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doi:10.1111/jpc.12631
VIEWPOINT
Coming of age: Is it now time for paediatrics to form its own college? Kevin Forsyth Department of Paediatrics and Child Health, Flinders University and Flinders Medical Centre, Adelaide, South Australia
Key words:
college; education; general paediatrics; postgraduate training; profession.
Is it time? Professor Frank Oberklaid had argued cogently1 that paediatrics and child health in Australia and New Zealand is ready to move to a new era where paediatricians control their own destiny, take responsibility for binational policy development and set standards of training in postgraduate paediatrics and child health. Such developments, he argues, would best be achieved through the formation of a College of Paediatrics. It is certainly timely to review this matter. Tracing the history of paediatrics in Australia, D.G. Hamilton clearly describes the strong imperative given to the profession of paediatrics by those active in paediatrics in the 1930s to 1980s.2 These earlier paediatricians were intent on formation of a fellowship to encircle them, to be a forum for robust scientific exchange and development, to provide excellence in education and training opportunities for budding paediatricians and to be the trusted policy repository for those in health and governments making policy decisions that affected children, adolescents and families. Enormous energy was expended in those years to form the discipline of paediatrics, shown by the subsequent development of a college (the Australian College of Paediatrics (ACP)), along with a coat of arms and constitution. So what happened? The necessary steps required to become a certifying body for paediatric specialists were not taken. The ACP Council at the time resolved to become its own certifying body apart from the Royal Australasian College of Physicians (RACP); however, this failed to gain enough support from the membership. In 1998, the ACP and RACP agreed to amalgamate, and the RACP established separate Adult and Paediatric Divisions. As training and certification of paediatricians remained with the RACP, it was decided to close the ACP. Reflecting on those earlier years, some of the drivers that led our earlier paediatric leaders to form a College of Paediatrics were a sense of identity, the distinctive characteristic and practice of medicine by those in paediatrics; a sense of profile, being recognised by policy leaders that paediatricians had a rightful voice in contributing to policy development around children and youth; and a sense of effectiveness, of being of a single discipline and like-minded enough to effect change in paediatrics through paediatricians. Correspondence: Prof Kevin Forsyth, Department of Paediatrics, Flinders Medical Centre, Bedford Park 5042, South Australia. Email: Kevin.Forsyth@ flinders.edu.au Conflict of interest: No Conflicts of interest. Accepted for publication 14 April 2014.
248
Perhaps the discipline of paediatrics was, in those earlier years, not mature or developed sufficiently or large enough to stand alone. Maybe the necessary expertise in training and assessment was not as well developed in paediatricians as it is today. More likely, paediatricians were working in an academic culture where paediatrics was considered a subgroup of adult medicine, as developed by the British Medical Association. Certainly in the earlier part of the 20th century, there was less distinctiveness in child health as a discipline. Perhaps it was necessary for paediatrics to develop and mature under the cover of a larger college of adult medicine. Paediatrics is now a fully mature professional discipline. This is evident in the separation of the clinical practice of paediatrics from adult medicine, in the growing array and complexity of themes and branches of knowledge within paediatrics, in the number of consultant paediatricians and paediatric trainees, and in the rapidly expanding range of subspecialties that are part of paediatrics and child health. Indeed, a flourishing of new paediatric subspecialties that have their own professional society is a testament to the growing importance and size of paediatric subspecialty medicine. Neonatology has developed in close association with obstetrics, with a very active perinatal society and a large and active research community. Rural paediatricians have formed the Australian Paediatric Society, with a considerable following in general, rural and remote paediatrics. New Zealand has formed a very successful multidisciplinary Paediatric Society, paediatric neurologists the Australia and New Zealand Child Neurology Society, behavioural paediatricians the Neurodevelopmental and Behavioural Paediatric Society of Australasia and there are many others. There is, in this expansion of the profession of paediatrics, a real danger that the discipline of paediatrics and child health may become fractionated with the explosion of smaller subspecialty groups, especially given that many of these paediatric groups have little allegiance or relationship with the RACP, but rather, either align to their adult counterpart or are independent. A core value for paediatrics is its holistic, integrative approach to the sick or needy child. All paediatricians, whatever the subspecialty, have an awareness and practice competency in the broader aspects of health impairment facing children. So in this new era of paediatric practice, we increasingly need an integrative approach, fostering the multiplicity of expression and practice of paediatrics and child health. If this is our clinical practice and a core value for the profession of paediatrics, we need a process and overarching structure that link these strands together under a
Journal of Paediatrics and Child Health 51 (2015) 248–250 © 2014 The Author Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
K Forsyth
