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LETTERS: J Bell and John Tooke New system threatens UK clinical research BMJ 2007; 334: 652-b [Full text]

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Doctors don't change their spots

Peter N Trewby   (3 April 2007)

Doctors don't change their spots 3 April 2007
Peter N Trewby, Consultant Physician Darlington Memorial Hospital DL3 6HX Send response to journal: Re: Doctors don't change their spots	Professors Bell and Tooke (BMJ 2007;334:652 31 March) regret that the application system for specialist medical training (MTAS) fails to recognise excellence in the academic domain. Sadly neither MTAS not the Modernising Medical Careers structure (MMC) are set up to recognise excellence in other domains either. The MMC creed focuses, perhaps necessarily, on basic and minimal competencies not excellence. The system has no way of picking up distinction in knowledge, diagnostic skills, humanity, or the ability to go beyond the call of duty for the patient even though these are the attributes we would all wish from our doctors and are certainly the attributes the patients and the GMC associate with the “good doctor”. To include these attributes in the short listing process must be the first priority of any improved MTAS process. How to do this is the question. Medical colleagues normally can agree on which doctors possess these attributes. Nursing staff certainly know and patients also know. We must use this local knowledge, not to grade, for that would not be discriminating enough, but to rank foundation doctors one against the other in each trust or foundation school. In medicine, we would use input from MAU staff, ward nursing staff, college tutor, medical SpRs and supervising consultants to rank the foundation doctors in the department every 4 months in order of perceived merit against their peers. For foundation doctors on 4 monthly rotations, five rankings would be available before shortlisting . This ranking of past performance need only form one domain in the short listing process but I suspect any short listing panel will favour a doctor ranked in the top 5 in their trust over one ranked lower but whose MTAS questionnaire describes yet again how single handed he or she has saved another patient with a ruptured aortic aneurysm. Consultants are ranked for discretionary points and merit awards; we must rank junior doctors. We must go back to first principles and realise if there is to be competition for ST posts those who have already demonstrated excellence in their foundation posts should be the ones short listed over and above those whose only skills may be in filling in (or copying) answers to questions that give little indication of past performance. Doctors don’t change their spots. Distinction in foundation years is the factor most likely to predict future distinction. We must find a way of measuring it if excellence in the NHS is to be promoted and rewarded. Competing interests: None declared