Friday, 9 January 2015

Credentialing: shifting more costs onto the trainee


Shape of Training has many disastrous regressive elements, not least the introduction of 'credentialing'.  Note first of all that the GMC defines a credential as a 'formal accreditation of attainment of competences'.  Therefore the direction of travel pushed by the government via the GMC and Shape is yet more competency based methods in training.  As if we haven't seen the harms of an over reliance on this deeply flawed reductionist approach in terms of encouraging minimum standards and demotivating trainees....

Look at the extract in the Figure above, it demonstrates concisely just where the cost of credentialing is going to be dumped, it will be the Royal Colleges initially and then, yep you've guessed it, the College will then pass this extra cost onto the trainee.  As if medical training wasn't expensive enough already with student debts, GMC fees, College exams and fees, Training body fees (JRCPTB/ISCP etc), now the government is dumping yet another cost onto the trainee.  It's just as well we don't have multiple recruitment crises at the moment, oh wait a minute....

This excellent piece in the NEJM summarises the lack of benefit of this kind of training bureaucracy and the huge costs involved in maintaining it.  This article relates to 'meeting maintenance of certification (MOC) ' in the US but there are stark parallels with both revalidation and credentialing. 

Much like the Shape of Training's recommendations, there is zero credible high quality evidence to justify the introduction of 'credentialing'.  Arguably revalidation and credentialing are of little, if not zero, benefit to both doctors and patients, while they introduce extremely costly self serving bureaucracies which can also do a lot of harm in a number of ways.  There are many more potential harms to credentialing, including fact that it introduces more employer control over access to training and the quality of training.  The lack of any proven benefit combined with the fact that it appears designed to dump yet more costs onto the trainee make it something that should be firmly rejected by the profession and any reasonable doctor.

2 comments:

Steven Edgar said...

the evidence of competency style of training does serve a purpose. It is to protect the educator and the system from blame when the imaginary future mistake is blamed on the doctor not having been taught properly. not that i think it will actually fulfil this role either. defensive education?

ben said...

Yep, nail on head.