Monday, 21 May 2007

The remarkable successes of Foundation training

'The successes of foundation training are undeniable'- discuss; instead of repeating a statement of fact over and over and over in the vain hope that saying something enough will make it true, I shall try to argue my case in a different way to the flimsy approach used by our despotic leaders.

MMC and its side arm MTAS have been rushed through without adequate consultation despite HMG's claims to the contrary. A proper consultation involves seeking opinion, listening and modifying ones actions based upon the aforementioned processes. The government's railroading through of MMC/MTAS has involved creating a malignant quango c
alled PMETB, using PMETB to take control of medical training, involving a minority of non-cronies whose remonstrations are ignored and whose non withdrawal is equated to consent, using a few token junior doctors on various panels whose opinions are ignored, not modifying the original policy thanks to the domination of various committees by government appointed cronies, ignoring any well grounded criticism of their policies, hiding those involved from exposure to the media and conducting all the crucial discussions about these tactics behind closed doors in an undemocratic manner.

We have seen the recent uproar in reaction to the farcical MTAS, a brilliant demonstration of how this corrupt policy making protocol can be guaranteed to generate utter chaos as the majority of medical opinion is set firmly against it. It has shown that no matter how hard the government tries to force its sofa through the cat flap, it will not fit. We have seen lie after lie after lie from the government's agents of destruction, a recurring theme has been the ignoring of any concerns raised and just pushing on regardless.

The utter reliance on the flawed competency based model of training is a massive danger to standards on its own. Martin Talbot has written some outstanding articles on this topic; Dr Grumble has printed a good Talbot letter that summarises the dangers of the MMC style approach. He is not the only highly respected medic to point out these glaring flaws, the BMJ has published a critique of the competency based model:

' If applied inappropriately, it can also result in demotivation, focus on minimum acceptable standards, increased administrative burden, and a reduction in the educational content.'

There are many other examples of similar well researched criticism. The end result of ignoring this criticism may well be a catastrophic dumbing down of medical training.

Importantly what do the guinea pigs think of Foundation training? After all if this great new MMC system was providing such good training, then surely an overwhelming majority would come out in support of MMC? It is a great shame that the BMA has no asked its junior members for their opinion on MMC, as the results from Remedy surveys are damning. Alex Liakos, an ex-student adviser to MMC, organised this petition against the competency based selection of medical students for their first doctoring jobs. The ridiculous reliance on self-assessment and the devaluing of academic achievement were among the main criticisms of this politically correct competency based process. Over 1300 doctors have signed this petition listing some pretty revealing comments along the way:

The MDAP system is NOT impartial as claimed: students who exaggerate their achievements and use the right buzzwords will score highly over those who are more realistic in their self-assessment. It is a cheater's charter."

"This MMC is a devious cost cutting measure which does not seem to care about the incipient deskilling of the medical profession it will inevitably cause."

"I don't understand why ignorant fools are being allowed to design and implement public/social policy. Especially where their decisions are likely to have dire consequences for the medical profession as well as this country's health service. WAKE UP!"


"I have been a teaching hospital consultant neurologist for 10 years. The new system deprives hospital doctors from selective the brightest and best medical students and is another fine example of dumbing down and political correctness gone mad"

There are many more comments like these. The warnings were there for all to see, this petition was done in 2006! The criticisms are virtually carbon copies of the criticisms of MTAS 2007. If I remember correctly we have even had to listen to politicians claiming how well the MTAS selection process was working for medical students, it seems the students on the ground would disagree.

Foundation training is based on the same shaky foundations as MTAS, the same principles apply. The establishment's psycho babblers Patterson and Thomas have provided the scanty evidence base upon which this crumbling shack was built. Genuine competence has been replaced by a politically correct pseudo-competence that relies on ticking boxes, bullshitting and minimum standards. The assessment tools such as DOPS, mini-CEXs, CBDs are relied upon despite the fact that they have been minimally tested and when tested have been found wanting on many levels. Clinical experience, honesty and doing your job well are all but ignored in the pursuit of meaningless paperwork that is claimed to prove a doctor's definitive 'competency'. The word 'competency', notoriously almost impossible to define when it comes to doctoring, has been completely misrepresented and abused by the government's educationalist nincompoops.

