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- 1. as a chronic problem with vague symptoms such as tiredness, breathlessness, fluid retention and loss of appetite however, it may also present acutely with severe breathlessness where patients are unable to lie flat and need to be rushed to the emergency department. Since I specialised in heart failure, there were the ACE inhibitor studies in 1993 and then beta- blocker studies in 1996 so we have seen a massive improvement in the quality of life and prognosis of heart failure with many patients no longer requiring transplantation. There has also been better primary prevention i.e. blood pressure and cholesterol managementandbettertreatmentofheartattackswith earlier revascularisation. Wearemovingawayfromtheverysick,end-stage critical heart failure patient stuck in hospital and are now treating people out in the community with heart failureandlivingnormallivesalbeitonpolypharmacy but we are able to stabilise them. While prevention is paramount, 40 per cent of cardiomyopathies are idiopathic, and thus cannot be prevented but can be treated.Also, Dr McCaffrey adds that as the population ages, the ageing heart may also become a failing heart so the prevalence of heart failure will continue to increase. Older people who feeltheirefforttolerancehasreduced,shouldconsider the possibility that this may be heart failure and see their GP to discuss rather than accept the limitations as normal. Exercise As a cardiologist Dr McCaffrey practises what he preaches he has always been a long distance runner The future is bright for medical education INTERVIEW Danielle Barron speaks to the newly-appointed Director of Medical Education at the UCD Beacon Academy, heart failure specialist Dr Dermot McCaffrey Dr Dermot McCaffrey 12 IRISH MEDICAL NEWS / TUESDAY MAY 5 2015 謂 MEDICAL EDUCATION and was involved in coaching junior soccer. Having spent 16 years in Australia, he saw how exercise is given greater emphasis in schools there, he explains. In an outdoors society like Australia, it was much easier to have primary and secondary school children involved in sport. We need to move away fromthecurrentIrishacademicmodel,whichdoesnt rate exercise, sport, drama, singing etc as equal to academic pursuits. The amount of stress current Leaving Cert students are under is unnecessary and doesnt make for healthy undergraduates. Heisenthusiasticaboutpromotingsportinschools and integrating exercise into the curriculum he points out that at parent-teacher meetings, the PE teachers are invariably facing empty chairs. This needs to be integrated the PE teacher needs to be appreciated as much as the maths or Irish teacher. Overweight children get locked in a vicious cycle of not exercising, he adds. If you are an overweight student, you might avoid sports or the gym. The changing rooms can be a cruel place and should be supervised. Children are removing themselves from activities in their formative years this needs to be addressed. They dont have to sprint the 100 metres or be first on the team an overweight girl or boy can still be fit if the PE teacher is allowed target activities to their needs. Exercise will help their study, their self-esteem and weight is not a major concern as long as they remain active. Weight isnt the issue activity is the issue. Big Brother Backtothehealthservice,andDrMcCaffreysuggests that there is a significant amount of waste within the health system in terms of prescribing and ordering. He believes that some form of oversight is necessary When I worked in Australia, I received an audit each quarter that showed me which and how many tests I had ordered eg how many ECHOs, X-rays, stresstestsetc.ThisshowedmehowIstoodcompared tomypeers,percentile-wise.Thisallowedphysicians to assess whether they were doing more than the normal amount of ordering of a test or prescribing of a drug. For example, as a heart failure specialist, I was in the top percentile for ordering ECHOs, as was appropriate. It allowed for continual practice review and change. Irish doctors, among many other professions, have an inherent aversion to the concept of Big Brother says Dr McCaffrey. We assume if somebody is watching us that they are doing it for the wrong reasons. This may come from our school experiences or may be an inherent Irish trait I would prefer to be monitored so if I am deviating incorrectly from the norm, to have that pointed out and explained so I can address it myself if neccessary.Itdoesnthavetobeanadversarialthing. In conclusion, Dr McCaffrey said he is excited about the future of medical education in Ireland, as the teaching capacity of private hospitals will be used to its full ability in the coming years. Private and public hospitals with guidance from the medical schools, can all work together to further enhance the experience of medical education in Ireland, to the benefit of the students and of most importance, of the patients. I N February of this year, the Beacon Hospital announced a new partnership with UCD that would make them Irelands first private comprehensive