Monday, May 21, 2007

Medical Training Application Service

Writing on Spiked, Dr Michael Fitzpatrick sets out the extraordinary details of this system:

In its modernising zeal, MTAS gives priority to doctors’ subjective ‘learning experiences’ and downplays objective indicators of performance. It allocates 75 per cent of its points to 150-word vignettes of clinical cases, in which doctors display fashionable concerns about ‘reflexive learning’, ‘team-working’ and ethical dilemmas.

According to critics this amounts to meaningless self-promotion as well as being open to plagiarism (which the system lacks the software to detect). Only 25 per cent of points are allocated to academic or research achievements. Extracurricular activities are marginalised, references sidelined and interviews rigidly standardised.

He also has fun with modern jargon

The new programme is ‘trainee-centred, competency-assessed, service-based, quality-assured, flexible, coached, structured and streamlined’; it is managed and structured, progressive, robust and seamless; it is ‘outcome-based’ and evaluates ‘observed behaviour, skills and attributes’.

No doubt some of this jargon conceals valuable educational and clinical activity, but it is difficult to believe that all the ticking of boxes reflects any improvement in the rigour of medical training. What remains unquantified in this system is the quality of doctors’ clinical knowledge and their experience of taking responsibility in treating and caring for patients.

And he sets all this lunacy in its historical context:

The 1858 Medical Act, which is established the General Medical Council, sought to establish a system of medical education that produced a doctor who, on qualification, was a ‘safe general practitioner’. This concept of an independent and competent general practitioner symbolised the confidence of the modern medical profession at the moment of its emergence in the nineteenth century.

By contrast, the ‘never quite competent’ doctor, one who requires continuous formal instruction and regulation, monitoring and mentoring, support and counselling, symbolises the abject state of the profession in the new millennium. While the junior hospital doctor of the past may have been used and abused, today’s doctors appear to have lost all initiative or autonomy in relation to their own professional development and in relation to their patients.

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