Tuesday, 29 January 2008

MMC inquiry rolls on

I apologise for not covering the recent Health Committee sessions, my mind has been erratically hopping from random topic to topic of late in a kind of angry frenzy. The 4th session saw the big cheeses from the Royal Colleges attempting to distance themselves from what they saw as the DoH's mess. Carol Black was a little limp, but Bruno Ribiero appeared to have a large quota of balls and admitted the Colleges could have done more to stop things going as badly wrong as they did. In this regard at least Bruno had the guts to take his fair share of the blame, unlike Carol Black whose weak defence of that infamous letter didn't really convince at all. It was made clear that the DoH was ominously stalling over Tooke and this must not be dropped.

The fifth session saw the idea of NHS Medical Education England (NHS:MEE) discussed by Professor Rubin, with the idea being that education was taken more seriously with its own ring fenced budget. DoH cronies didn't seem too keen on this idea with comments like this uttered in response claiming that NHS:MEE would 'fracture the relationship between service and education’. In my mind if cronies from the DoH like Sian Thomas see NHS:MEE as a bad idea, then it is most probably a very good idea as it would stop the government buggering up education by prioritising short term service needs over the long term service and high training standards. Interestingly Prof Rubin was not convinced by Foundation training, while apparently

"The Health Select Committee has not scheduled any further oral evidence sessions as part of its inquiry into MMC and MTAS. However, it is possible that another session may take place after the Department of Health publishes its formal response to the Tooke report at the end of February. A final written report from the committee is not expected until after Easter."

I hope the Department of Health are kept well away from future medical job application processes and the following quote hardly fills me with glee:

"The Department of Health is in the process of establishing a number of pilots in order to rigorously test a variety of new methods for recruiting and selecting trainees for specialist training. The aim of this research is to review the effectiveness of the different selection methods and processes being piloted, their appropriateness in a variety of circumstances and their impact on applicants and selectors. It is intended that the findings from this research inform planning for current and future medical recruitment"

It is good to use solid evidence as a base on which to change policy and implement change. However the deliberate manufacture of shoddy evidence to fit a politically driven plan is not a good idea for the future of medical training and job application systems.
Like many lame duck studies conducted by the DoH to fit a political glove, the kind of evidence crafted is likely to never make it into even the lamest of peer-reviewed journals; in my eyes until proper solid evidence is obtained for a new process and then accepted formally by the medical profession following proper consultation, the old tried and tested CV and interview should be continued until further notice.

I have to say I am very impressed with some of the recent comment in blogosphere on this hot potato of a subject. Chez Sam's has been on the case energetically, an excellent piece that brings these issue in the perspective of the dreaded and useless 'skills escalator'. The Witch doctor has been in good humour and is impressed with Bruno Ribiero, I just wonder whether there is a hint of romance in the air there? Some commentary on the events that I have also described, and I particularly love this quote from Bruno Ribiero. It encapsulates the feeling that many of us doctors in training have, it sums up the complete and utter frustration that we feel towards the stupid patronising competency based assessments that we have to manipulate our way through day in day out, medicine is an apprenticeship and not a stupid protocol-led tickey box load of old manure, well said Bruno:

“When I applied for Medical School in 1962 I had no idea whether I was going to be a surgeon, a physician, or a gynaecologist – being a doctor was all that mattered. Interviews were designed to establish whether you had the qualities and vocation to become a doctor. This was not about ‘touchy-feely’ qualities, but whether you had the ability to care for your patients.

Putting patients first before all else should be your aim in life.

Vocation like compassion is now seldom referred to as a reason for going into a healing profession.

Doing an apprenticeship so that you boss could assess all your qualities, good and bad, has given way to competence assessment in an attempt to define what is often indefinable in a professional.”

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