Dr Ravi Tomar discusses why the medical school curriculum must include health technology
Medical school plays a major role in shaping the careers of our future doctors. I still remember how the quality of teaching I received in neurology was far above what I received in many of the other big specialities; that made, what is notoriously one of the more complex fields, simple. The same however cannot be said of health technology, which remains entirely absent from the medical school curriculum.
Up until my first year as a qualified GP, technology in health had always existed with an air of mystery. A subject only for those who possess an accepting “hybrid” mind, halfway between computer programmer and doctor.
After medical school and junior doctor training, GP training consists of three years of focused study and practice. These years include a breadth of medical subjects in significant depth, but not to specialist level. Although this clinical training prepares graduates for patient consultations and the ability to manage most medical cases within the community, it does not provide exposure to the practical implementations of health technology which play a large role in life as a GP, especially in a post-COVID-19 reality. The lack of health technology in core medical education results in GPs trying to navigate the med-tech landscape when they are already in practice, which we have seen poses many challenges.
Fellowships
Currently, the only way to gain a foundation of technology before practicing is to take an optional fourth year known as a fellowship. I was one of very few members of my graduating class who chose to pursue a fellowship. This additional year is less financially attractive as the rate of pay is significantly lower than those working as locums or full time in surgeries. Thus, fellowship is a rare choice for new graduates with six years of student loans and GP exam fees to pay off.
However, there are some incredible benefits to pursuing a fellowship which I have experienced. My fellowship gave me the opportunity to strengthen my experience by spending time focussing on a quality improvement project. The focus of my project was the integration of digital technology into primary care. I evaluated the inefficiencies in patient appointment bookings in primary care and spent time learning about the integration and possibilities of the digitalisation of the industry.
I feel extremely fortunate to have seen the long-term benefits of investing in the fellowship year and it could not have better prepared me for the new reality that the COVID-19 pandemic has forced the health industry to adopt. The time I was given to learn how to integrate digital services into healthcare not only made it possible for me to guide our surgery through this new reality but to demonstrate the benefits to our patients.
Digital services at Portland Medical
The introduction to technology I gained during my fellowship led to the integration of a wide range of digital services at Portland Medical, where I am now Partner. We utilise an online symptom assessment tool called Doctorlink, which forms part of our total triage model. This allows patients access to healthcare advice 24/7 without needing to speak directly to a GP. It also gives them the ability to book their own appointments on the phone, via video, or if needed in person; all without utilising valuable reception time. Via this route, patients can also request medication, obtain sick notes, and book in blood tests.
Because I pursued an education in digital technology in the industry, I had the prior knowledge and comfort to have this integrated at my practice for our patients 18 months before the pandemic. This allowed us to run health services efficiently and almost without change when the crisis hit. Neighbouring practices, on the other hand, had to very quickly adapt or risk being unable to provide primary care as laid out by the RCGP and NHS England.
COVID-19 pandemic
These changes came about for many in the time of the Pandemic as a forced necessity rather than an optimised and embraced choice. As a result of the lack of training for most GPs without a digital solution, they have struggled with the integration and have found it challenging to get engagement from both staff and patients.
Since the beginning of the pandemic, we have worked with many practices to help emulate the efficiency, workload management and cost savings our practice has benefited from. The awareness has been further spread by speaking on webinars led by SW London STP to encourage other practices to move towards the new normal in General Practice.
The process of further scaling up the utilisation of digitally integrated services forms a balance between overcoming the anxiety that many GPs and staff have of technology, simplified down to the fear of the unknown; against the huge benefits we have realised. Over the past year, we have reduced calls into the surgery by one-third, improved access to our high health need population (through a shift of the less complex patients online), reduced our waiting time for an appointment to a few hours and saved 4,500 appointments.
I hope to see an uptake of health technology incorporated into medical education or at a minimum into post-graduate training. It would allow us all to benefit from the efficiencies, cost savings, and lowered workload within the NHS and as a result and inarguably most importantly of all, better patient care.
