Volume 04 / Issue 03 / September 2016
Page 18
boa.ac.uk
JTO News and Updates
The American British Canadian Fellowship 2016
Jonathan Miles, William Eardley, Sam Oussedik, Ajay Malviya The ABC Fellowship is designed to encourage high class clinical care, translational research and teaching. Their integration is the most obvious marker of a successful unit but we experienced many different strategies to achieve them. We had informative discussions about recruitment, the pros and cons of internal appointments and the balance between the need to conform against the risk of stifling innovation. The United States has introduced bundled care models which has focused the larger units on assessment of outcomes and prevention of complications. There were high variances in the models adapted throughout the units in achieving a predictable outcome. The Campbell Clinic is rapidly moving to a day-care arthroplasty model through case selection and minimal post-operative input, aided by recruitment of a family member to provide nursing and therapy. This
The ABC Fellows visiting the Mayo Clinic
L-R: Jonathan Miles, Cameron Anley, Michael McAuliffe, Will Eardley, Ajay Malviya, Sam Oussedik and Andrew Graydon – the Fellows wearing their new ABC ties
requires more pre-operative input but is realising significant savings. The Mayo Clinic and University of Calgary had more traditional models, using volume and pathway control to deliver more consistency of outcome. Our countries are all re-evaluating the need for expensive investigations and implants in patients as the cost burden rises.
The North American model of funding for research is a mixture of centrally controlled funding, donations, industry sponsorship and institutional funding. There was a higher emphasis on animal modelling than in the UK. There could be tensions in salaried units where those with a higher volume clinical output subsidise the more academically active. The best leaders had addressed these concerns directly and ensured that everyone benefited through enhancement of the institutional reputation. Dan Berry and Bernard Morrey at The Mayo Clinic were highly instructive on this balance. The North American model of teaching has a tendency to focus on a single institution and overall training time is shorter than in the UK. There are similar challenges in a week curtailed by working hour regulations. We noted the Canadians favoured international fellowship whilst the USA residents almost all stayed within The States. There was a
tendency to centres appointing the majority of physicians from their own resident programme. This may contribute to an inward looking philosophy but helped to ensure alignment of the whole team with their stated goals and values. We had many debates as to where the line should be drawn between minimising costs and accepting risks. There was universal agreement that healthcare costs, as a proportion of GDP, are too high in the developed world. The strategies to address this must not be too biased against patient care or overly detrimental to training. We conclude that the ABC Fellowship is as relevant now as ever. The sharing of techniques and surgical skills can now be achieved through the multitude of internet and journal outlets. The philosophies of healthcare governance are far more suited to discussion than didactic styles.