Archive for January 28th, 2009

Be good or be gone

I never thought I would be one to get particularly excited about medical politics. But you get older and more frustrated with the system and dare I say it actually more idealistic.

Medical training is one of  many personal bug bears.

I got into medical school on the basis of grades and a UCAS form alone. No one spoke to me and asked me questions as to whether my personality and character and all the rest was in any way amenable to it.

I have said this before about medicine. You do not need to be smart to do this job. You need to be smart enough (echoes of outliers there…), but overall it’s not quantum physics or maths or anything truly requiring smarts.

The vast majority of what i do is talking to people and good old fashioned hard work. Grades are no reflection of this. As grades for entry to medical school continue to rise – in order to find some way of differentiating the thousands of candidates – then more and more we are producing legions of bookish docs with smarts coming out their arse but who couldn’t talk their way out of a paper bag. I’m not suggesting a better system. Just saying the one we have sucks…

I worked out in the first term of medical school that i could pass exams with little work and proceeded to spend five years getting solid below average marks. And no one pulled me up and said you should have done better.

I came out of medical school with just enough knowledge not to kill someone. And no idea how to make them better.

I have spent the past 5 years studying and learning all the things i think i should have learnt in medical school. Medical School was largely a waste of time in my case.

Hopefully that concerns you some what.

Over the past 5 years there have been significant changes in both under graduate and post graduate medical education. Not that they were perfect before but I’m pretty sure they’re a bit shit now.

Most will have heard the MTAS fiasco that made headlines a few years ago. That and the lost tribe of junior docs with few options for further training.

There as been a bit of an obsession in medical education on competencies and juniors being signed off as fit to manage and perform certain skills, procedures and conditions. No mention of them being good at it. Just as long as they’re competent.

Which brings me to this month’s EMJ editorial (yes i read a journal called the emergecny medicine journal. I’m comfortable with that. There’s a journal simply called “gut” for gasrtoenterologists…)  where someone sensible has piped up and said that maybe competencies aren’t all they’re cracked up to be and perhaps someone with all the competencies in the book mightn’t be quite what they’re cracked up to be.

Maybe i just like the cynicsm cause i’m one of the lost tribe in effectively a dead end job who in the grand scheme of things hasn’t so much as a single competency signed off.



January 2009
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