Tuesday, 16 April 2013

The Francis report and what it should mean for medical training- part 2

Here is my part 2. The first chunk is extremely significant, it highlights the gross failings of the current regulatory system.  PMETB, the GMC and the Deaneries are all mentioned, it is made abundantly clear that the system was superficial and that it was not properly looking at training experience on the ground. Francis reiterates much of what I have already said in a BMJ Careers article, the system is toothless and ineffective:

" Deanery/universities

1.84 The system of regulation and oversight of medical training and education in place between
2005 and 2009 failed to detect any concerns about the Trust other than matters regarded as
of no exceptional significance. There were a number of factors contributing to this:
-While patient safety was theoretically given primacy in the system, the domain to be monitored was unduly limited to the potential risk posed to patients by the trainee.
-Insufficient consideration was given to the relevance of good quality training of practice in a setting which complied with minimum patient safety and quality standards, and to the professional obligation to protect patients from harm.
- The Postgraduate Medical Education and Training Board (PMETB)/GMC/deanery wide reviews focused on deanery systems of quality management, resulting in only superficial examination of the standards being observed. Such reviews did not consistently consider compliance with patient safety standards.
- When concerns were raised about inappropriate pressure or bullying by staff towards trainees these were not followed up or investigated.
- Systematic communication of indications of serious concern, such as the HCC investigation, was almost completely lacking between the regulators, and between them and the deanery.
- A reluctance to prejudice the provision of a service or the training of trainees has resulted in the implied threat of removal of approval for providing training places being largely theoretical."

The next two  paragraphs make the obvious but necessary point that training cannot be allowed to take place in clinical areas in which patient safety is not adequate:

"1.85 While requirements for remedial action must be proportionate, training should not be allowed to take place in an environment where patient safety is not being adequately protected. Perceived difficult consequences should never be permitted to hinder steps required to protect patients, and the oversight of medical training should not condone or support unacceptable practice. As elsewhere in the system, a sense of urgency may have been lacking, even after the scale of the deficiencies at the Trust had become apparent.

Medical training and education
1.172 Medical education and training systems provide an opportunity for enhancing patient safety. Students and trainees should not be placed in establishments which do not comply with the fundamental standards, and those charged with overseeing and regulating these activities should, like all other participants in the system, make the protection of patients their priority. A number of recommendations for this purpose have been made."

Overall these sections I have highlighted sum up all that is wrong with medical training as things currently stand.  The regulation of quality is poor and as a result it is far too easy for trainees to be put into dangerous clinical environments.  Francis hits the nail on the head in my opinion.  Part 3 is still to come.

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