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ANALYSIS: George B P Madden and Anthony P Madden Has Modernising Medical Careers lost its way? BMJ 2007; 335: 426-428 [Full text]

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Adverse clinical risk from Modernising Medical Careers

Jyothis T George   (6 September 2007)

Adverse clinical risk from Modernising Medical Careers 6 September 2007
Jyothis T George, Specialist Registrar, Diabetes, Endocrinology and General (Internal) Medicine York Hospital, York Send response to journal: Re: Adverse clinical risk from Modernising Medical Careers	Madden et al summarises the evolution of Modernising Medical Careers (MMC) to its present format. However, the serious adverse clinical impact the system has had on out of hours care in hospitals is perhaps overlooked by the authors like many other commentators. Historically, NHS hospitals in the UK have provided a three-tier on-call system in many specialities, especially the ones with higher patient intake like general (internal) medicine. Senior House Officers (SHOs) provided the first port of call, backed up by middle-grade doctors (like Specialist Registrars) and the consultant. SHOs had a requirement to achieve competencies in practical skills and knowledge associated with that specialty. (1) Majority of them also worked towards specialist exams in their field like the MRCP and aspired for a career in the specialty they worked in or its related specialties. SHOs assessed, diagnosed and initiated treatment for the acutely unwell patient, supported by their seniors. With the extinction of SHO grade following MMC, hospital trusts have drafted in second year foundation trainees to fulfil this role. However, foundation doctors need not have a career aspiration in the specialty they work in and are often doing the job because they have been allocated it. These doctors have less experience (current foundation year one doctors often do not work overnight) and the skills and competencies they are expected to achieve are generic ones, not necessarily related to the specialty.(2) This results in additional responsibility on the middle grade doctors to compensate for the ‘slack’ in the junior level. Needless to say, the skill pool available to recognise, diagnose and treat acutely unwell patients out of hours has diminished. Changing the titles of all junior doctors to ‘registrars’ post MMC is not a solution and only gives false reassurance to vulnerable patients that they were seen by someone more experienced. References 1.    1.    Core curriculum and appraisal record for Senior House Officers http://www.rcplondon.ac.uk/pubs/brochure.aspx?e=71  (Accessed 07/09/07) 2.    2.    Modernising Medical Careers, Assessment.  http://www.mmc.nhs.uk/pages/assessment (Accessed 07/09/07) Competing interests: None declared