Community mental health service delivery consultancy and training for government officials, hospital directors, psychiatrists and doctors, nurses and primary health workers. Post disaster psychosocial intervention training for psychiatrists and doctors, psychologists, volunteers and family members. Biological, applied and translational psychiatric research training and collaboration to build research capacity and skills. AAMH and China: Service reform

19 A global first: The establishment of the University of Melbourne and Peking University Centre for Psychiatric Research and Training April 2014

20 Examples of what we have achieved Within the first year Three PhD students jointly supervised between PKU Institute of Mental Health and University of Melbourne Supported post-doctoral fellows to visit Melbourne to discuss analysis of large datasets in maternal and infant mental health

22 Department of General Practice China Program Goal: Build research collaborations Activities: Short course attendance Clinical observership: GP clinics, GP clinical training from medical student level through to GP registrars Academic observership: at research, research training, ethics, teaching and learning committees, attendance at seminars, confirmation and completions, general practice based research network events, research meetings, participation in research design and translation events, conference attendance Collaboration: work up new research protocols

23 Department of General Practice Chinese Visitor Program Dr Man Li Chan 7 September to 18 September 2015 Department of Family Medicine & Primary Health Care, Tuen Mun Hospital, Hong Kong. Hosted by A/Prof Meredith Temple-Smith (Introduced by Prof Doris Young) Prof Samuel YS Wong 18 to 22 May 2015 Professor and Head, Division of Family Medicine and Primary Healthcare, Institute of Integrative Medicine. Faculty of Medicine, The Chinese University of Hong Kong. Hosted by Prof Jane Gunn (Introduced by Prof Doris Young). Dr Yuanjie Li 20 April to 20 July 2015 Division of General Internal Medicine, Department of Medicine, Peking Union Medical College Hospital, Beijing, China. Hosted by Assoc Prof John Furler and the Ageing, Chronic Disease and Equity Research Group (Introduced by Prof Doris Young). Dr Jin Xu 28 April to 14 July 2015 Department of Medicine, Peking Union Medical College Hospital, Beijing, China. Hosted Assoc Prof John Furler and the Ageing, Chronic Disease and Equity Research Group (Introduced by Prof Doris Young). Dr Bean Fu Sau Nga 10 to 21 August 2014 Associate Consultant, Department of Family Medicine & Primary Health Care, Kwong Wah Hospital, Hong Kong. Hosted by Prof Doris Young and Assoc Prof Meredith Temple-Smith Dr Yue Sha 1 July to 30 September 2014 Peking Union Medical College Hospital (PUMCH). Hosted by Prof Doris Young and Assoc Prof Meredith Temple-Smith.

24 Short course teaching in China Introduction to Primary Care Research Hong Kong Hospital Authority, 2012 Fudan University/Zhongshan Hospital, Shanghai, China 7-8 July 2014 Peking Union Medical College Hospital, Beijing, China 7-9 May 2015 Qualitative methods in Primary Care Research Hong Kong Hospital Authority, Nov 2015

25 Research collaboration Dept General Practice (DGP)and Peking Union Medical College Hospital (PUMCH) currently collaborating on two literature reviews: Non-urgent presentations to Emergency Departments Role of general practice in a hospital emergency department DGP and PUMCH planning to apply for research funding to implement and evaluate the effectiveness of a GP clinic in PUMCH ED to divert non-urgent presentations.

26 Collaborative & Multidisciplinary

27 Victorian Comprehensive Cancer Centre AUD $1 billion Mid June cancer researchers Dedicated to integration of cancer research, education, treatment and patient care Includes Peter MacCallum Cancer Centre Melbourne Health The University of Melbourne The Royal Women's Hospital Walter and Eliza Hall Institute of Medical Research The Royal Children s Hospital St Vincent s Hospital Melbourne

28 Peter Doherty Institute AUD $210 Million 700+ expert researchers Dedicated to research excellence, education and training Focus on infection and immunity Includes IBM supercomputing facility Includes The University of Melbourne Victorian Infectious Diseases Reference Laboratory Victorian Infectious Diseases Service Victorian Life Sciences Computation Initiative Victorian Nosocomial Infection Surveillance System WHO Collaborating Centre for Reference and Research on Influenza

29 Melbourne Brain Centre Parkville and Heidelberg 700+ researchers AUD $225 Million Australia s largest brain research collaboration Includes The Florey Institute of Neuroscience & Mental Health Melbourne Neuroscience Institute, University of Melbourne The Royal Melbourne Hospital Austin Health

30 Melbourne Children s an integrated facility AUD $1 billion Integrating: - Royal Children s Hospital - Murdoch Childrens Research Institute - University of Melbourne Department of Paediatrics Research Capability: Public Health, Clinical Practice & Policy and Translation Activities

RCH Epic Medical Record $48 Million Investment Epic Electronic Medical Record (EMR) 1 st hospital in Australia with EMR $14 Million for growing ECH expertise One system, all patient information in

31 RCH Epic Medical Record $48 Million Investment Epic Electronic Medical Record (EMR) 1 st hospital in Australia with EMR $14 Million for growing ECH expertise One system, all patient information in one place Integrated access streamlines and simplifies admin Enhanced research capability The EMR is, in my view, more transformational than the move to the new hospital - Prof Christine Kilpatrick, CEO Source:

32 Academic Health Science Centres in Australia Diamantina Health Partners South Australian Centre in Progress Melbourne Academic Centre for Health (MACH) Monash Partners Westmead Millennium Institute Image source: virtualanz.net

