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January 2014

Dear Fellows and colleagues,

2013 had been a very busy yet exciting year as it marked the 20th anniversary of the Academy since its inauguration in 1993. We celebrated the occasion with a series of events throughout the year, including media gatherings, press briefings, an open day for students, with a ‘grand finale’ consisting of a 4-day congress in December. I hope those of you who participated share my feelings that these celebratory events were all held successfully. You will find the detailed reports and photos later in this issue. Renovation and upgrading works in various areas of the 15-year old Academy building, such as the examination rooms and multi-purpose meeting rooms, have mostly been completed, leaving just some repairing and maintenance works that will be carried out gradually in due course.

Dr Margaret Chan, Director-General of World Health Organization, gave a highly enlightening keynote lecture about medical manpower - the theme of the congress. Here are extracts from her speech, entitled "Human resources for medical care: black-out, burnout, or turnabout?":

No health system can function well without adequate numbers of properly trained, qualified, certified, and motivated staff. I see this first-hand all the time as I visit countries around the world....

In the developing world, most health systems were designed, financed, staffed, and equipped to manage brief episodes of infectious diseases, in which the patient either survives or dies.

These health systems are absolutely, totally unable to cope with the demands of costly long-term or even life-long care...

The rise of chronic diseases, with their needs for long-term and often intensive care, has contributed to a worldwide shortage of more than 4 million doctors, nurses, and other medical staff. The shortage is most acute in sub-Saharan Africa where the need is greatest.

In  the  developing  world,  many  doctors,  including  highly  skilled  specialists,  leave  the  countries  that invested in their training to pursue better-paid and more promising careers abroad. This migration contributes to the global imbalance in medical personnel.

Some countries have too many specialists, which encourages the over-medicalization of care. Others have too few.

Dr Chan also had the following comments with regard to primary care:

In another disturbing trend, fewer and fewer medical graduates are choosing family medicine as their specialty, further adding to the imbalance of skills.

In the absence of family physicians and primary care services as gate-keepers, patients tend to flood emergency rooms, driving up costs even more.

Older people frequently experience multiple co-morbidities requiring holistic treatment.

When no family physician is in charge of overall care, treatment by several specialists increases the risk of duplicate tests and procedures, and dangerous drug interactions, to which the elderly are particularly susceptible.

  • The world needs much better governance for health.
  • The world needs more family physicians.

Dr Chan concluded with the following remarks on the present healthcare system in Hong Kong:

It is an outgrowth of policies, strategies, and systems of financing that were deliberately designed to give publicly-financed health care the dual attractions of top quality and affordable prices.

The quality comes from outstanding schools of medicine, nursing, dentistry and pharmacy.

It comes from the work of the Academy of Medicine, to organize, monitor, assess, and accredit all medical specialist training, and to oversee continuing medical education.

It further benefits from the Academy’s collaboration with specialist colleges abroad, its training of specialists in public hospitals, and the regulatory backing of its accreditation scheme.

In just 20 years, the government’s investment in training human resources for health has been paid back in the health of its citizens, making Hong Kong one of the healthiest places on earth. In your next 20 years, I’m sure you will make greater strides in training future generations of doctors/dentists that are fit for addressing the health challenges of the 21st century.

Providing the depth of training and experience that trainees and Fellows need to meet our standards is an ongoing challenge requiring innovative approaches. One such approach is simulation training.

As reported previously, I led a delegation to study simulation training at the Center for Medical Simulation (CMS) in Boston to gain knowledge in the setting up of a simulation centre at the Academy.

In October 2010, the Academy Council adopted a “Position Paper in Postgraduate Medical Education” prepared by the Education  Committee. One of the recommendations in the paper states “Colleges should be encouraged to build more skill / simulation laboratories and develop simulation-based training. Doctors-in-training should have adequate exposure to simulators. In the longer term, some parts of simulator training should be mandatory and be made widely available so that it can precede practising on the patient. Simulators should also be developed for assessment purposes. We should start as soon as possible with areas in which the technology is more mature and ready.”

Following the recommendation of this Position Paper, the Academy Council agreed that a simulation centre should be established at the Academy to provide training for trainees, as well as for Fellows who may wish to gain knowledge of novel procedures which they have not had an opportunity to learn before. The establishment of a simulation centre at the Academy would thus facilitate training of trainees and update of knowledge for Fellows, especially those who are in private practice and not able to gain access to simulation facilities in public institutions.

We are indeed grateful to the Hong Kong Jockey Club for their funding of $53M plus for the Academy to build a simulation centre on the 7/F of the Academy Building. On behalf of the Academy, I wish to express our sincere thanks to the Department of Health, the Hospital Authority, and Medical Schools of the two Universities for their letters of support to the Hong Kong Jockey Club for the funding.

It is certain that collaboration with a well-renowned overseas simulation centre would facilitate the development of the Academy’s  simulation centre and create a regional centre that excels in providing simulation training. Your Academy has entered into a 5-year  service contract and long-term collaboration with CMS, one of the very first established in the world and the first simulation centre  setup in the Harvard medical community and recognised as a global leader in the field of Simulation-based Education.

Following the approval of funding by Jockey Club in May, we started the project in full speed. The Centre was completed as  scheduled and opened officially on 10 December 2013 during the Anniversary Congress, the last two days of which were particularly  dedicated to the topic of simulation training.

I would like to thank members of the Management Committee, namely Dr WK Tung (Chairman), Dr PP Chen (Vice-chairman), Prof CS Lau, Dr CC Lau and Dr HT Luk, for their hard work in this project. My special thanks go to Dr Tung for his commitment and his involvement in liaising with CMS, setting up the collaboration, and his unfailing support in the planning and setup of the Centre under a very tight schedule.

In this issue, Dr Jeffery Cooper and Dr Robert Simon from CMS have written an article to introduce to us to their views on simulation. Dr WK Tung, Chairman of the Management Committee of the Academy’s simulation centre, has also written something on simulation. I hope you find these articles interesting to read.

I trust most Fellows have taken a break during the Christmas and New Year holiday. I hope you have managed to refresh yourselves and recharge, and are ready to meet new challenges in the year ahead. May I wish you all a prosperous Year of the Horse!

Dr Donald Li

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