18 May Turning the tide: the importance of health science on rebuilding society post-COVID
Cathal Kelly, CEO, RCSI University of Medicine and Health Sciences, Ireland, discusses the impacts of health sciences on our community and crucial revolutions in the way health science is taught to develop a more sustainable future
What differentiates your educational institute from others in Ireland and the world?
The Royal College of Surgeons in Ireland (RCSI) was founded in 1784 and has evolved into a health sciences university focused on all aspects of human health research and education. Many things are unusual about us. The first is that we are completely focused on health sciences. Second, we are Ireland’s only independent, not-for-profit university. Third, we are the most internationally focused of Ireland’s universities. And last, we combine a university of medicine and health sciences with a significant postgraduate training body. For example, we have an undergraduate school of pharmacy and run an internship program for all the master’s students in pharmacy in Ireland. We also host the Irish Institute of Pharmacy, which provides continuing professional development for all pharmacists and practice in Ireland. We have this same continuum in surgery, radiology, emergency medicine and sports and exercise medicine. This is unique because in anglophile countries the university is separate from the postgraduate training body. We do both. We were the first to introduce graduate-entry medicine in Ireland and nurse prescribing. We established a Foundation School of Physician Associates in Ireland and a School of Nursing Midwifery. We think the role of advanced nurse practitioners has huge potential.
In 2020, RCSI ranked number one in the world in terms of the UN’s Sustainable Development Goal 3 for good health and wellbeing in the Times Higher Education Impact Ranking that measures universities’ contribution to the United Nations Sustainable Development Goals. Our mission is to educate, nurture, and research for the benefit of human health.
What reach does the school have in educating health sciences worldwide?
Our international footprint is wide. We run the two following medical schools in Malaysia: RCSI UCD Malaysia Campus in Penang and a collaboration with the Perdana University in Kuala Lumpur. The former we have run since 1996 and the latter for almost 10 years. We run a fully owned university in Bahrain, called Royal College of Surgeons in Ireland Bahrain, that looks after medicine, nursing and postgraduate studies. We also run a training institute for healthcare leadership in Dubai. Additionally, we have a collaboration around pharmacy with Soochow University in Jiangsu, China.
RCSI, in collaboration with Irish Aid, the Irish government’s foreign aid service, is the largest Western supporter of surgical training in the College of Surgeons of East, Central and Southern Africa (COSECSA) region, from Ethiopia down to but not including South Africa. We recently consolidated our long-standing commitment to global health and equity of access to surgery with the launch of the RCSI Institute of Global Surgery in March this year. As a result of the global pandemic, we are seeing increased pressures on under-resourced local health services in developing countries. We hope our new Institute will be a leader in the response to this global crisis in surgical care.
What focus does your university have in terms of research?
We concentrate on healthcare research that bolsters medical innovations and new diagnostics and treatments for patients. Our expertise is in bioengineering, neurological and psychiatric disorders, population health, vascular disease and oncology, particularly breast cancer. Our research is high impact and involves almost 3,000 international collaborations. Our researchers are prolific and influential in their fields; our field-weighted citation index is the highest in Ireland and twice the world average.
What specific goals does RCSI have in modernizing the local and international medical community?
Our strategy can be summarized in a phrase that others have used called One Step Up. Even before the pandemic, the world was facing a public health crisis, with an aging population with more complex illnesses and expensive treatment with limited resources. The only way we can fill this gap is for everybody to step up, thus why we call it One Step Up. The public needs to be better educated and take more control of their healthcare and personal wellbeing, which we aid with a public program of engagement and education called RCSI MyHealth. This is the first step.
Second, every health professional group needs to extend the scope of their practice. In many countries they have done this on an emergency basis due to the pandemic. This needs to be institutionalized and made a reality in the long term. For example, pharmacists can and have potential to play a greater role in health care in terms of prescribing and renewing prescriptions, providing testing and administering vaccination programs. Physiotherapists can play a greater role in terms of organizing imaging such as magnetic resonance imaging and X rays, prescribing anti-inflammatory medication and playing a greater role in the management of musculoskeletal injuries.
Additionally, we would like to introduce other professional groups into the healthcare ecosystem. In agreement with the Irish government, we introduced a pilot school of physician associates (PAs) four years ago. There are about 150,000 PAs in practice in the U.S., and the practice has been there since the 1960s. In the UK it is still not a fully recognized professional group, but there are at least 17 PA schools in the UK graduating about 1,000 PAs into the NHS per year. They play an important role in primary and hospital care. There is a service gap in Ireland that this professional group can fill. We are committed to addressing this.
We also want to introduce more education and training around healthcare economics, including the organization, delivery and redesign of health systems starting as undergraduates and building to postgraduates. Other elements we want to stress on the medical community are personal well-being, professionalism and application of lifestyle medicine. As a healthcare clinician, if you do not look after yourself, you cannot look after patients. A doctor who does aerobic, anaerobic or mixed exercise programs are more likely to recommend healthy lifestyles. Health care professionals need to be familiar with the tenets of lifestyle medicine.
What skills do you think are most important and most lacking in modern day curriculums for health practitioners?