common and strong paediatric foundation, rather than have it progressively weakened through fractionation. What about maturity in size? Do we have sufficient numbers to consider being a stand-alone college? In the 1990s when the ACP folded fully into the RACP, the number of paediatricians across Australia and New Zealand was just less than 1000 and was considered too small to be able to function as an autonomous training and advocacy organisation for paediatricians. The discipline has since grown significantly, with 2880 registered paediatricians in Australia and New Zealand and almost 1500 trainees. If formed as a college, this would be the 4th largest speciality medical college (of 15) in Australia and New Zealand. Paediatrics and child health has always had a strong multidisciplinary component to its practice. Is there a way that a new paediatrics college could reflect this? Specialty medical colleges in Australia and New Zealand are solely medical. This model has worked well in the past when medicine ‘dominated’ clinical practice. Can we align a paediatrics professional structure that ensures consultant medical paediatric training, assessment and certification are preserved, yet values and reflects the breadth of clinical practice in child health? Forming a body such as a new college would enable considerable flexibility of structure and design. It could be imagined, by way of example, that a new college might be formed that had three arms: a certifying/ assessment section for training in paediatrics, policy development and advocacy in children and young people’s health, and education in paediatrics and youth health. The latter two of these could be open to, and enriched by, the active participation of child health professionals other than just paediatricians. Paediatrician training would be the responsibility of the first section of such a college, including certification and assessment, and has explicit links to the policy and education arms. There would be other designs that could ensure standards and training are of the highest calibre for paediatric trainees, yet be inclusive of other child health professionals. In the current training and assessment of paediatric trainees through the RACP, paediatricians are responsible for the curriculum components of training, the supervision of trainees, the assessments (written and clinical), oversight of training and decisions on certification of training. For training in smaller subspecialty areas, there is clearly overlap with adult medicine. This overlap in the smaller subspecialties with the equivalent discipline in adult medicine brings strength to those smaller disciplines, albeit with modification of training and assessment to align with paediatric requirements. How might this function if paediatrics formed its own separate college? Such overlap would need to continue to exist in a new college; indeed, there are many examples of successful cross-college training programmes currently. These include conjoint programmes in paediatrics between the RACP and the College of Pathology, the College of Intensive Care Medicine and the College of Psychiatry. Combined training in the smaller paediatric subspecialty disciplines with the equivalent programmes in adult medicine would need to be continued. However, there is a new trend emerging in some of the paediatric subspecialty groups. As such groups develop, expand and become increasingly competent within their paediatric subspecialty, they are severing links with their adult counterparts. This is a trend likely to continue and
Paediatrics’ own college: is it time?
expand over time. Ensuring strong connection between these paediatric groups and a paediatrics college would be essential, would tie together the increasingly diverse aspects of paediatrics, and would ensure coherence in the profession. Stronger links between these paediatric specialty societies and educational and assessment could be more easily facilitated through a stand-alone College of Paediatrics. The old Australian College of Paediatrics faltered at the point of becoming a stand-alone training and certifying body for paediatric specialty status. In a new college, it would be critical that it becomes the certifying body for speciality paediatrics. This requires Australian Medical Council (AMC) approval, a process that involves demonstration that the college meets the AMC standards for postgraduate training and continuing professional development (CPD). Might this be a significant obstacle? Although the AMC postgraduate standards are comprehensive, the current paediatric training programme meets these standards. The standards are clear and easily attainable with the right processes and structures of training. Many paediatricians have been and continue to be intimately involved in AMC accreditation for postgraduate training. One of us is a senior member of the AMC, responsible for accreditation of specialist training colleges, and another one is the immediate past Dean and Director of Education of the RACP, responsible for ensuring that all the RACP programmes met AMC standards. We already have the intellectual and educational expertise within our discipline to run a comprehensive training programme that meets AMC standards. Aligned to this is the full capability to run a continuous professional development programme that meets AMC standards. Educationally, training, assessment and certification are all within the current capability of our paediatricians. What does the business case look like for a new college? Could the formation of a separate college be considered viable financially? Discussed earlier was the issue of size, of scale. With the size of the proposed new college, assuming all or most paediatric fellows came across and fees were charged at a similar rate to the current RACP rates, there would be no difficulty in having a financially stable organisation. Other new, smaller colleges have been formed in Australia and New Zealand in recent times. Their experience highlights that set-up costs are the most significant hurdle, requiring the establishment of necessary governance arrangements, the infrastructure for training and GPD, an office and hiring of staff prior to a new college ‘going live’. This requires an existing funding resource or a forward investment to implement. One way this has been managed by some new colleges is to request that fellows pay 1-year subscription in advance, thus providing a foundation to begin set-up and operations. What disadvantages are there in removing ourselves from the RACP and forming a new college? The RACP is a well-known and established institution, and its diploma, Fellowship of the RACP, is a highly regarded certification. Within the RACP structures, we have close links with adult medicine and the other branches of the RACP. This assists with advanced training in paediatric subspecialties, which is particularly important in the smaller subspecialties. As the RACP is a large college, its influence in matters of health and governments should not be underestimated.
