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.”