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a good morgan the colleague an that exhaust knowledge and
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and it's very nice to be and and many points defend for the invitation to come
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what i'd like to do is just start by setting the scene as to why
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it is important for us to consider it some new rules in health care
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why it is important for us to look at how we need demand in the future
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this particular code is something that i came across in two
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thousand and twelve and really sets the scene for today
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if we simply think about doing the same as we're doing uh
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the same as we did it the twentieth century into the twenty first century
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problems it's going to be impossible to meet the needs of or populations
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it would require us to train and educate an impossible number of doctors
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so we have to do something different when you look at the top ten
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global priorities for the world health organisation
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the first to talk about growth
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we talk about growth and life expectancy which
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will increase by an average an average
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the five years between two thousand two thousand fifteen that's not that's happened
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and that's the fastest growth that we've seen since like the sixties globally
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but we also see is the global health a life expectancy at bar of
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is estimated to be almost sixty to use sixty three one use
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no that's the standing as an average global life expectancy
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now that would be wonderful
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if we were able to say that all of these populations will live while
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as we go we hope that we will love well but we want we will live longer but we would necessarily but well
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and the cost of global health care is escalating exponentially
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so this slide here is and trillions of us dollars
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and you can see the growth from ninety five to the projected growth in twenty twenty to is i watch right
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and we have to respond in terms of how we're going to provide health care
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so going back to how we age and how we are going to live our lives going feature
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according to the united nations the population of the world is going to grow
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by one billion people by twenty twenty five of my masters correct
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that's seven years away
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and off that billion people
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three hundred million they're expected to be people aged over sixty five and older
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interesting thing according to the broker bookings in stitches
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that is also shown to be a growth in the middle classes like most
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of us we fit into that category are expanding a few inches
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and with that and better lives comes more exposure to things like diabetes and
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heart disease all the things that we know that are a negative
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about drawing drawing um richness and growing population the middle classes
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so that means that the squeeze on healthcare becomes even more important
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and we have to ask them to use questions about how do we do this do we do with the typical model that we've had
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over the centuries of doctors doctoring nurses nursing and allied health professionals
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providing that care to our patient population or to do something different
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this is our in two thousand thirteen a breakdown of global medical coverage
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per ten thousand population so in europe it looks quite good thirty two point
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one how doctors per ten thousand and africa it looks pretty awful
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and part of that all phone less as our needs to draw doctors
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away from africa to come work in europe and america um
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and i can still clasped britain is part of your for now at least until next year
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uh but the global population of doctors is thirteen point nine doctors
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per ten thousand population that is not a great ratio
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so we've got to do something different
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we think if i go back aside this is great thirty two point one doctors per ten thousand
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but the projected shortfall of doctors in europe is going to
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be in the region of two hundred and thirty
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thousand
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and with basic caregivers in africa unable to meet demands so we
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have to do something different the number medical school places
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is not going up exponentially it's not going up to meet demand so we have to look at some new rules
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so we talk about the physician assistant the physician associate the medical
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lesson ship the clinical assistant any of those on a box
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it's not new
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peter the great
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had medical assistance in his arm is long goes the fifteenth century the swiss army base
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had the barber surgeons seventeen century german felt shivers
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so this is not a new concept the concept of having an assistant to the position is not me
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the first time i discuss this in the united kingdom in two thousand and
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three when i decided it was time to do something about it
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and i wrote the first physician assistant program
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my colleagues in dean's of medical schools in one a newspaper
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article called me a medical heretic i quite like that
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i quite like that but it's not new
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this is something that has been around for centuries the barefoot doctor in china
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today still today pack to sing in rural china providing most of the healthcare en route china
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so this is an important part of our medical family providing really good health care and they're
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flexible so this is our journey so far and the u. k. this long unwinding road
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started off with me walking a path very very very alone
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it was an interesting time but i was you gather and i would encourage
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you as you're considering the physician assistant in switzerland to look at
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supporting those for visionary supporting those who are leading the way with this
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because it can be very lonely path
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and even if you don't guess it right now even
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if you're not totally convinced support your pioneers
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i was talking to some yesterday
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so the potential options i would tell in two thousand three was drawing invent something completely
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different order look at what's happening in successfully us model starlight of the vietnam war
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so in the nineteen sixties we how i had all these wonderful field medics you could
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quite happily happened amputate of them in the field of battle with greater comes
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would leave the military and have nothing to do all those skills all that knowledge was wasted so
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you got to huge instead of duke university north carolina decided to do something about it
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and started a a certificate program which is now grown there are some hundred and twenty thousand
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physician assistants working in the us i almost as or one to ten ratio with doctors
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over two hundred programs with the bomber care i grew even more
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i think there's some in the region of thirty to fifty programs currently opening
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in developing so being a good academic i decided to play drawings
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and take all their learning in their programs and develop a program in the u. k.