Journal of Paediatrics and Child Health 51 (2015) 248–250 © 2014 The Author Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
249
Paediatrics’ own college: is it time?
K Forsyth
What advantages would there to be to paediatricians in forming a new college? By way of example, there would likely be: • A sense of greater integrity of the specialty of paediatrics • Greater ownership of child health matters by child health professionals • Increased collaboration and co-ordination through a college devoted solely to matters of the profession • Responsiveness to child health issues through advocacy by its membership • Improved co-ordination of child health policy and education across the diversity of paediatric practice • Improved networking across the profession • The strategic directions and emphases and voice held within the profession by child health professionals Where to from here? For such a change, there would need to be a sense from our younger and older paediatricians that such a move was advantageous for paediatrics into the future. A ‘mandate’ for change is required from the fellowship. We encourage you to give us your thoughts on this proposal. All of
the last five Paediatrics Divisional presidents support the principles espoused in this paper. What do paediatricians and trainees think? You are strongly encouraged to make your views known through an online survey. Please log onto the poll at: http://www.snipurl .com/paeds-college or https://www.surveymonkey.com/s/ PaediatricsCollege This will only take a few minutes, is anonymous, but critically will give us a sense of your views on these matters. Without support of paediatricians, we will not advance this proposal. We need your thoughts.
References 1 Oberklaid F. It’s time: a new era for paediatrics and child health in Australia. J. Paediatr. Child Health 2013; 49: 361–3. 2 Hamilton DG. A History of the Australian College of Paediatrics 1950–1980. Parkville, Victoria: The Australian College of Paediatrics, 1990. ISBN 0 646 07946 8.
Giraffe by Ashlee-Marie Bennett (11) from Operation Art 2014.
250
Journal of Paediatrics and Child Health 51 (2015) 248–250 © 2014 The Author Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Copyright of Journal of Paediatrics & Child Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
doi:10.1111/jpc.12631
VIEWPOINT
Coming of age: Is it now time for paediatrics to form its own college? Kevin Forsyth Department of Paediatrics and Child Health, Flinders University and Flinders Medical Centre, Adelaide, South Australia
Key words:
college; education; general paediatrics; postgraduate training; profession.
Is it time? Professor Frank Oberklaid had argued cogently1 that paediatrics and child health in Australia and New Zealand is ready to move to a new era where paediatricians control their own destiny, take responsibility for binational policy development and set standards of training in postgraduate paediatrics and child health. Such developments, he argues, would best be achieved through the formation of a College of Paediatrics. It is certainly timely to review this matter. Tracing the history of paediatrics in Australia, D.G. Hamilton clearly describes the strong imperative given to the profession of paediatrics by those active in paediatrics in the 1930s to 1980s.2 These earlier paediatricians were intent on formation of a fellowship to encircle them, to be a forum for robust scientific exchange and development, to provide excellence in education and training opportunities for budding paediatricians and to be the trusted policy repository for those in health and governments making policy decisions that affected children, adolescents and families. Enormous energy was expended in those years to form the discipline of paediatrics, shown by the subsequent development of a college (the Australian College of Paediatrics (ACP)), along with a coat of arms and constitution. So what happened? The necessary steps required to become a certifying body for paediatric specialists were not taken. The ACP Council at the time resolved to become its own certifying body apart from the Royal Australasian College of Physicians (RACP); however, this failed to gain enough support from the membership. In 1998, the ACP and RACP agreed to amalgamate, and the RACP established separate Adult and Paediatric Divisions. As training and certification of paediatricians remained with the RACP, it was decided to close the ACP. Reflecting on those earlier years, some of the drivers that led our earlier paediatric leaders to form a College of Paediatrics were a sense of identity, the distinctive characteristic and practice of medicine by those in paediatrics; a sense of profile, being recognised by policy leaders that paediatricians had a rightful voice in contributing to policy development around children and youth; and a sense of effectiveness, of being of a single discipline and like-minded enough to effect change in paediatrics through paediatricians. Correspondence: Prof Kevin Forsyth, Department of Paediatrics, Flinders Medical Centre, Bedford Park 5042, South Australia. Email: Kevin.Forsyth@ flinders.edu.au Conflict of interest: No Conflicts of interest. Accepted for publication 14 April 2014.
