Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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EWTD - curse not blessing
- David S Game (12 January 2008)
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Staggeringly unfair timetable
- Thomas Nolan (12 January 2008)
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question
- benjamin dean (15 January 2008)
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More medical schools? Or not?
- Stephen J Bonny (17 January 2008)
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Uncoupling of run-through training?
- DAVID MUSA (18 January 2008)
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Don't try to copy the American system
- A Adam (20 January 2008)
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EWTD
- Chris M Laing (20 January 2008)
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Who will run NHS Medical Education England
- Tim Parratt (20 January 2008)
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Don't try to copy the American system?
- Robert Watson (22 January 2008)
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Where should the bottleneck be?
- Sarah Spencer (23 January 2008)
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what is the future of doctors from asia
- khawaja ehteham ahmad, frances groen (25 January 2008)
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Re: Don't try to copy the American system
- Max Priesemann (31 January 2008)
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Re: Where should the bottleneck be?
- Max Priesemann (31 January 2008)
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Re: EWTD
- Max Priesemann (31 January 2008)
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General practitioners' pay
- GEORGE Y CALDWELL, SINGAPORE 259858 (31 January 2008)
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Re: Don't try to copy the American system?
- GEORGE Y CALDWELL, SINGAPORE 259858 (31 January 2008)
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David S Game, Clinical Lecturer Imperial College W12 0NN
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In my view the EWTD is contributing to all sorts of problems for junior doctors: (1) Pay. Clearly banding suffers with the reduction of hours and, despite assurances, the DDRB will not raise basic pay to anything like the banded salaries we are used to. (2) Wellbeing. Having worked with ADHs, banding, the New Deal etc., I do know that a reduction of (>90) hours has been beneficial to my wellbeing. However, this has clearly gone too far. Professionals are expected to work long hours and if doctors no longer work hard, they will lose the repect and support of the public. (3) Training. I acknowledge that, historically, junior doctors have been hard pressed in tasks with little educational value. However, there will be, and should be, medical training by service delivery: this is what we do once we are Consultants, GPs etc. I strongly believe the further reduction of hours to EWTD will impair training. In summary, the New Deal, when implemented, was sufficient, the EWTD should be rejected for doctors, and if we doctors bring this to the public it will be a win-win for all of us. Do you agree? Competing interests: None declared |
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Thomas Nolan, F2 Royal Free Hospital, London, NW3 2QG
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What is your view of the timetable for the announcement of specialist training job offers, whereby offers are staggered depending on the specialty and deanery? Would it not be fairer to have a date when all job offers are made, to enable successful candidates to make an informed decision on where they wish to train? This would also help us to feel that we have some control over our future, which would boost morale. Competing interests: None declared |
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benjamin dean, sho oxford
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The Tooke review has come up with several excellent suggestions, however it is not only medical training that must be addressed to ensure that high standards can be achieved in the future NHS. 1. What is the BMA and Remedy's position on nurse practitioners doing what is traditionally seen as the job of a doctor? (The job of doctor I refer to is one of taking a history, examining, investigating and managing medical problems without supervision. I ask this as nurses with no more training that a nursing degree are being empowered to diagnose and treat medical disease in Walk in Centres, and the justification for this is 'competency based assessments'.) 2. In reference to the above question and Tooke's emphasis on the redefining of the role of a doctor, surely it is now time to explicitly define some tasks which should only be undertaken by doctors who have obtained a medical degree? (for example the unsupervised diagnosis and management of medical problems) 3. What is the BMA and Remedy's position on 'competency based training'? (By this I am trying to probe whether you think that the amount of paperwork that trainees are bombarded with is a little over the top, and maybe there should be more focus on other assessments such as reports from supervisers etc.) regards Competing interests: None declared |
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Stephen J Bonny, Specialist Registrar in Acute Medicine Manchester Royal Infirmary, M13 9WL
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Given the current recruitment crisis, I would be interested to know what plans are in force for generating additional foundation and specialist trainee posts for the new doctors qualifying from the many new medical schools that have opened in the UK? Competing interests: None declared |
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DAVID MUSA, ST1 St Ann's Hospital .London N15 3 TH
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There has been talks and speculations in various quarters regarding the uncoupling of the run-through training.My question is :for those of us who were offered run-through training posts in 2007, is the 'run-through' still guaranteed or what is the real situation? Competing interests: None declared |
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A Adam, SpR UK
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My advice to you is to return to the old effective British system of training and not to copy the American system.I believe that all your troubles come from your attempts to copy USA system.Britain has trained excellent doctors in the past who contributed significantly to the development of medical sciences, what made you to change that type of training? Competing interests: None declared |
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Chris M Laing, SpR ITU/Renal Thames Region
