It’s been a year of change for us.
Following learning from our collaboration with Kamuzu University for Health Science, Malawi, we diversified our programme structures to encourage even greater case‑based learning. The NHS Highland microbiology and respiratory teams were the first to try it out, and the early results were promising. Not only did it encourage richer case‑based discussion, but the sessions also revealed real‑world system issues unique to Highland. We also saw a significant uplift in annual attendance, and this pattern is continuing into 26–27.
Our most recent collaboration - exploring complex decision‑making in Frailty, in Highland, is ready to begin in early September. We saw nearly 100 registrations in just four days, with interest stretching to the central belt and beyond. We are also beginning work on training design to equip advanced practitioners to lead ECHO, alongside the return of established networks for Non‑Medical Prescribing and Respiratory practice.
Perhaps our biggest change will be the repositioning of ECHO to sit within the Hospices Knowledge Exchange activity where we will expand this website function to reflect this.
So why the change of pace?
To answer that, we need to go back to the origins of ECHO, which was to spread knowledge, fast. We haven’t lost sight of that, but we are now working in a significantly more complicated landscape.
For one example, the line between doctor and patient has changed, with more information than ever before available to the public. Realistic Medicine has strengthened patient - doctor collaboration, for the better, but with change comes new expectations.
The question for practitioners is no longer just “How do I master clinical complexity?” Increasingly, they are being called upon to ask themselves, “How do I relate within it?”
In Malawi, spiritual beliefs walk hand in hand with medicine. As one practitioner explained during an ECHO session, “You must respect beliefs to keep the conversation open. I ask patients about their beliefs in spiritual healing, and I share my beliefs about medicine.” That humility, that willingness to meet people where they are, is something we have reflected on at home.
With a palpable rise in social‑media‑driven health remedies and new lifestyle paradigms, western practitioners are being called upon to integrate new beliefs while system pressures allow those beliefs to move into a larger space. We see this discussed more and more in ECHO communities of practice, where beliefs - cultural, spiritual, social, digital - are becoming an emerging currency in patient–doctor collaboration.
ECHO is evolving not just as a place to strengthen clinical reasoning, but as a space where relational skills, cultural humility, and the ability to keep conversations open are becoming central.