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so we knew there was a crisis looming we knew that
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there was something driving us to think part of it
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was poor workforce planning i don't know if that happens in switzerland it certainly happened in the u. k.
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the number of doctors that we needed going forward with the number of medical school places
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that were actually commissioned didn't work that the the math did not have that
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so we have a crisis looming for our medical
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for workforce lack of resources and shortages
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the tony blair government
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came up with the any chance planned and two thousand
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and that talked about doing something different data services
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better resources but at the same time we addressed
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the working time directive for junior doctors
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so forty eight hours maximum over a two week period each week
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essentially cutter medical workforce almost in half
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was it right of course it was right tire doctors don't make good decisions right we've seen this
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we also have the modern lies in the n. h. s. workforce looking at how we develop something different
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and so they came up with the medical care practitioner surgical care practitioner and this
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after the same times those looking physician assistant and we brought that together
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but it's important to define what a physician assistant position
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associated that's if you don't have a clear definition
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people will go pharaoh
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they'll develop their own ways of working will develop their own methodology so the first thing that we did
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after the established the first program was look at what we would talk about
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commonly when we talked about the physician assistant or in the u. k. physician associate
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so it's clear to say a physician associate is not a daughter that's okay just fine
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but in your health care professional importantly working in a medical model they're
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part of the medical family different from other groups of healthcare workers
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and with that they have to choose skills the knowledge base that a doctor asked working in the
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same space to deliver this holistic care and treatment
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so one sweet actually did develop this
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we then started looking at uh designing programs and this
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is really important if i can really encourage you
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if you're seriously considering physician assistants in switzerland
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you need to develop really good university based education
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some of the work that was done by of our code in the
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late nineteen eighties talks about the movement from occupation to profession
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if you don't structure this around high quality education
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it will remain an occupation
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and i'm strongly argue that the physician assistant as a profession they're part of the medical workforce
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so we started our first program in two thousand and four and this is been our road map
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this has been our journey so far it's been full of hot it's been full of dance
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so we got our first program up and running in two
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thousand and four we developed a higher education institute board
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where the higher and education see the universities of
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working together came together and discussed curriculum together
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and in two thousand six we set a national standard which is hard competency in curriculum
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framework for physician assistants and this means any
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university wishing to start up the program
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has to comply with the c. c. f. i'll come back to that in a few minutes
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there's been times when some of the funding to support it was
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withdrawn and the for programs that were open became one
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but the momentum has been great and it's been driven by us has been driven by the clinician
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why has the well because we're sitting on the front line we know what it's like
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we understand the needs of our patients we understand the needs of all departments
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we understand the long hours people are working and we understand that that need is getting more more more
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we understand that we are the ones that should be driving it so this is their story now
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the call me the grandfather of p. a. is in the u. k. i wish it
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was the father i think a grandfather makes me feel a little bit old
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two thousand and fourteen we had five programs today we have thirty four
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that that growth has just been our watering i i look back at it and i'm very proud
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of the fact that we've grown next year we will have our first four digit graduation
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over a thousand physicians associates graduating from the universities in the u. k.
