February 2020 | Feabhra 2020

Prepared for the Future

Sat, 1 February 20 20:33

An Interview with Prof Yvonne O'Meara

The big focus for medical schools now is ‘preparedness for practice,’ to produce graduates who are empathetic, resilient, and with the requisite skill set to function as doctors in the changing medical environment ahead, according to Prof Yvonne O’Meara, the newly appointed UCD Full Professor of Medicine & Therapeutics at Mater Misericordiae University Hospital.

The year 2020 is an auspicious one for the University, with the appointment of Prof Yvonne O’Meara as the first woman to the Chair of Medicine & Therapeutics and Prof Helen Heneghan as the first woman to the Chair of Surgery.

Prof O'Meara observed,

“We are putting a lot of work into the area of ‘preparedness for practice’ now, with a dedicated Professional Completion Module in the last semester.  We are also working to introduce our students to the ideas of self-care, professional self help and monitoring their own health, which in the past may not have received sufficient emphasis.

“We are also increasing our emphasis on practical skills with a programme of an intern shadowing which has been very well received. 

“Importantly, all of these developments are embedded in a research–rich curriculum where students learn not only current knowledge and skills but also where new knowledge comes from”.

A native of Scariff, Co Clare, Yvonne O’Meara, graduated in medicine from UCC.

“I was inspired to pursue a career in nephrology by Dr Derry Murnaghan (then a Consultant Nephrologist in UCC).  He was a wonderful physician, with incredible dedication to his patients and attention to detail. My excellent clinical training in Cork University Hospital, and subsequently in Beaumont Hospital, set me up for a prestigious nephrology fellowship at Boston University (BU). 

“While there has been much negative comment about the Irish healthcare system over the decades, it undoubtedly provides young clinicians with clinical training which is up there with the best on offer anywhere in the world. Having said that, the move to Boston was an eyeopener for a young physician, because of the strong focus in the US on pathophysiology and mechanisms of disease, along with the sheer scale of resources available in their academic medical centers.

“It was in Boston that I acquired my love of research. The research programme at Boston University was, and is, at the leading edge of nephrology research worldwide. The more time you spend at the clinical coal face, the more you appreciate how relatively flimsy our knowledge of clinical medicine is. These gaps can, of course, only be filled through high quality research. I had the privilege of immersing myself for three years in laboratory research into the pathogenesis of glomerular disease. One of my biggest influences was the inspirational David Salant. – then Chief of Medicine in Boston University Medical Center, and an icon of US nephrology. Importantly for me, that period yielded several papers in leading journals that formed the basis of my MD degree and earned me the Evans Young Investigator Award from BU.

“Having completed my research fellowship, I then had one of those crossroads moments, when I had to decide whether to pursue a career as a laboratory researcher or as a clinical investigator and educator. I chose the latter and joined the BU Faculty, where I served as Director of Clinical Nephrology and Director of the Nephrology Fellowship Programme. This was a very exciting time and my husband and I may have ended up staying in the US if it had not been for the birth of our triplet sons! Suddenly proximity to family became very important and we moved back to Ireland.

“I suppose the lesson from this experience is that careers rarely take a linear path – a fact that is even more true nowadays.  You have to be ready to adjust and grasp new opportunities as they arise. This, of course, is especially true for women.

“I was fortunate in that, following a period of maternity leave around the birth of my children, I secured the post of Consultant Nephrologist/Senior lecturer in Medicine at the Mater and UCD. I have enjoyed balancing my clinical, teaching and research interests – although this can be very challenging in the Irish system, where resources on all fronts are so much more constrained than in the US. I have also enjoyed contributing to a number of important national initiatives and served as ICHMT National Specialty Director in Nephrology and President of the Irish Nephrology Society.”

Asked about her top priority as Professor of Medicine, she said,

The sine qua non for the Professor of Medicine, as I see it, is to be the custodian of an inspiring and high quality student experience. Of course, the Professor of Medicine also plays important roles in postgraduate education, building research capacity and representing the Medical School across the University and on the national and international stage. However, without our undergraduate and graduate entry medicine programmes, we simply would not have a medical school. Education lies at the very heart of the mission of a medical school. It accounts for a major component of our reputation. And, of course, it pays the bills”.

“We have already made great strides in medical education in UCD and the Mater, St. Vincent’s and our other teaching hospitals in Ireland East Hospital Group. We consistently lead in attracting the brightest and the best students from Ireland and across the world. I’m very proud of the work we’ve done on our curriculum – moving to a systems based approach and a modular system, reforming our assessment practices and introducing important innovations in the final year of programme. I’m delighted that so many of our students take time to immerse themselves in a research project during their time with us as this gives them a sense of where new knowledge comes from and will serve them well later in their careers.

