Does more education for health professionals equal better patient care? - Healthy Debate
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Does more education for health professionals equal better patient care?

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  • Leanne says:

    I have no issue with hospital pharmacists and those working for a wage under a health authority. But what isn’t talked about is the major changes in pharmacies and their corporatization. They sell anything from quick weight loss programs, candy, groceries, beauty supplies, magazines clothing to dubious blood tests etc. They are driven by profit.

    Nurses and doctors aren’t driven by profit by selling wares. They are paid by health authorities or via provincial medical plans. Their very ethics forbid commercialization. However, if speaking about privatized care such as cosmetic and anti-aging medicine, it is similar to pharmacies. In my experience it has become very American and has lost the confidence and trust of Canadian patients. Some paid private doctors offer incentives to staff to sell products. They try to offer this to nurses who refuse to take the money. In consequence, the doctors try to hire those who are not bound by these professional ethics as a workaround with sometimes harmful results. This is abhorrent in our Canadian system of excellent medical and nursing ethics.

    Until the commercialization and corporatization of the pharmacy business is brought to light, I can not take seriously, the professions’ claim to be acting in the best interest of the public. If pharmacists didn’t own pharmacies which are in the business of groceries and anything they can hawk, I would see this differently. In this regard, don’t compare doctors and nurses, to pharmacists. I have seen pharmacies be sketchy providers of methadone programs, without providing naloxone. There have been cases of corruption in using tactics to win over the homeless so they would choose their pharmacy for methadone access as well as corruption in payments and records. There is a clear conflict of interest when pharmacists who own pharmacies are trying to profit from the public as customers. When was the last time you bought candy, groceries, cosmetics, magazines and a track suit from the doctor or nurse?

    Pharmacists are pushing to expand scope into administering immunizations, prescribing medications and now chronic disease management under the guise of helping patients and alleviating healthcare system stress. They don’t do trauma informed care and there is a lack of privacy and consideration for the entire psychosocial element in a patient’s makeup. Patients don’t divulge their family issues, traumas etc to a pharmacist. These are key aspects to patient assessments which impact compliance and trust.

    Pharmacy owners who are pharmacists are more accurately interested in increasing profits by offering these services to increase foot traffic through their megastores of drugs and merchandise. Soon they’ll be selling gas,

    It’s time to recognize the differences in motive,

    Lewis is incorrect in stating older diploma RNs and LPNs have the same education. LPNs take two years of college. Diploma RNs 20 yrs ago completed 3 yrs of education in 2 years in an accelerated program, The RNs did not take the traditional summer breaks like other programs and instead studied through for six semesters.Many programs were integrated with the hospitals from the first month into the program. There is a very distinct difference between the two tiers in critical thinking and with a focus on depth over breadth in RN programs. Comparing the textbooks between programs shows further evidence of this. The taught ability to critically analyze research studies and apply this knowledge in higher level administration and planning in RN training vs a very task focused, practical application focus in LPN training, is evident, I’ve seen the differences play out as a patient when I needed more pain meds from the LPN damaging my esophagus than obstruction pain. She didn’t check tubes for patency after insertion, left dirty syringes bedside, and failed to recognize signs of fluid overload. It wasn’t her fault as they were extremely short staffed and were pressured to practice beyond scope. A physician friend warned of an increase in patient mortality and lawsuits in the wake of creating a second tier of less educated nurses. And indeed it is exactly what happened in the States.

    Cutting corners initially saves money but it costs lives and thus impacts families and future generations. Our quality of care has diminished to a point I know longer recognize due to politics and pressure to cut costs. I’m sick of the lab coat wearing actuaries crunching numbers and measuring care only in quantitative terms. People deserve more than measuring their worth in dollars and cents. Patient focused care is an absolute joke. It is a buzz phrase and is no more than that. We have lost patient trust fir good reason. They are wise to the BS and jargon. This is the fault of many intersections factors and I hope we go back to actually caring instead of business interfering with care.

  • Eva says:

    With the shift to a team based approach and collaborative care, the subject of degree creep is an extremely interesting one and can be viewed from different angles. With the expanding scope of regulated health professionals, such as the pharmacist, advanced credentials make complete sense. Having worked in the pharmacy field from the mid 80’s, I have witnessed the impact of the evolving role of the pharmacist on the profession and on the role of the pharmacy technician. The pharmacist went from someone who mostly checked prescriptions and counseled patients on how to take their medication, to a highly trained expert in medication management and provider of health services. The complexity of medication management is critical to our health care system, especially with the aging population. The need for the expanded role of the pharmacist created a need for an expanded scope of practice for pharmacy technicians. The pharmacy technician program remains a two-year college diploma program, however, the program required integration of new elements that would develop critical thinking and foster confidence so that graduates could perform some of the tasks that were previously only performed by a pharmacist.
    Scientific progression along with technological advancement requires the skills of a highly skilled healthcare worker. College programs are 2 or 3 years in length during which students engage in a comprehensive outcome based education that prepares them for entry to practice. It is important to use this time to ensure students are able to demonstrate the appropriate skills, attitudes and behaviors of a health care professional. As a college educator working with allied health programs, I think it is important to consider the following aspects when we look at advancing credentials: What will the impact of adding more time to programs be to clinical placements? Our placement partners are already stretched to the max so will adding more time put more strain on our placement partners. Shouldn’t the main focus be on constantly improving current pedagogy? By expanding the length of certain programs, (diploma to advanced diploma, diploma to degree) programs need to consider the true meaning of competence and the way we assess competence. Will advancing credentials better prepare students to tackle problems, collaborate within teams to make patient centered decisions? How do we ensure our students are competent and how do we assess competence? I think paramedicine should advance credentials to better prepare student to cope with the demands of the job; however, overall I think allied health education does a good job ensuring that curriculum is grounded in humanistic philosophy that teaches students to practice critical reflection, values team-based approach and fosters the behaviors and attitudes that support ongoing professional development and life long learning.