248
Perhaps the discipline of paediatrics was, in those earlier years, not mature or developed sufficiently or large enough to stand alone. Maybe the necessary expertise in training and assessment was not as well developed in paediatricians as it is today. More likely, paediatricians were working in an academic culture where paediatrics was considered a subgroup of adult medicine, as developed by the British Medical Association. Certainly in the earlier part of the 20th century, there was less distinctiveness in child health as a discipline. Perhaps it was necessary for paediatrics to develop and mature under the cover of a larger college of adult medicine. Paediatrics is now a fully mature professional discipline. This is evident in the separation of the clinical practice of paediatrics from adult medicine, in the growing array and complexity of themes and branches of knowledge within paediatrics, in the number of consultant paediatricians and paediatric trainees, and in the rapidly expanding range of subspecialties that are part of paediatrics and child health. Indeed, a flourishing of new paediatric subspecialties that have their own professional society is a testament to the growing importance and size of paediatric subspecialty medicine. Neonatology has developed in close association with obstetrics, with a very active perinatal society and a large and active research community. Rural paediatricians have formed the Australian Paediatric Society, with a considerable following in general, rural and remote paediatrics. New Zealand has formed a very successful multidisciplinary Paediatric Society, paediatric neurologists the Australia and New Zealand Child Neurology Society, behavioural paediatricians the Neurodevelopmental and Behavioural Paediatric Society of Australasia and there are many others. There is, in this expansion of the profession of paediatrics, a real danger that the discipline of paediatrics and child health may become fractionated with the explosion of smaller subspecialty groups, especially given that many of these paediatric groups have little allegiance or relationship with the RACP, but rather, either align to their adult counterpart or are independent. A core value for paediatrics is its holistic, integrative approach to the sick or needy child. All paediatricians, whatever the subspecialty, have an awareness and practice competency in the broader aspects of health impairment facing children. So in this new era of paediatric practice, we increasingly need an integrative approach, fostering the multiplicity of expression and practice of paediatrics and child health. If this is our clinical practice and a core value for the profession of paediatrics, we need a process and overarching structure that link these strands together under a
Journal of Paediatrics and Child Health 51 (2015) 248–250 © 2014 The Author Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
K Forsyth
common and strong paediatric foundation, rather than have it progressively weakened through fractionation. What about maturity in size? Do we have sufficient numbers to consider being a stand-alone college? In the 1990s when the ACP folded fully into the RACP, the number of paediatricians across Australia and New Zealand was just less than 1000 and was considered too small to be able to function as an autonomous training and advocacy organisation for paediatricians. The discipline has since grown significantly, with 2880 registered paediatricians in Australia and New Zealand and almost 1500 trainees. If formed as a college, this would be the 4th largest speciality medical college (of 15) in Australia and New Zealand. Paediatrics and child health has always had a strong multidisciplinary component to its practice. Is there a way that a new paediatrics college could reflect this? Specialty medical colleges in Australia and New Zealand are solely medical. This model has worked well in the past when medicine ‘dominated’ clinical practice. Can we align a paediatrics professional structure that ensures consultant medical paediatric training, assessment and certification are preserved, yet values and reflects the breadth of clinical practice in child health? Forming a body such as a new college would enable considerable flexibility of structure and design. It could be imagined, by way of example, that a new college might be formed that had three arms: a certifying/ assessment section for training in paediatrics, policy development and advocacy in children and young people’s health, and education in paediatrics and youth health. The latter two of these could be open to, and enriched by, the active participation of child health professionals other than just paediatricians. Paediatrician training would be the responsibility of the first section of such a college, including certification and assessment, and has explicit links to the policy and education arms. There would be other designs that could ensure standards and training are of the highest calibre for paediatric trainees, yet be inclusive of other child health professionals. In the current training and assessment of paediatric trainees through the RACP, paediatricians are responsible for the curriculum components of training, the supervision of trainees, the assessments (written and clinical), oversight of training and decisions on certification of training. For training in smaller subspecialty areas, there is clearly overlap with adult medicine. This overlap in the smaller subspecialties with the equivalent discipline in adult medicine brings strength to those smaller disciplines, albeit with modification of training and assessment to align with paediatric requirements. How might this function if paediatrics formed its own separate college? Such overlap would need to continue to exist in a new college; indeed, there are many examples of successful cross-college training programmes currently. These include conjoint programmes in paediatrics between the RACP and the College of Pathology, the College of Intensive Care Medicine and the College of Psychiatry. Combined training in the smaller paediatric subspecialty disciplines with the equivalent programmes in adult medicine would need to be continued. However, there is a new trend emerging in some of the paediatric subspecialty groups. As such groups develop, expand and become increasingly competent within their paediatric subspecialty, they are severing links with their adult counterparts. This is a trend likely to continue and
Paediatrics’ own college: is it time?