Training is being dumbed down before our very eyes. Foundation programmes have converted numerous non training posts into training posts, while doing nothing to increase their training content. Many of these Foundation jobs therefore have zero acute experience; the impact of this on training cannot be underestimated. This August will see numerous staff grade jobs converted into FTSTAs, decent training is being diluted down. The logic of our competency based fundamentalists would assume that the process of filling in eighteen bits of paperwork a year and documenting what the ward clerk thinks will miraculously train competent doctors; their logic circuits must have shorted many years ago. This goes on as training budgets are slashed, royal college exams are dumbed down and study leave becomes much harder to obtain. The malignant PMETB oversees this disaster while the dis empowered royal colleges that once held training standards high, now know not what to do next in order to save the day?

The end result will be a poor training system that will produce a much lower calibre of doctor, and there will inevitably be consequences for the patient as a result of this. The grass roots of the medical profession are no fools, they can see that the new MMC system will not help them become the outstanding doctors that they so badly want to be. The introduction of the sub consultant grade will cuts costs, but it will also result in a shoddy service for anyone unfortunate enough to be treated by this lower tier of staff. The frustration and anger felt by juniors of today is tangible and it cannot be allowed to continue. A solution that drives training standards up will only be found if the grass roots are properly consulted, and the real issues that threaten medical training today will only be defeated with a strategy of genuine cooperation.

The thinking behind MMC/foundation training and MTAS has been shown to be significantly lacking. A finely evolved medical training system that used to be the envy of the world is being cast aside, in favour of a dimwitted psychologist's crackpot scheme that threatens to turn us into a humiliated laughing stock. The creation of a disempowered sub consultant grade is the genuine aim, and the government cares not if it ruins medical training in the process. It is time that the medical profession unilaterally
withdrew and refused to cooperate any longer with this half witted burglary of our crown jewels.


Anonymous said...

Aren't these the required standards for the Tesco GP?

Anonymous said...

Hey, I felt I had to respond after reading this blog post. I have read tons, infact probably more than that amount of articles about the NHS and the new training system failling Doctors and dumbing down medicine. I've researched and researched all these issues and it leaves me feeling rather dismayed, confused and worried. I have been accepted in to medical school but I worry for my future now, I am not rich I can't afford to incur debt from Med School only to find myself unemployed at the end of it which I am fully aware could happen
but it is not that that grieves me so much as the current system and the NHS failling us. A small part of me is starting to wonder whether I should turn down the offer of acceptance or not. I never thought the day would come when I would say that. I am not your tradditonal student, I am a mature person who came to Medicine the long way not by choice but due to circumstance; my Mum (single parent) died when I was 18 of cancer, I left school to care for her I was all she had, this naturally meant that I would return to education later. My father died also of cancer whilst I was at college as a mature student doing Highers. I faced many challenges when young not just my grief but of supporting myself young and having literally myself to rely on and battling my bereavement issues whilst working as a carer and fighting to keep the house I shared with my Mum so as no to end up homeless.
I've overcome all the adversity
and all challenges so here I am today 24 and being accepted into Med School. Several of my friends and loved ones have been affected by various Metal Health illnesses and Cancer which only fuels my passion and drive more to help and to heal and to be there for people who like me had noone to talk to or to help them following a loved ones diagnosis, well my future patients will have me someone who has been through it themselves.
branches of Medicine I am interested are Palliative Care and Psychiatry for obvious reasons due to my life experience in both. I want to ask you the following: Knowing what the NHS is like now, the corruptness and the vast and diverse range of problems in the service (I will not go on about then for there are literally loads) would you do it all again if you had the chance? Would you discourage people from entering the profession? I'm just curious. I don't allow opinions broadcasted on the internet to affect my judgement, or to put me off doing what I want to do but I can't ignore the points either.
The NHS needs more future Doctors like me coming into it, the sad thing is that the poor conditions
of the NHS, MTAS, MMC just pushes the good ones away which can only be detrimental for patient care.

Garth Marenghi said...

don't let me put you off, I love medicine and my daily work, I regret my decision to do medicine rarely, most of the time I have no regrets at all

If you think medicine is for you, still go for it I reckon,

come and join the masses and we'll make the system something to be proud of once more,

feel free to email me if you have any questions, and I'll give you my biased rantings!



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