  • Audrey Lowe says:

    While this discussion focused on credential creep and entry to practice educational credentials, just as O’Connor has stated I would like to hear about what the vision should be for continuing practice requirements. Educators have professionals for a short period of a professionals career. Professional associations, regulators and employers have the professionals for much longer. What about the strategy to have robust work oriented systems in place via regulatory and employers that makes sure that the personnel trained are continuously critically thinking for the benefit of improving the quality of patient care and the health systems. Lets develop a culture in which all health professionals from entry to practice and throughout their career are and (allowed to) think critically and work in quality systems for the benefit of patients. I am not sure that focusing the debate on higher credentials for entry to practice degrees alone achieves this vision. Perhaps a healthy debate should also include what should be the continuing practice requirements that build upon entry to practice requirements.

  • Rob Halkes says:

    Is “Quality of care” directly related with level and quality of medical education? The complicated relation between personal ability, motivation, quality of educational school, conditions of entry into real care etc. etc. is an issue of study for as long as medical education exists. Putting it in the way this blog is stating, is a rather tiny perspective on the matter. Why not just turn the question around: “What should medical education do and how would they need to do that”, to ensure that medical education improves health care practices!

  • Susanne says:

    I am not sure what evidence the above authors and Lewis actually explored, but I have read numerous peer-reviewed studies that suggest that patients receiving care from a nurse with baccalaureate education are more likely to live beyond 30 days after surgery than those who received care from diploma nursing graduates. It might be interesting for the authors to explore the issue of such abilities as critical thinking, communication and collaboration and their association with increased patient safety and better health outcomes.

    I suspect that many readers may be making the assumption that I am a nurse. However, that is not the case; I am a dental hygienists interested in understanding how we could achieve better oral health outcomes for Canadians.

    I do understand that many of the examples of ‘credential creep’ in the article were related to professions seeking to go from master’s to doctorate education and I do not have the knowledge to comment on that shift. However, I would encourage people to closely explore the importance of enhanced critical thinking abilities gained through baccalaureate education and the impact of those abilities on patient safety and better health outcomes.

    Personally, I appreciate receiving care from professionals with a wide range of educational backgrounds, but I would be comforted by the presence of a baccalaureate educated nurse if I was hospitalized. My husband had surgery recently and that was our focus. We listened to the input of all providers but we sought the input of baccalaureate nurses to guide our decision making. Of course we also sought the guidance of the surgeon but surgeons are not often on the wards. That is the reality and it is quite reasonable from an economic perspective.

    However, before you start judging changes in education to be examples of unjustified credential creep, you many need to reflect on the educational background of the professionals who are going to assist you when the doctors are not necessarily there. I know who I would like to be present on the wards.

  • Denyse Lynch says:

    Does increasing, enhancing our knowledge have to equal earning another degree or making a higher salary? As a “patient and caregiver”, necessity was the “Stimulation & Motivation” for me to learn, as much as I could, when I could, however, I could to help myself and be of assistance to my loved ones. There was/is no “degree” I aspire/aspired to or “salary” increase I could/can expect. Learning is a life-long opportunity, if we choose it. This “Necessity Learning” has benefitted me beyond what I imagined in that: the more I learned, the better I was/am able to care for my health and assist those close to me. I’ve become better at asking questions, acquiring answers, making plans, following-up, monitoring and adjusting for health changes and making decisions that align with my values. And oh, yes, less stress and better life quality.

  • Randy Luckham says:

    I can only speak in regards to the profession of pharmacy, both as a pharmacist who went to the U.S. myself to obtain Doctor of Pharmacy education back in 1983, and as a current pharmacy owner who very recently hired a newly minted Pharm D graduate from U of T.
    What the advanced education does is make the professional ready to handle complex patient cases earlier and makes them more confident to use their knowledge in the real world of patient care. To quote from above: “Professionals who’ve seen their entry-to-practice requirements change say it’s less about having advanced credentials and more a response to increasing complexity in patients, a need for more clinical confidence.” That is it in a nutshell. The title itself is not needed, nor is it really used in practice, but the education and the confidence is. My newly hired grad was ready to confidently go from the start.
    Many pharmacists practice today who have gained the same knowledge and confidence through experience and desire, and they are just as qualified. I imagine that many of them wish they had been able to have that confidence right from the start of their careers.
    Keep the good practical education that students are receiving now. The titles and degree designations are not as important.

  • Patricia says:

    are we pricing ourselves out of the opportunity to provide good primary care for an affordable amount by requiring advanced degrees and then the salaries that go along with that?
    Many services that patients need do not require advanced degrees for each practitioner, as we require advanced degrees we encourage autonomy of practice that can interfere with offering a nimble team based environment

Authors

Karen Palmer

Contributor

Karen is the Destination Development and Marketing Coordinator at The Corporation of the County of Prince Edward.

Christopher Doig

Contributor

Christopher is a Professor in the Departments of Critical Care Medicine, Community Health Sciences, and Medicine at Cumming School of Medicine at the University of Calgary.

Jill Konkin

Contributor

Jill is a professor in the Department of Family Medicine at the University of Alberta.

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