The Future of General Internal Medicine Discussed at the Institute of Medicine Autumn Symposium 2024
The future of General Internal Medicine training and delivery in Ireland was the central theme of the Institute of Medicine Autumn Symposium, held on 13 September at the Royal College of Physicians of Ireland on Kildare Street.
The morning session was chaired by Dr Emer Kelly, Director of Education and Training, Institute of Medicine and Consultant in Respiratory Medicine, St Vincent’s University Hospital, and Dr Lucy Ann Behan, Director of Examinations, Institute of Medicine and Consultant Endocrinologist, Tallaght University Hospital and Trinity Medical School. The session featured a rapid-fire series of talks on essential topics in acute medicine. These presentations provided valuable updates on various specialties, highlighting both advancements and challenges within the field. Key topics included:
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Updates in Geriatric Medicine - Dr Paul Cotter, Consultant Physician and Geriatrician/Stroke Physician, St Lukes Hospital, Kilkenny
The speakers showcased the latest updates in the fields, offering case-based learning and addressing the current challenges faced by healthcare professionals.
The afternoon session, chaired by Prof Edward McKone and Prof Mike Watts, shifted focus to the future of General Internal Medicine training and delivery in Ireland.
Dr Laura Durcan, Consultant Rheumatologist at Beaumont Hospital, shared insights on delivering medical care in a Model 4 hospital. She discussed key challenges such as an aging population, infrastructure limitations, and the increasing demands of outpatient care. Dr Durcan also touched on advances and innovations in medicine, which are reshaping how medical care is delivered.
Next, Prof Clare Fallon, Consultant Geriatrician and General Internal Medicine Physician at Regional Hospital Mullingar, offered her perspective from a Model 3 hospital. She emphasised the complexity of General Internal Medicine, where physicians must excel in diagnosing and managing complex adult diseases while also coordinating referrals and collaborating with other specialties when necessary. Prof Fallon also touched on training challenges, including inadequate infrastructure, insufficient rest and food facilities on call, and the intensity of on call work. She raised the need for safe staffing guidelines to protect both patient care and staff wellbeing. Additionally, she suggested measures to support recruitment and retention in Model 3 hospitals, such as more equitable workloads and protected time for research and teaching.
Prof Anthony O'Regan, NDTP Director and Consultant in Respiratory and Internal Medicine, University Hospital Galway, expanded on these themes and talked about the evolving medical workforce, noting that while the number of healthcare professionals has increased, the infrastructure has not kept pace with this growth. He emphasised the complexity of the acute workload in hospitals and discussed the role of dual specialties and hyper specialty in medical training. Prof O'Regan also highlighted the growth of hospitalists in other healthcare systems and considered whether such a role could be integrated into the Irish system. He also looked at General Internal Medicine as a standalone training programme and how this model could address current training needs.
Finally, Dr Sean Fleming, National Specialty Director in General Internal Medicine, addressed the future challenges of training General Internal Medicine physicians. He provided an overview of the current training landscape, discussed recent relevant reports, and explored future directions for General Internal Medicine training and service delivery. Dr Fleming identified a disconnection between service delivery and training, highlighting the need to realign these aspects. He also advocated for professionalising training at clinical sites and called for improved training infrastructure to better support postgraduate medical education.
The day concluded with a panel discussion featuring all the speakers, alongside Prof Garry Courtney, National Clinical Lead for the Acute Medicine Programme, and Dr Ellen Walsh, Infectious Diseases and General Internal Medicine Trainee at St James' Hospital, who offered perspectives from a Trainee.
The symposium has addressed the some of the key issues shaping the future of General Internal Medicine in Ireland, providing valuable perspectives on training and delivery, and workforce development in a rapidly evolving healthcare environment.