The butterfly is a flying flower, The flower a tethered butterfly

Tuesday, 1 January 2008

Lost direction ...

The current true shape and direction of Post Graduate Medical Education in Britain ..

David L.Cox (thank you), a regular visitor to this site, recommended a BBC Radio 4 programme called 'where is the femur?' it went on air today from 8.00 to 8.40pm. The programme will be repeated again on Sunday 6 January 2008 17:00-17:40 (Radio 4 FM), but I expect that Remedy UK may add it as a podcast on their site since they were represented by Matt Jameson Evans, who again, excelled in explaining the current training problem and the adverse impact of the reduced work hours due to the EWTD on junior doctors training.

In the programme, the presenter; Clare English,

"examines the state of medical training in Britain amid fears that the next generation of consultants will have significantly less experience. Junior and senior doctors claim that massively reduced time in surgery, less training in the human sciences and a disastrous programme of reform are major threats to the future quality of healthcare."

From a non medical point of you, my first impression after listening to the programme was that the seniors in charge of and/or influencing post graduate medical education in Britain are themselves 'confused' about which direction this should take or what should be the content. Do you run through or preserve competitive points to encourage competition and, therefore, excellence? Was the old method better than the new MMC that proves competences in different procedures and levels? What to do with the EWTD when it reduces the maximum hours a young doctor can work to 48 rather than the current 56? Are we currently 'over training' our doctors?

It really was very apparent that there has not been sufficient consultation amongst the seniors or even enough study done to determine clear criteria for what you want the doctor of tomorrow to do and how to design and implement change effectively, before designing the new system then before changing from the old to the new. The result, in reality, is the same as this blurred mixture of opinions as was on this programme Of course, this only depicts and confirms the picture of uncertainty that is also the main feature of MMC as it stands at the moment, in short .. chaos, even now.

The CMO admits that MMC needs adjustments and makes assurances that change will happen but he does not commit himself to confirming whether the Tooke recommendations will all be implemented or what will happen exactly to address the current situation. The presenter did not take the opportunity to inquire with him about the low numbers of posts for 2008.

IMO, He seems to be firmly set on his idea of 'run through', which, had the number of posts been equal to that of the applicants, the idea would have passed well as no juniors would have unfairly been frozen out of training as is happening now. Then again, since Britain is aiming for self-sufficiency, this means that in reality, the number of training posts will never match that of all applicants unless Remedy's attempt at reviving an old DoH promise of a 'consultant led service' is implemented. (See Prof Pounder's presentation this and the near future workforce planning on the Remedy UK site)

As you can see, the matter is becoming more and more complicated by the day. IMHO, to progress from such critical position, ways should be found to first, simplify matters, by identifying a real clear set of criteria of what the doctor of tommorrow's role should be, then base the content of the training syllabus on this well defined role. Once this is clear, take Professor Tooke's final report and have it studied against this new set of agreed criteria and syllabus. Then, have that reflected upon by as many seniors, individually, who are involved in medical training as possible, those same seniors can then meet afterwards, compare notes and ideas and agree a final shape and direction of medical training in Britain. That done, get 'real' representatives of junior doctors, like Remedy UK and others already in ST posts of all levels, to give their opinion on the final product and adjust as necessary ... done! ..

... So, it's all about organization and team work ... for the seniors :-) ... But, what about 2008, no mention at all?!

Of course IMHO, over training is never a problem or a safety risk, under training is ... always ;-)

The secret of all victory lies in the organization of the non-obvious.”


Witch Doctor said...

Happy 2008 to you and yours, Sam.

Unfortunatley, I think the "blindfolds" are not far off the mark. Senior medics are only just wakening to the possibility that the European Working Time Directive was an excuse for occultly redefining the role of the doctor without consultation. And it has almost been accomplished - although MTAS has served the function of making many doctors, for the first time, realise what is happening.

I just wonder who exactly will be charged with "re-defining" the role of the doctor, since it will also require to "re-define" the roles of some of the new health care professionals, as well as tackling the "Agenda" in Agenda for Change.

Not an easy task!

Sam said...

Thank you Witch doctor and a very happy 2008 to you and yours, not forgetting black cat of course.

I have no idea who will be in charge of redifining the role of the doctor, or even if this will be redefined at all! Don't forget, this redifinition is, thus far, a 'recommendation' by Tooke and from what I gather, after listening to this radio programme, it seems that the CMO is set on protecting his invention; as whole as possible. If this will be the case, only a few bits and pieces from the final Tooke report will be 'manipulted' and implemented. Otherwise, the whole concept of 'unfinished business, NHS plan 2000 and Agenda for change', will all come under the microscope again to find out exactly what they all aim to achieve as, judging by the seniors response in this programme, it seems this is something that is not at all clear now, hence the contradicting views. Or, whatever is clear, is now percieved not to be in the intrest of the medical profession, hence, the resistance, especially by people like Prof Brown and Ribiero.

We can only wait and see what will the CMO's response be after the final Tooke report comes out on 8 Jan.

The more urgent problem now of course is, what will happen in 2008 and if anybody is doing anything to help save the thousands who will be harmed if left to proceed as is?!

Sam said...

"David L. Cox said...
A very interesting review of the training of doctors in the UK on the Radio 4 programme. Much commonsense from Profs Brown and Rahilly of Fidelio and useful input from RemedyUK. Some valuable insight from others including Ribeiro.

Sadly there was some dire input from Donaldson again - the policy "was correct" and such errant nonsense.

It is clear that as so far developed the MMC/Foundation years and even the university problem based learning approaches have left much to be desired.

Tooke's approach is clearly the only way forward, provided it is accepted quickly and in its entirety; Donaldson was already obfuscating about that - maybe a hidden agenda?

No doubt all SHO grades and equivalents and some of the seniors too will suspect Donaldson's lack of commitment to Tooke's findings in a similar way! Perhaps he'll find it difficult with an audience of medics to persuade anyone to his views.

It is however clear that with the working time directive limiting doctor's time, and presumably service needs put ahead of training, that MORE doctors will be needed and these will only be available if the training place provision is expanded to encourage them to stay."

But self-sufficiency means pushing doctors into trust grades too David. The CMO looked more ready to co-operate when he was at the HSC that in this programme! Let's wait for Tooke's report and see what will be next.

David L. Cox said...

You are right Sam, in that self sufficiency means use of trust grade jobs or something similar. Of course such jobs in the past were used to supplement experience for juniors in traing, something that run-through has destroyed.

Tooke's suggestion that flexibility return will require the return of some point/s in training of juniors where experience builds up, before a return to training.

My main fear is that the CMO in his folly tries to avoid the full backing of Tooke. His comments in the programme were far from the ringing endorsement needed. Of course the correct progression from accepting Tooke would be his acceptance of responsibility for the disaster and his resignation! I won't hold my breath!

I do fear however that his reticence might auger badly for some new government approach, perhaps shy of the Tooke recommendations. This would exacerbate the problems further. We must wait and see.

Sam said...

As you say, the problem with MMC is that you are either 'in' or 'out', therefore, with MMC as it stands, once in a trust grade, will most probably be 'always' in a trust grade, forever. I wonder if this was an intended part of the design of MMC and the strive for self suffeciency, which, in itself, is a good thing IMO

Of course, as a non medic, I can be very wrong (Read my next post, I was just thinking aloud, trying to understand why things are the way they are now. is it just a load of nonesense? ..:-)