“Our students enjoy infrastructure on the Belfield campus and hospital sites that is second to none. Over the past two decades, we have seen the development of the new medical school building, the Conway Institute, Charles Institute, Systems Biology Ireland, McAuley Centre and Clinical Research Centres, as well as our world-class Student Centre”.

“And, very importantly, our students are supported on their journey by our superb staff – both pre-clinical and clinical academic staff and our professional services and operations staff across the University.”

Asked about how the pressure on the health service affects the relationship between the medical school and its hospitals, Prof. O’Meara said.

“Our hospitals are indeed under huge pressure and do superbly well, given their limited resources. I see this on a day-to-day basis in my work on the wards, in outpatients, in the intensive care unit and in our dialysis unit. The University is also stretched by comparison with international competitors, as our EU fee levels are so low and are effectively frozen, while government investment per student is being progressively eroded. But despite these pressures, our Medical School and our affiliated hospitals are stronger together. Our teaching hospitals are central to the success of UCD Medical School, and indeed to the University, and the University affiliation is beneficial to our hospitals.

“Our Medical School is as old as our University. One of John Henry Newman’s first acts over 150 years ago was to establish the Catholic University Medical School – the antecedent of UCD Medical School. Our teaching hospitals were key to its success in the 1850s and remain so today.  And, it is important to remember how important the Medical School is, in turn, to UCD’s success more broadly. While there will be variation depending on the country, funding model and university structure, as a rule of thumb a top class medical school will account for over a quarter of a university’s research publications and citations, over a quarter of tuition fee income, over a quarter of research income and over a quarter of philanthropic income, as well as being a major contributor to the university’s reputation as a force for good in its local community.

“And, of course, it cuts both ways! Affiliation of a hospital with a successful medical school and university typically benefits the hospital in a number of important ways. First and foremost, patient outcomes are superior as practice is more likely to be evidenced-based and new diagnostics, therapies and technologies are adopted more quickly. Secondly, it is a draw for top quality staff.  Most high quality clinicians attach a premium to working in a teaching hospital – they enjoy teaching, strive to maintain their research reputation, and appreciate the wider benefits associated with a university affiliation and academic title. Thirdly, the relationship guarantees a dependable pipeline of high quality junior hospital doctors and, indeed, allied health professionals. And the affiliation provides staff on the hospital campus with access to research funding and facilities. Finally, and importantly, the hospital’s national and international reputation is enhanced through the university’s graduates, research outputs and global profile”. 

“There are, of course, always tensions between medical schools and teaching hospitals, principally around competition for resources! The most successful medical schools and teaching hospitals recognize the complexity of the relationship and the mutual benefits, and actively manage these tensions. The Professor of Medicine, as a key university leader based on the hospital sites, has an important role to play ensuring that these mutual benefits are understood.”

Prof. O’Meara said she anticipated that the key challenges over the next decade would be multiple and varied.

“I’m also certain that our Medical School and hospitals are strong enough to withstand them if we use our collective ingenuity to good effect”.

“Funding is always a challenge whether in higher education or the health service. In the short term, this is compounded by political and economic uncertainty related to Brexit, trade wars and other factors. One has to anticipate that any government will be reluctant to loosen the purse strings until these issues play out. There is a job for all of us who are passionate about education and research to do everything in our power to persuade government to invest more if we are to compete internationally, as we have done successfully for decades”.

“From an academic viewpoint we will have the exciting challenge of balancing the traditional strengths of our medical curriculum with the need to incorporate new concepts and breakthroughs in areas such as genomics, synthetic biology, precision medicine and digital health. We will also have the challenge of increasing the resilience of our students so that they can cope with this rapidly changing environment. We need our students to be competent and compassionate doctors from the day of graduation while also being equipped with the learning and life skills to incorporate new knowledge into their practice while looking after their own physical and mental health.

Asked if she had any advice for young people considering a career in medicine, she said the medicine we were practising now was quite different from what it was when she qualified. 

“There is always change and for the most part it is for the better. Things are so much better in so many ways. The graduates of the future will have to learn a lot of flexibility to adapt to new ways of working and embrace new technology. When I graduated, medicine was an incredibly rewarding and varied career, and that is still the case.  There is a lot of negativity, especially in the media, about the health service and sometimes people become demoralised. We are working under very tough conditions at present with insufficient resources, but ultimately medicine is a wonderful career and people have to stick with it, not lose heart and seek to be the drivers of change for the better. While there is a lot more to do, the environment now is much more supportive for women. I believe the new generation of doctors will have a better work-life balance than their predecessors and that is a good thing.

Prof O'Meara was in conversation with the health analyst and commentator, Ms Maureen Browne of Hartcliffe Communications.