Symposium 7 - Professional and Organizational Training for Better Standard and Competency

In 2018, I was given the honour by the Macau Director of Health Bureau to set up the Macao Academy of Medicine, in recognition of my previous work with the Hong Kong Academy of Medicine. The purposes are obvious, to enable Macao doctors to follow a structured and unified training that would enhance the practice of medicine in Macao. Although Macao and Hong Kong are both of Chinese heritage and physically separated only by the Pearl River Delta, there are subtle socio-cultural and obvious legal system differences. Strategies and measures that worked in Hong Kong must be adapted and never transplanted to Macao. The legal system differences present as a key challenge as I never have any formal legal training. Apart from differences in common law and statute law, there are subtle differences in the Basic Law such that professional standard setting bodies must reside within the government machinery. That dictates the Academy has to be part of the Health Bureau. There are certainly benefits as well as limitations with this practice. Gratitude must be accorded to the Director who is making every effort to keep an arm’s length from us to ensure the Academy’s actual and perceived autonomy of decision making powers. The support from the Director and the Macao government has made the set-up work easier. In addition, a lot of “change” management are encountered as individual hospitals in fact were having some kinds of individual training all along. With the collaboration of all parties, the Macao Academy was officially inaugurated on 13th July 2019 with over three hundred doctors being admitted as First Fellows. As at today, we have set up 40 training programmes and accredited the related training units. The first batch of doctors under the new training system will be admitted soon and that would be an exciting moment.

Experiential learning is the key to success for medical students to learning clinical medicine. However, didactic lectures and bedside teaching, traditional teaching methods commonly used in clinical medicine, can provide only limited chance for the students to experience clinical challenges. Some clinical skills/knowledge are particularly difficult to be experienced by the students: teamwork in crisis, conducting focused examination, delivering bad news, obtaining informed consent conversation, and making decision based on the clinical findings and investigation result.    
A series of flipped classroom teaching using e-learning platform have been developed for the clinical year medicine students based on the above topics identified by a group of clinical teachers from different specialties in the Faculty of Medicine, the Chinese University of Hong Kong. The key concepts and expected difficulties in flipping the classroom will be clarified in the talk using the production of our work as examples. 

Burnout is a pandemic with a prevalence of 27-76% across the world. 31 and 71% of young doctors in Hong Kong in 2012 and 2021 respectively was reported to have experience burnout. It is a topic with both serious personal and organisational impact. The loss of enthusiasm and engagement at work leads to impaired performance for both individuals and teams, increased staff turnover, and poorer quality of care.
There are three components of burnout brought on by stress, namely emotional exhaustion, depersonalisation and a sense of lack of accomplishment. So building resilience requires strategies for all of these. Of the strategies, though individual stress management are helpful, organisational interventions have been found to be more effective.
Of the personal methods, various forms of rest that provide physical, mental, emotional and spiritual energy are the most important. While programmes to train individuals in stress management and resilience (the most popular being mindfulness workshops) are helpful, self-help strategies alone are not sufficient and may even be counterproductive. Genuine care by colleagues in the recognition of burnout, in line with compassionate leadership, is also required and professional coaching may be beneficial for some.
As for organisations, at the individual level, making sure that basic needs like food and water are met, providing at least 20% of meaningful work are key elements. At the institutional level, maximising psychosocial safety culture (such as community building and work-life integration) would be motivating, while ensuring a smooth working environment, innovation to improve productivity to meet increasing demand, better planning of surge capacity and simulation training in crisis management could reduce stress.
The challenge is in integrating these strategies into the daily operation of delivering quality healthcare.