Sunday, 18 May 2008

PMETB - wrecking medicine

As entry standards for medicine at University are dumbed down in a rather politically correct fashion, PMETB continues to oversee the wanton destruction of decent medical training, with years of knowledge and expertise being thrown in the bin because the political stooges at PMETB would prefer to implement the unwieldy psychobabble that spews forth from the recta of educationalists.

Educationalists have a lot of waffle that they used to justify their half witted rubbish, they believe that they can pull the wool over our eyes by repeating words like 'reliability' and 'validity' until the cows come home. In fact A Levels and GCSEs have been dumbed down in the same manner as the Royal College membership exams, the MRCP and MRCS, by making everything so objective that is ceases to be a useful measure of anything at all.

Educationalists do not allow experienced clinicians to use years of their expertise and knowledge to judge candidates, they insist upon replacing tried and tested exams with tick box exercises that allow no room for subjective manoeuvre. In denying the value of subjectivity PMETB regulations have forced the Colleges to comply with their vacuous plans that enforce the dumbing down of training standards, in this way the surgical vivas and clinical exams that are assessed by top consultants are being replaced by OSCEs that can be manned by non-medically trained technicians. This is happening across the board.

PMETB has also dumbed down what 'training' actually means. The poorly worked Foundation program and MMC have resulted in thousands of posts that were previously non-training posts magically becoming 'training posts' overnight, despite the fact that these jobs still have no proper training content. This means that thousands of doctors in training are struggling to get the necessary experience because their job simply does not give them adequate exposure to the core of what they need to learn.

Competency based assessment is then used to pretend that the overtly woeful training is actually thorough and comprehensive. In the old days one had to do decent chunks of a wide variety of specialties to progress, meaning that one needed a broad base of skill and experience to progress to the next level. Now all one needs is a few bits of paper signed that prove one has done a few things once, and one is magically transformed into a super-competent doctor. The wonders of competency based training never cease.

In reality the great irony is that competency is not encouraged by competency based training. Competency is a very grey entity and one cannot prove one's competency by doing something once, and then getting a piece of paper signed. PMETB produces more turd burgers than the biggest dairy farms in the land, it is an organisation that has been found wanting in recent inquiries and investigations into it's complete failure throughout the implementation of MMC. So why on earth is PMETB still being listened to? Why are PMETB's educationalists still allowed to carry through the implementation of the dumbing down of medical training? Why are the competency based fundamentalists being allowed to triumph? PMETB should be wiped out of existence and we should only listen to the sound of it's explosion.


PhD scientist said...

I have a classic "competency" story for you, FF.

Mrs Phd Sci, after 4 yrs round our region as a medical SHO, and a stint as a Med Reg at A.N.Other Big Teaching Hosp. joined the Anaesthetics/ICU training scheme in the region.

One of her SHO stints on the scheme was on the ICU at Big Teaching Hosp.

During this stint, every time she asked someone to come and watch her do procedure X, the response from the consultants nominally doing the training was "but... you know how to do that, surely?"

Mrs PhD: "Yes, I do, but the training scheme logbook says I have to get someone to come and watch"

Consultant: "But you were a med reg here.. we know you can do X - you must have done dozens of them.. I'm busy teaching Dr Y to do Z, we're swamped, can't you just do it?"

This happened many numerous times, for a bunch of different procedures.

Then at the end of her ICU stint, she needed someone to sign off her tickbox competencies.

Same consultant who was "too busy" above: "Oh no, sorry, I'm sure you are competent, but I can't tick the box for you as I've never actually watched you do X..".

Again, this happened a bunch of times.

To coin a phrase: you couldn't make it up.

Ms Medic said...

It happens like that at all levels. As a final year student, I was supposed to shadow house officers, but when they're busy or away, I'd simply be a house officer. I wrote notes in ward rounds, checked results, took bloods, cannulated, assisted in theatres, clerked the admissions. However, because I could clearly do all these things and got on with it, no-one watched and not a lot of my logbook is signed. ARGH!

On the plus side Ferret, our 'OSCE' mark schemes are a few categories like 'professional behaviour' and 'clinical knowledge'. They are marked by consultants and the options are clear pass, borderline and clear fail, with comments, so rely on a consultant judgement of clinical skill rather than a 'technician' ticking boxes as had happened in the past. A big relief for me anyway.