clinical teaching and research hospital. The first of 20 UCD medical students plan to commence clinical training at Beacon Hospital in September2015,andthiswillbemerelyaninitialfirst stepinthehospitalspathtobecomingafully-fledged teaching hospital. Consultant cardiologist and Director of Medical Education at the hospital Dr Dermot McCaffrey is helping to lead this new development with colleague Dr Peter Widdes-Walsh, consultant neurologist, and he tells IMN that the Beacon has been steadily working towards this latest venture. Dr McCaffrey explains that the hospital currently has four interns and has already enjoyed a fruitful liaison in recent years with UCD nursing, physiotherapyandoccupationaltherapystudents.The Beacon has 183 acute care beds with nine operating theatres, oncology day care, therapeutic radiotherapy andendoscopysuitesaswellasadvancedITsystems. The medical student programme is an extension of the training experience in the Beacon and in the future, we aim to have SHO and registrar positions accredited by the Medical Council as training positions, he says. Medical education According to Dr McCaffrey, private hospitals are set to become valuable teaching environments for medical trainees. As there are more private hospitals, especially those with A&E facilities who offer comprehensive care including all major surgery, doctors working here are exposed to the whole gamut of medicine. Previously NCHDs working in smaller private hospitals, were mainly clerking elective cases but that has all changed with private hospitals admitting complex cases. This is a process heading towards the North Atlantic situation where there is less difference between public and private teaching hospitals as long as the doctors and students can receive the same quality teaching programme, he says.Thisprocesswillalsoinvolvepatientsinprivate hospitalsunderstandingthatsomeoftheirdoctorsare still learning as medicine is a continuous learning process and does not stop, even when one becomes a consultant, he adds. Several preliminary meetings between the two institutions led to the creation of the Academy, and there were many practical steps the hospital has to take to become an accredited teaching hospital, Dr McCaffrey explains. According to Dr McCaffrey, Irish medical undergraduate education has transformed in recent years, and has become more of a continual learning process. I qualified in 1989 and our final medical exams counted for the majority of our degree similar to the Leaving certificate system with little continual assessment; whereas now, while there is still a final exit exam, students receive 60 programme credits in each of their 5 years that contribute to their degree. It is therefore easier to spot someone having problems and intervene earlier.The modern system is therefore fairer,betterbalancedwithoutmassivepressureatthe end and allows graduates learn to be good doctors. While the quality of Irish medical graduates has remained high, the sheer volume of them has meant that students nowadays get somewhat less exposure to patients, Dr McCaffrey added. There were fewer medical students and more patients but now its the other way around. Students may not necessarily have as much hands-on patient contact so the universities have tried to compensate with the use of actors and computerised simulation systems. Career pathway The recruitment and retention of medical graduates is finally being somewhat addressed by the powers that be, but swingeing cuts to consultant salaries have meant that positions have been left unfilled throughout the country. Dr McCaffrey believes that it is not the particular salary level that is in question, rather it is the inequity between consultants ability to earn. If the playing field was more equal there would be less resentment includingthehighcostofmedicalindemnity,hefeels. In addition, the concept of a public hospital consultant job being full time should be reviewed where consultants could do a percentage of work and be paid that percentage of the full salary, said the consultant. For example, a consultant could do eight hours a week, cover two outpatient clinics and an angiogram list. This would allow public clinics run more smoothly, ease the constant pressure on those currently full time and not cost the HSE as much, Dr McCaffrey explained, adding that this is how the system operated inAustralia when he worked there. Heart failure Dr McCaffrey is also the Chair of the Heart Failure Council in the Irish Heart Foundation (IHF). While it is estimated there are 90,000 people living with the condition in Ireland, it is not a widely understood condition. Although public awareness of heart failure is low, and the IHF have previously sought to address this, Dr McCaffrey points out that the condition is not that straightforward. The problem is that heart failure usually presents The recruitment and retention of medical graduates is finally being addressed by the powers that be, but swingeing cuts to consultant salaries have meant that positions have been left unfilled throughout the country