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embedded in madsen
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embedded in our health care does everyone know what they are
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now my colleagues in the united states where i teach in kentucky in
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in new york tammy after fifty years of p. a. is
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people still say to the students what do you do what is it you want
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but that's okay that's okay
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the journey start small
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so overall training it's i'll put all these office about three thousand two hundred hours over two years
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this is hard hard work for the students there first agree holding students so they've all
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done the degree and health or life sciences we're seeing an increasing number of nurses
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change to be physician associates physical therapist psychologists radio buffers
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and that's great because they bring clinical knowledge the other good thing about this is they've got life
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experience these are not children these among young kids these are people who've been through university
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i've got some life experiences and then we going to do this
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two year master's level program sixteen hundred hours is taught
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sixteen hundred hours is in clinical packed us including
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or can include two hundred hours of simulation
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the competence in curriculum framework uh this is the benchmark this is what every program has to follow
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and they cannot deviate from it because set with than
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it is to sections essentially unless it's with the
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what we call the matrix of cool conditions this is broken down with this with the role colleges
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well call just surgeons physician obstetricians in agony
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our friends and a page and the college of emergency medicine
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um and so there are two sections what physician assistants can
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diagnose and treat and those that they would like nose and refer to the supervising physician
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this is what we cover in sixteen hundred hours over two years it's intense it's a ninety
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week program so they're doing forty five forty six weeks of the year
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so i i want to show you how we split the step
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so this is the this is the split of the clinical experience we have a large
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section on general practised that's ever since our health minister very very quick helpfully
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said he wants advise and p. a.'s in general practised quickly
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so we had to reject this a little
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but we cover in tournaments and primary care and then we go
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into the specialities so we have emergency mats and mental health
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option got any pediatrics general surgery and then there is two hundred hours of electives
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so if the physician associates shouldn't wants to come work in vascular surgery
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they can elect to have their elected with them vascular of the p. d. or the empty
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we have a clear definition for competence it's and how they measured against the competencies
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that's that's within the c. c. uh but this is an important slide at graduation
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we expect the physician associated to work at the same
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standard as a junior doctor that please see why
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i've underlined this um they the comments at the bottom this does not mean the same level
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that's important because that's a bit career progression into
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training as a registrar and then those consultant
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this is about the same standard so our physician associate should be able to
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deliver the same standard of care is o. g. u. doctor at graduation
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this is a typical program this is our program in birmingham um
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we have theory focus in semester one three and four
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intermingled without is from day one they're allocated to primary care physician
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and they spend a day a week with the primary care physician from the beginning
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is a lot of these people never sat in front of the patient before but it's important to get them into the clinical
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to learn the art of madsen as well as the science
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of that's to understand the choreography of the consulting room
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then semester six we have additional theory and a lot
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of simulation we use what we call our clinical
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yeah at our clinical uh actors so these are actors who have been trained in the
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medical school and they will simulate standardised patient i guess this would know the mass
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they can pick an optional third year to top up the post graduate diploma to a master's of science
