Sunday, 17 June 2007

Dumb and dumber


It turns out that, as expected, MMC is leading to a rather worrying dumbing down in training standards; the transitional MRCS examination is looking set to contain no clinical examination:

"1. The present proposals for the new MRCS do not represent an adequate level of knowledge or clinical skill to merit the award of the Diploma. The Court feels strongly that the MRCS Diploma should not be awarded without assessment by written, oral and clinical examination.

2. There will be a disparity between what is required for the award of the MRCS Diploma for candidates in the UK and overseas. This will introduce a two-tier system.


3. The introduction of the need for a surgical tutor to give clinical approval based on workplace-based assessment is unsatisfactory, and workplace clinical assessments have yet to be adequately validated.


4. The Court feels strongly that the level of knowledge and skill required to achieve the Diploma of MRCS should be defended and not compromised by the drive for intercollegiate cooperation and to meet specialty demands.


5. The Court feels that the difficulties arising in delivering the proposed changes to training and assessment exist because we are failing to take into account the need to set and maintain standards. If changes are to be introduced, we feel strongly that they need to be piloted in a way that demonstrates their superiority to existing systems."


Is anyone else surprised to see untried, untested and unvalidated tests being introduced over tried and tested ones thanks to the magnificent MMC? It appears to be out of the same lame duck box as the Foundation year workplace assessments; the competency based fundamentalists are turning their hand to dumbing down specialist training.

Does anyone actually genuinely believe that Modernising Medical Careers is about improving medical training? To me it seems to be doing the precise opposite, the government's cynical vehicle for catalysing the privatisation of the NHS is a dangerous menace. Introducing the sub consultant grade is a step back to the dark ages, a step away from excellence towards mediocrity which must be militantly resisted.

1 comment:

tired doc said...

Well what did you expect?

Given the scary lack of knowledge in those emerging from medical school - and I'm not talking in-depth physiology, just basic name-recognition of things like:

Salter-Harris
Thalassaemia
Porphyria
Meckel's diverticulum

amongst many others, all of which have met with a totally blank response from group of 2nd year doctors. They denied being taught anything about the haemoglobin pathway, or even that fractures could be classified.

I can teach them about CCF on the patients they see every day. medical school is there to provide a wide base of knowledge so that the rarer pathology slots into place when they see it. How can you ever be a diagnostician when you only know about the common stuff.

I suppose this is why, increasingly, patients are discharged from hospital with a letter that boils down to the following:

Dear Dr GP Cardigan,
Thank you for sending Mr X. The (tentative admission diagnosis) has been excluded. He still has abnormal LFTs, abdominal pain and is losing weight. Thank you for taking back his care. We have made no plans to see him in outpatients because we really aren't interested in whether he continues to deteriorate.
FY2 (My SHO told me to discharge the patient)