expand over time. Ensuring strong connection between these paediatric groups and a paediatrics college would be essential, would tie together the increasingly diverse aspects of paediatrics, and would ensure coherence in the profession. Stronger links between these paediatric specialty societies and educational and assessment could be more easily facilitated through a stand-alone College of Paediatrics. The old Australian College of Paediatrics faltered at the point of becoming a stand-alone training and certifying body for paediatric specialty status. In a new college, it would be critical that it becomes the certifying body for speciality paediatrics. This requires Australian Medical Council (AMC) approval, a process that involves demonstration that the college meets the AMC standards for postgraduate training and continuing professional development (CPD). Might this be a significant obstacle? Although the AMC postgraduate standards are comprehensive, the current paediatric training programme meets these standards. The standards are clear and easily attainable with the right processes and structures of training. Many paediatricians have been and continue to be intimately involved in AMC accreditation for postgraduate training. One of us is a senior member of the AMC, responsible for accreditation of specialist training colleges, and another one is the immediate past Dean and Director of Education of the RACP, responsible for ensuring that all the RACP programmes met AMC standards. We already have the intellectual and educational expertise within our discipline to run a comprehensive training programme that meets AMC standards. Aligned to this is the full capability to run a continuous professional development programme that meets AMC standards. Educationally, training, assessment and certification are all within the current capability of our paediatricians. What does the business case look like for a new college? Could the formation of a separate college be considered viable financially? Discussed earlier was the issue of size, of scale. With the size of the proposed new college, assuming all or most paediatric fellows came across and fees were charged at a similar rate to the current RACP rates, there would be no difficulty in having a financially stable organisation. Other new, smaller colleges have been formed in Australia and New Zealand in recent times. Their experience highlights that set-up costs are the most significant hurdle, requiring the establishment of necessary governance arrangements, the infrastructure for training and GPD, an office and hiring of staff prior to a new college ‘going live’. This requires an existing funding resource or a forward investment to implement. One way this has been managed by some new colleges is to request that fellows pay 1-year subscription in advance, thus providing a foundation to begin set-up and operations. What disadvantages are there in removing ourselves from the RACP and forming a new college? The RACP is a well-known and established institution, and its diploma, Fellowship of the RACP, is a highly regarded certification. Within the RACP structures, we have close links with adult medicine and the other branches of the RACP. This assists with advanced training in paediatric subspecialties, which is particularly important in the smaller subspecialties. As the RACP is a large college, its influence in matters of health and governments should not be underestimated.
Journal of Paediatrics and Child Health 51 (2015) 248–250 © 2014 The Author Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
249
Paediatrics’ own college: is it time?
K Forsyth
What advantages would there to be to paediatricians in forming a new college? By way of example, there would likely be: • A sense of greater integrity of the specialty of paediatrics • Greater ownership of child health matters by child health professionals • Increased collaboration and co-ordination through a college devoted solely to matters of the profession • Responsiveness to child health issues through advocacy by its membership • Improved co-ordination of child health policy and education across the diversity of paediatric practice • Improved networking across the profession • The strategic directions and emphases and voice held within the profession by child health professionals Where to from here? For such a change, there would need to be a sense from our younger and older paediatricians that such a move was advantageous for paediatrics into the future. A ‘mandate’ for change is required from the fellowship. We encourage you to give us your thoughts on this proposal. All of
the last five Paediatrics Divisional presidents support the principles espoused in this paper. What do paediatricians and trainees think? You are strongly encouraged to make your views known through an online survey. Please log onto the poll at: http://www.snipurl .com/paeds-college or https://www.surveymonkey.com/s/ PaediatricsCollege This will only take a few minutes, is anonymous, but critically will give us a sense of your views on these matters. Without support of paediatricians, we will not advance this proposal. We need your thoughts.
References 1 Oberklaid F. It’s time: a new era for paediatrics and child health in Australia. J. Paediatr. Child Health 2013; 49: 361–3. 2 Hamilton DG. A History of the Australian College of Paediatrics 1950–1980. Parkville, Victoria: The Australian College of Paediatrics, 1990. ISBN 0 646 07946 8.
Giraffe by Ashlee-Marie Bennett (11) from Operation Art 2014.
250
Journal of Paediatrics and Child Health 51 (2015) 248–250 © 2014 The Author Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Copyright of Journal of Paediatrics & Child Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
