António de Sousa Pereira, MD, PhDAntónio de Sousa Pereira, MD, PhD

ICBAS UPICBAS UP

• Created in August 1975Created in August 1975

• Multidisciplinary SchoolMultidisciplinary School

• Teaching staff with backgrounds Teaching staff with backgrounds from different fields of studyfrom different fields of study

• Teaches medical doctors and other Teaches medical doctors and other professions related to life sciencesprofessions related to life sciences

ICBAS UPICBAS UP

• Undergraduate students Undergraduate students ±1600±1600• Postgraduate studentsPostgraduate students

– Master degreeMaster degree 419419– PhD studentsPhD students 283283

• Total StudentsTotal Students ±±23002300

(from 18 countries)(from 18 countries)

ICBAS UPICBAS UP

0

5

10

15

20

25

30

35

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

PhD Graduations

ICBAS UPICBAS UP

202

204

206

208

210

212

214

216

218

220

2003 2004 2005 2006

Publications ISI

ICBAS UPICBAS UP

• Funding of the activities of the faculty (1)Funding of the activities of the faculty (1)– Contribution of the government for an annual Contribution of the government for an annual

fixed number of studentsfixed number of students– Fees paid by students who have not qualified Fees paid by students who have not qualified

for state commisioned positionsfor state commisioned positions– Competitive research funding from the Competitive research funding from the

Portuguese Research Foundation or European Portuguese Research Foundation or European grantsgrants

– Work on contract basisWork on contract basis

ICBAS - UPICBAS - UP

• Funding of the activities of the Funding of the activities of the faculty (2)faculty (2)– The total funds allocated to de Abel The total funds allocated to de Abel

Salazar Institute for the Biomedical Salazar Institute for the Biomedical Sciences Sciences

– about 13 millions Eurosabout 13 millions Euros

(including donations)(including donations)

HGSA - UPHGSA - UP

• BudgetBudget 215 millions Euros215 millions Euros

• Medical doctors Medical doctors 755 (including 755 (including internships)internships)

• BedsBeds 615615

• Inpatient admissionsInpatient admissions 24 50024 500

• Inpatient surgery Inpatient surgery 12 50012 500

• Outpatient surgery Outpatient surgery 10 00010 000

• OutpatientsOutpatients 375 000375 000

• Emergency patients Emergency patients 130 000130 000

ICBAS UPICBAS UP

• Why are interactions between Why are interactions between university and health care difficult?university and health care difficult?– Different culturesDifferent cultures– Lack of communicationLack of communication– Health care R&D is an academic affairHealth care R&D is an academic affair– Achievement in R&D is not rewarded by Achievement in R&D is not rewarded by

hospitals.hospitals.

ICBAS - ICBAS - HGSAHGSA

• At government level does not exist a At government level does not exist a strong link between their departments strong link between their departments of health and department of education.of health and department of education.

• Professionaly we see medical education Professionaly we see medical education as a continuum, begining with the as a continuum, begining with the undergraduate education and undergraduate education and continuing through professional continuing through professional development until the end of our development until the end of our professional lives.professional lives.

ICBAS - ICBAS - HGSAHGSA

• Unfortunately the many players Unfortunately the many players involved in medical education are not involved in medical education are not well coordinatedwell coordinated

ICBAS – HGSAICBAS – HGSAdrivers for change drivers for change

ICBAS – HGSAICBAS – HGSAdrivers for change (1)drivers for change (1)

• Service – Pressures to reduce costs Service – Pressures to reduce costs of clinical care, provide care more of clinical care, provide care more locally. Pressures to demonstrate locally. Pressures to demonstrate quality of carequality of care

ICBAS – ICBAS – HGSAHGSA

drivers for change (2)drivers for change (2)

• Research – pressures to improve Research – pressures to improve competitiveness, linked to competitiveness, linked to institutional income. And pressures institutional income. And pressures from the health system for a different from the health system for a different kind of researchkind of research

ICBAS – ICBAS – HGSAHGSA

drivers for change (3)drivers for change (3)

• Education – pressures to reform Education – pressures to reform medical education, increase patient medical education, increase patient contact, broaden experience of contact, broaden experience of illness and its contextillness and its context

ICBAS – ICBAS – HGSAHGSA

drivers for change (4)drivers for change (4)

• The way the medical school, The way the medical school, university and health system govern university and health system govern their shared interests has to be their shared interests has to be rethought according to the changing rethought according to the changing context. The traditional model of context. The traditional model of liaison is increasingly ineffective as a liaison is increasingly ineffective as a form of governanceform of governance

ICBAS – HGSAICBAS – HGSACooperation agreementCooperation agreement

ICBAS – HGSAICBAS – HGSACooperation agreementCooperation agreement

• Joint management, in this Joint management, in this cooperation agreement, is more fluid cooperation agreement, is more fluid than a merger implies and is not than a merger implies and is not necessarily about integrating necessarily about integrating structures, which might be better structures, which might be better thought of as joined management of thought of as joined management of teaching, research and service.teaching, research and service.