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currently in the u. k. there's almost a thousand p. a.'s from next year there will be a thousand every
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year coming out of medical schools and universities and these
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are the areas that they're predominantly working in
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internal medicine number of areas of surgery primary care mental
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health and increasing we also losing conical academics
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the marriage those who want to teach the physicians distance of the future
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we're not alone so the pay a family is growing
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so there are fifty one countries i'm privileged to have been
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the past present of international academy a physician associate educators
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and uh the conferences in zambia the sharon october if anybody would like to come
00:21:19
please speak to me um and the greatest number of p. a. analogue us
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as in africa
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the bean programs in africa since the nineteen sixties and earlier in tampa
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the most significant growth has been in the u. k. we have programs in germany your programs
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in the netherlands and we hope it would be nice to have programs in switzerland
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and increasing number programs in the u. s. a. after the affordable care act
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uh about like a that asia is really starting to develop a place
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we're seeing growth in the middle east there's a program and siding
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uh the uh looking a program and to buy a and i've been a talking
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with the uh the united arab emirates about developing programs that in there
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australia has been trying to develop programs for many years
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but still struggling with there's a two programs uh currently
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james cook university and uh was to strut
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but slow growth but the biggest characters and we're still part of europe and
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you're gonna claim it has the biggest growth in europe right now
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so what is the conclusion to this
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our current model of of medical provision it's failing it's not gonna work
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the burden on doctors is going to increase if we do nothing different
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and our ability to meet the needs of our population is it gonna become more more compromised
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and we need to do this change at pace
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we've seen the growth figures we nor demography we know what's happening in our countries
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the physician associate works
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it's proven and it's safe and it provides high quality care to our patients
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as much as we don't like if we do have to embrace change and feel sometimes i'm getting too old to change but you know
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i think that when you embrace change on this level the benefits are for not just the patients but
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therefore junior doctors in training when you have a stable
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wise junior doctor workforce from the physician assistant
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you junior doctors in training have more protected learning time and
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actually helps them but also in terms of our own
00:24:05
work life balance it absolutely has an impact to have to physicians uh seems to work on my project
00:24:16
we have this conditions
00:24:19
the responsibility we cannot disassociate ourselves from this it is our responsibility
00:24:26
to leave behind us as we get to the end of
00:24:29
our careers something sustainable for the population coming behind us
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so that the responsibilities it's with us
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and we have to make a global contribution
00:24:42
we can't sit comfortably when we have two point seven doctors per ten
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thousand population and africa that's not something we can sit comfortably with
00:24:56
that is my message for you uh i hope that it generates some thoughts on

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Conference Program

Begrüssung und Einführung ins Thema
St. Breitenstein
18 May 2018 · 10:05 a.m.
Einführung
E. Girsberger
18 May 2018 · 10:10 a.m.
Interprofessionality - 20 years of Experiences from UK
Ph. AP. Begg, Birmingham/UK
18 May 2018 · 10:12 a.m.
Q&A - Interprofessionality - 20 years of Experiences from UK
Ph. AP. Begg, Birmingham/UK
18 May 2018 · 10:37 a.m.
Interprofessionalität: Wo stehen wir in der Schweiz?
J. Schlup, Bern
18 May 2018 · 10:42 a.m.
Physician Assistant im Operationssaal - ein Beispiel aus der Herzchirurgie
W. Gerr und F. Rüter, Basel
18 May 2018 · 11:08 a.m.
120 views
Q&A - Physician Assistant im Operationssaal - ein Beispiel aus der Herzchirurgie
W. Gerr und F. Rüter, Basel
18 May 2018 · 11:22 a.m.
Als APN im ärztlichen Team in Southampton (GB)
O. Stamm, Southampton/GB
18 May 2018 · 11:24 a.m.
Q&A - Als APN im ärztlichen Team in Southampton (GB)
O. Stamm, Southampton/GB
18 May 2018 · 11:36 a.m.
Physician Assistant in der Neurochirurgie am Kantonsspital Luzern
K. Kothbauer und C. Sidler, Luzern
18 May 2018 · 11:37 a.m.
Q&A - Physician Assistant in der Neurochirurgie am Kantonsspital Luzern
K. Kothbauer und C. Sidler, Luzern
18 May 2018 · 11:49 a.m.
Klinische Assistenz zwischen Interventioneller Radiologie und Gefässchirurgie
A. Monard und P. Wigger, Winterthur
18 May 2018 · 11:51 a.m.
Q&A - Klinische Assistenz zwischen Interventioneller Radiologie und Gefässchirurgie
A. Monard und P. Wigger, Winterthur
18 May 2018 · 11:59 a.m.
Diskussion
D. Liedtke (Zürich), A. Nocito (Baden). M. Wepf (Winterthur)
18 May 2018 · 12:02 p.m.

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