It is time for a fundamental rethink of the education of healthcare professionals. There is no doubt that the healthcare professional of today and tomorrow is embarking on a life journey in a complex and rapidly changing environment. The days when a doctor was a master of all information and a wise figure guiding patients are gone. We need to work as a servant or partner to our patients because our patients are now much more informed about their options and their health care. There was evidence of significant burnout and loss of resilience among healthcare professionals before the pandemic. We need to equip our young healthcare professionals with the correct skills to absorb, accommodate and understand new knowledge that continues to grow exponentially. We need to collaborate with patients and their own personal life skills rather than just allowing them to survive in the modern world. We want patients to thrive and realize their full potential.
How is RCSI leveraging on new digital technologies to advance its educational facilities?
One of the great strengths of Irish clinical education is junior students and doctors having access to senior clinicians in clinical environments, and this will continue. However, there are tremendous opportunities with simulation. We built an award-winning simulation center at our Dublin City center campus. RCSI’s Centre for Simulation Education and Research (RCSI SIM) contains many elements of a real hospital setting. Students are trained and debriefed using structured and repeatable teaching models in a safe learning environment to develop their skills before engaging with real patients in the hospital setting. More than 20 staff deliver vibrant simulation programs embedded across our curricula, starting from undergraduate medical, physiotherapy and pharmacy students through to advanced postgraduate simulation, including specialist surgical training.
We recently appointed Walter Eppich to lead RCSI SIM. The training done at our center is underpinned by internationally recognized simulation methodologies, which Eppich brings from his extensive teaching and research experience at the Harvard Center for Medical Simulation and from his studies on teamwork effectiveness in extreme environments. We received funding to appoint Eppich as Ireland’s first chair in simulation to look at the use of simulation in science. We made a major investment in digital enhanced learning to better educate tomorrow’s healthcare professionals.
How did Ireland’s academic body respond to the COVID-19 pandemic?
The Irish public responded well to the COVID crisis. There is tremendous societal cohesion and cooperation with the Irish government in dealing with this crisis. This is evident from the high acceptance rate of potential vaccinations and public response to the lockdown. We still have a balanced national media. Our newspapers, TV and radio channels adhere to best practices in terms of broadcasting and provide balanced fact-based information.
This has been a great moment for Irish universities. Many of our academics have played leading roles informing the public and have become trusted advisors. We supported the government and debated when debating was necessary. Our public experts in infectious disease and microbiology have played a considerable role in our country’s reaction to the virus. On the hospital side, our clinicians have played an integral role in guiding our hospital systems. We are partners with the RCSI Hospital Group in Ireland. Our professors in intensive care, respiratory disease and microbiology and infectious diseases have taken a lead role in the management of the pandemic. The RCSI Hospital Group performed well, including supporting nursing homes where there was a crisis in their region.
Our researchers played a role in supporting the hospital system, setting up polymerase chain reaction testing, providing buffers and doing fundamental research. Perhaps one of the most important papers to come out of RCSI on the pandemic was by James O’Donnell and his group at the Irish Center for Vascular Biology that identified there was inflammation of the vascular system and high evidence of pulmonary embolism in COVID patients rather than carriers of a traditional respiratory virus. The pandemic illustrated the importance of science, healthcare systems and universities in contributing to society. We have seen that both here in Dublin and internationally.
How has the pandemic impacted working healthcare professionals and the wider public?
The pandemic has taken its toll on the mental health of the general population, including healthcare professionals. We recently launched the RCSI Centre for Positive Psychology and Health. Our curriculum is focused on building resilience and wellbeing using the tenets of lifestyle medicine. More than 18,500 people registered for a free ten-week online public course called The Science of Health and Happiness that we launched in March, illustrating the enormous appetite from members of the public to equip themselves with the knowledge and skills to build their resilience and help maintain their own well-being.
The Irish government recently allocated $1 billion in research and development activities. What areas offer the most promise for investment?
The Irish government is to be congratulated in their ambition and investment. Early career funding and opportunities for biomedical researchers and other researchers is crucial. This will foster a research ecosystem that can serve Ireland well. Every country needs to get the balance right between translational research and basic fundamental research. When you have limited investment potential we tend to focus on translational research because we receive feedback sooner. However, Ireland needs to keep its eye on fundamental basic science research and carefully maintain that balance.
What new investments is RCSI making to upgrade its facilities and programs?
We invested more than $120 million in our campus over the last 10 years, including the building of our clinical simulation center, the largest in Europe. We have received European Investment Bank funding and planning permission for a further major development, a 130,000-square-foot academic building on St. Stephen’s Green, which is in the heart of Dublin’s central business district. We are looking for more collaborations with Soochow University where we recently started a joint PhD program. In terms of international expansion, we want to do it in collaboration with local partners. In the COSECSA region in Africa, we are very much informed by the Paris Declaration in that we are supporting local providers to enhance their operations rather than competing with them.
What do you envision for the future of RCSI in Ireland?
Ireland is a small country and has soft power. We have a seat on the UN Security Council. We have a much bigger influence than a country our size deserves, related mostly to our immigration diaspora caused by historical activities of religious orders overseas. I want RCSI to play a role in supporting and influencing Ireland’s soft power internationally. We can best exercise our international influence through education. Our country also has an open economy and a highly competitive environment. I want RCSI to be a key player in the government’s armamentarium to attract overseas investment in healthcare technology and research. I want RCSI to create a tide that lifts all boats.