33 Members of the MACH

MACH Clinical Trials Coordination Synergized and coordinated clinical trials enable

undertaking clinical trials One centralized, streamlined Research Ethics and

Children s Hospital & Murdoch Children s Research Institute Florey Institute Austin

34 MACH Clinical Trials Coordination Synergized and coordinated clinical trials enable improved outcomes and investment opportunities St Vincent s Hospital Eleven partners undertaking clinical trials One centralized, streamlined Research Ethics and Governance process University of Melbourne Peter MacCallum Cancer Centre Royal Children s Hospital & Murdoch Children s Research Institute Florey Institute Austin Health Royal Melbourne Hospital Walter & Eliza Hall Institute Royal Women s Hospital Western Health

Wearable Medical Devices Smart Contact Lens for Diabetes Measures glucose levels in

measure body temp, heart rate, brain activity, hydration levels etc Wirelessly

Real-time head impact monitoring and concussion management system for athletes and

com/articles/novatis-google-to-work-on-smart-contact-lenses-1405417127 www.

36 Wearable Medical Devices Smart Contact Lens for Diabetes Measures glucose levels in tears Google prototypes currently being tested Skin sensors and Biostamps Can measure body temp, heart rate, brain activity, hydration levels etc Wirelessly transmits data to devices Head Impact monitoring for athletes - X2 Biosystems Real-time head impact monitoring and concussion management system for athletes and their physicians and trainers. Now in use in USA football leagues Sources:

37 Kaiser Permanent Information Systems have impact Source:

Melbourne Biomedical Precinct Collaboration 13,491 Publications with two or more collaborating institutions 7000 Melbourne Biomedical Precinct 6000 5000 4000 3000 2000 1000 0 2007 2008 2009 2010 2011

38 Melbourne Biomedical Precinct Collaboration 13,491 Publications with two or more collaborating institutions 7000 Melbourne Biomedical Precinct Total Medical Publications Publications with two or more precinct partners One Precinct Partner Only 64% increase in precinct partner articles in 2013 compared to 2008 Source: Web of Science

Kaiser Permanente s Electronic Record KP HealthConnect KP Health Connect is the largest private electronic health record system in the world The huge patient database fuels transformational health

39 Kaiser Permanente s Electronic Record KP HealthConnect KP Health Connect is the largest private electronic health record system in the world The huge patient database fuels transformational health research which in turn improves clinical practices Fully integrated system enables safer, more effective, more convenient and efficient care Allows KP to assess and track the cost and value of its care helping to reduce disparities and improve health outcomes for entire populations. Sources:

40 3D printed heart saves child s life A collaboration between University of Louisville engineers and physicians at Kosair Children s Hospital. A 3D printed model of the child s heart was constructed using a template created by CT scan images The model heart allowed doctors to develop a surgical plan and complete the heart repair in only one operation Printing cost: $US600

Johns Hopkins Medicine 3D Printing 3D printing technology + Prosthetists + Crowdsourcing and Volunteers = FREE prosthetic hands for kids Over 1000 recipients worldwide Anyone can get one of

41 Johns Hopkins Medicine 3D Printing 3D printing technology + Prosthetists + Crowdsourcing and Volunteers = FREE prosthetic hands for kids Over 1000 recipients worldwide Anyone can get one of these hands: it doesn t matter what insurance or health provider you have - Dr. Albert Chi, assistant professor of surgery at Johns Hopkins Medicine. 5yr-old Griffin has a new glow in the dark hand

42 Towards Personalised Medicine

43 The Melbourne MD Transition Project Overview Scholarly Review Benchmarking Consultation Desired attributes developed/defined Biomedical Science Foundation Clinical Practice Scholarly Selectives Transition to Practice Melbourne Medical Student Cohort Study Academic reflection Vision Graduate Attributes Student Selection Course Structure & Curriculum Assessment policy Evaluation Strategy Implement -ation Produce work-ready, world-class medical professionals Academic Merit Aptitude Personal Qualities Reliable/valid/feasible Reflect graduate attribute domains Blue-print to the curriculum Facilitate feedback and remediation Logistics LMS Communications Teacher training Student Recruitment Evaluation

44 Medical Education in 2030 Doctor Chair in every home. Source:

45 Cross-disciplinary collaboration and industry links lead to real world outcomes

46 The Melbourne MD Transition to Practice Trainee Intern Term Vocational Selective Term Phase 1 Phase 2 Phase 3 Phase 4 Intern Vocational Training Entry to practice qualification (Universities) Prevocational Training (PMCs) Vocational Training (Colleges)

47 Four successful centres recognised by NHMRC as Academic Health and Research Translation Centres (AHRTCs) in March 2015 South Australian Advanced Health Research & Translation Centre Melbourne Healthcare Partners Monash Partners Sydney Health Partners The panel strongly commends the efforts...to reform and improve systems of health care and the overt real desire to act in the best interests of communities, working to make their local health delivery more evidencebased, collaborative and seamless. - International Panel Review Report to NHMRC Image source: virtualanz.net

glow green Currently in use by Australian Red Cross Blood Service

48 Vein Visualization Device Infrared technology highlights blood, makes veins easy to find Deoxygenated hemoglobin absorbs the infrared light and veins glow green Currently in use by Australian Red Cross Blood Service

Western Health. Research Roadmap Enabling the strategic plan through leading translational and health service research

Western Health. Research Roadmap Enabling the strategic plan through leading translational and health service research Western Health Research Roadmap 2015-2020 Enabling the strategic plan through leading translational and health service research Research Roadmap 2015-2020 Foreword INTRODUCING THE RESEARCH ROADMAP Our