Published: 2017-12-01 10:15 | Updated: 2017-12-01 12:56

How education and clinical research can be managed in the new healthcare landscape

In line with an increasing proportion of healthcare being conducted outside the emergency hospitals, there is now a major challenge arising – how to ensure training and clinical research maintain priority. The annual conference ‘InFuturum’, with Karolinska Institutet and Stockholm County Council as hosts, focused on management and leadership in the new healthcare landscape.

When healthcare managers met representatives from the country’s medical faculties at Aula Medica on 23 November, it was to discuss the future challenges within the new healthcare landscape.

This upcoming spring, it is expected that a new law on highly-specialised care will be pushed through. Hospitals will now focus on the patient groups they know best. Seriously ill patients are treated in hospitals providing highly-specialised care, while others are cared for in nearby emergency care hospitals or within primary care.

The reshaping is called ‘level structuring’ and means that the patient receives the right are at the right level. Karolinska University Hospital focuses on highly-specialised care, and next year will see the opening of the new highly-specialised intensive emergency department for only the most seriously ill patients. This will have consequences to research and training at KI.

“The future is already here. The conditions have changed and we therefore have new challenges in how research and training is to be organised. Healthcare will be given through a greater number of providers and research must be conducted where the patients are,” said Ole Petter Ottersen, Vice-Chancellor at Karolinska Institutet, when he introduced the conference together with Malin Frenning, Director at the Stockholm County Council (SLL).

Malin Frenning emphasised the strong link needed between healthcare and educational institutions, but also between the institutions themselves.

“We need a forward-looking way to meet the healthcare challenges of the future. To achieve success we also need to deepen and improve the collaboration between the university and colleges,” she said.

The new intensive emergency department affects medical training

The fact that there aren’t expected to be many patients at the highly-specialised intensive emergency department at Karolinska University Hospital, together with there being only a limited number of diagnoses, will all impact the medical students. In order for the medical students to get the right training, it must be organised in a new way. The entirety of medical training is simultaneously facing a reshaping. The day before the conference the government issued a proposal for an one-year basic service requirement for medical students. Jens Schollin, Senior Professor at Örebro University, who created the proposal, was also present.

“The basic service requirement should focus on primary care and emergency care, and there should also be a freedom of choice. We want people to know one or two specialities,” he said.

The basic service requirement, which replaces AT, is introduced on condition that a proposal for an entirely new six-year medical training period will be put through. Stefan Lindgren, professor at Lund University, was tasked by the government to investigate the new medical training.

“If the students are trained in professional roles, we need to have a focus on the environments where they can actually learn. Training has previously focused on the serious illness processes, but we need more focus on chronic illness processes,” he said.

Academic specialist centres medical students new training areas

Sofia Ernestam, operations manager at the Academic Specialist Centre [Akademiskt specialistcentrum] within SLL, with the Medical centre for Rheumatology, Centre for Diabetes and Centre for Neurology, considers the Academic Specialist Centre to be an excellent training location for students, but also a good example of a business where research-intensive care is already carried out.

“But we can learn so much more, and in addition, we need to have academically-driven individuals who are committed, involved and who push development forward. By moving closer to primary care, we will be able to ‘capture’ these patients and do studies, perhaps before they become ill. But we need to network more in order to get good results and work together with primary care,” she said.

The clinical research follows the patients

Also of the opinion that the clinical research should follow the patients was Annika Tibell, associate hospital director at Karolinska University Hospital:
“Clinical research must, as far as is reasonably possible, follow the patients. This means that the network of researchers reaches out further to other parts of the healthcare chain,” she said.

Anna Martling, professor of surgery at Karolinska Institutet, shared some examples of how she networks with hospitals across Sweden - known as ‘clinical networking research’. In her research on colon and rectal cancer, she needs to screen 4,000 patients in order to achieve a sufficient amount of patient data.

“Building clinical networks was necessary in order to have access to patients. We went and spoke with every hospital in each region and found 27 centres that are now involved with us. We also have to train doctors and nurses to go into new roles and begin researching. This needs resources and takes time, but we’re now underway with the study,” she said.

Text: Maja Lundbäck