ICBAS – HGSAICBAS – HGSACooperation agreementCooperation agreement

• Research, service and teaching Research, service and teaching should all be complementary but should all be complementary but instead compete. The reason they instead compete. The reason they compete is that usually the medical compete is that usually the medical school has responsability for school has responsability for research while the teaching hospital research while the teaching hospital is held accountable for the quality of is held accountable for the quality of clinical care.clinical care.

ICBAS - HGSAICBAS - HGSA

0102030405060708090

100

1stYear

2cdYear

3thYear

4thYear

5thYear

6thYear

clinical practice

clinical studies

Pré-clínico

Basic sciences

ICBAS - HGSAICBAS - HGSA

0102030405060708090

100

1stYear

2cdYear

3thYear

4thYear

5thYear

6thYear

Clinical practice

Clinical studies

Pre clinic studies

Basic sciences

ICBAS – HGSAICBAS – HGSACooperation agreementCooperation agreement

• Medical school Medical school Management Management BoardBoard– DeanDean– Head for scientific Head for scientific

affairsaffairs– Head of teaching Head of teaching

affairsaffairs– Administrative Administrative

directordirector

• Hospital Hospital Management boardManagement board– Administrative Administrative

director (CEO)director (CEO)– Medical directorMedical director– Teaching directorTeaching director

ICBAS – HGSAICBAS – HGSACooperation agreementCooperation agreement

• The Hospital Teaching Director mediates The Hospital Teaching Director mediates between the Hospital CEO and the Dean. between the Hospital CEO and the Dean. This has not removed the tensions but has This has not removed the tensions but has to an extent mitigated them. This model to an extent mitigated them. This model was adopted from the one that exits in the was adopted from the one that exits in the Johns Hopkins University, Baltimore and in Johns Hopkins University, Baltimore and in some Europen Medical Schools. In these some Europen Medical Schools. In these institutions, as in ICBAS-HGSA, service, institutions, as in ICBAS-HGSA, service, research and teaching all retain their research and teaching all retain their individual balance through integrating individual balance through integrating their functions.their functions.

ICBAS – HGSAICBAS – HGSACooperation agreementCooperation agreement

• We assume the death of the triple We assume the death of the triple threat leaderthreat leader– The medical leader, usually a professor The medical leader, usually a professor

and a head of an academic department and a head of an academic department who was outstanding at clinical practice, who was outstanding at clinical practice, teaching and research no longer exists, teaching and research no longer exists, if indeed he ever existedif indeed he ever existed

ICBAS - HGSAICBAS - HGSA

• Clinical academic staff recruitmentClinical academic staff recruitment– Clinical leadersClinical leaders– Leaders of the professionLeaders of the profession– RecruitmentRecruitment– RetentionRetention– Role models?Role models?– International linksInternational links– Agents for change?Agents for change?

ICBAS – ICBAS – HGSAHGSA

Cooperation agreementCooperation agreement

• Clinical academic staff recruitmentClinical academic staff recruitment– The head of the clinic in the Hospital is The head of the clinic in the Hospital is

not necessarily the head of teaching in not necessarily the head of teaching in the subjects related to that areathe subjects related to that area

– Every medical doctor has an obligation Every medical doctor has an obligation to take part in teaching either on pre-to take part in teaching either on pre-graduate level or on post-graduate levelgraduate level or on post-graduate level

ICBAS - ICBAS - HGSAHGSA

• Strategies for university and health care Strategies for university and health care interactionsinteractions

– Create forum for informal communicationCreate forum for informal communication

– Development of common R&D strategyDevelopment of common R&D strategy

– Focus on larger program areas and Focus on larger program areas and integration of quality assessmentintegration of quality assessment

ICBAS - HGSAICBAS - HGSA

• Strategies for university and health care Strategies for university and health care interactionsinteractions

– Stimulate academic career opportunities in Stimulate academic career opportunities in health carehealth care

– Improve scientific status of clinical R&DImprove scientific status of clinical R&D

– Stimulate interactions between pre-clinical Stimulate interactions between pre-clinical and clinical researchand clinical research