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I agree entirely with David Game (and Tooke) regarding EWTD. EWTD has had a very detrimental impact on training and patient care. I also have to say I don't think EWTD compliant rotas are necessarily easier. Cover is thinner, so on-calls are much higher intensity and there are prolonged spells of night shifts. Most of these rotas are crunched through computer software to yield maximum legal hours and lowest pay. This has destroyed the team structure and continuity of care. The New Deal was adequate. No other credible profession in the UK, nor doctors elsewhere in the EU, conform to EWTD. I think BMA and Remedy (as well as our other representative bodies) should back Tooke's well considered proposals, including an urgent assessment of where EWTD compliance has led us. Competing interests: None declared |
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Tim Parratt, SHO Royal National Orthopaedic Hospital, Stanmore, HA7 4LP
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It was with great interest that I read the results of the Tooke review. However, I have one question for the BMA and RemedyUK along with the readers. Exactly who would run "NHS Medical Education England?" It seems from the review that, to take a borrowed phrase, the Department of Health should be "uncoupled" from the education and training process, which should be taken over by the above named body. Who exactly would form this body and who would select it? Competing interests: None declared |
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Robert Watson, clinical instructor Chapel Hill - USA
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I apologize for this diatribe but I wish to reply to an earlier comment by A. Adam. Although I do not wish to be entirely supportive of the US system I do however think that the belief the UK is in any way attempting to ‘copy’ the US system somewhat misleading. Without an appreciation of the differing countries pre/post-graduate medical education algorithms together with the alternative healthcare delivery models, remuneration and regulatory systems any similarities are difficult to interpret and not exactly translatable. The US has a very large undersupply of US medical school graduates and effectively two tiers of medical school with MD or osteopathic graduates. Also note that any foreign postgraduate qualifications/experience is not recognized and healthcare delivery is, in the most part, consultant delivered. I personally believe the forces that have driven change within the UK medical system over the last 20 years, and will continue to, have occurred due to reaction to EU integration (e.g. Calmanization, EWTD, MMC (MTAS) etc) and certainly not through any desire for excellence. A review looking at systems in France, Germany, Poland etc may well be of more relevance to the future of medicine in the UK. Ultimately the problem with MMC maybe the career lock-in or lock-out experienced by those who have succeeded and those who have ‘failed’ which again is different than in the US due to short residencies (3yrs gen. medicine!), pre-categorical positions and the multiple fellowship options. I do not agree that a UK golden age existed and I personally think the old system was/is opaque and at worst nepotistic as well as being hypocritical by producing either consultants or non-consultant career grades to provide the same service supervision role. I was an HO/SHO in the UK between 1993-98 and then a surgical resident and fellow in the US up to the present time. Within the context of postgraduate education, the UK system of training was poor and the application procedures for posts and the moving locations ever 6 months chaotic. On the other side of the argument financially the rewards were very good and the system very flexible for the individual (NB- I earned more 10 yrs ago in the UK than I do now, swapped my specialty and vacationed often). The high reputation of UK postgraduate training was maintained due to the experience gained over a very, very long unsupervised time (+15yrs) of non consultant delivered service commitment. The inconvenient truths for the future of UK doctors (I believe as an
outsider) include;
I predict however that the profession will accept the MMC/Tooke proposals because the junior wages will remain highish and ‘training’ short. A sub-consultant grade will emerge in 7-10yrs to maintain service commitment but still with the title ‘consultant’ (if it hasn’t another name then the colleges can ignore it) and remuneration for all but a new higher tier of consultants will gradually fall (to the level of the rest of Europe?). In the end its just the economics of supply and demand but within a pseudo-monopolistic market place (NHS) and poor supply side management. I just hope I can continue to observe from afar. Kind Regards
Competing interests: None declared |
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Sarah Spencer, Consultant in Emergency Medicine Bridgend
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Should we train all appropriately qualified and able doctors to CCT level and let the bottleneck arise after CCT (but enable people to take their CCT wherever they can)? Or should we limit access at entry to training (a la run through grade)? Or should the bottleneck be at entry to higher training (ST3 (or ST4 in some specialties))? Given current medical school output (and ongoing high intake) - and cessation of consultant expansion - there will necessarily have to be a bottleneck somewhere between graduation and appointment to a consultant post. Where should it be? Competing interests: None declared |
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khawaja ehteham ahmad, Dr/sho in pakistan pakistan ,25000, frances groen
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sir, im a doctor from pakistan.when i started my medical education i was dreaming to work and get post grad training in uk. but when i completed my education the situation become worse uk ammended its laws of taking doctors for training.now they are giving preference to EU on NON-EU.my dream was shattered and i stop thinking about PLAB.can u help me in this matter to clear the cloud of uncertainty for asians to get job and training post in england.plz tell me the right perspective becoz many agencies are working there and giving false impression that there is lot of posts for us. i want to pursue my post grade training in paeds or ophthalmology. i will wait for ur answer eagerly. Competing interests: None declared |
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Max Priesemann, Paediatric SPR Poole BH15
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I do very much agree! But I think they also want to adapt to the German system, which is much more hirarchic and clinical medical training certainly is not the best there - Own experience! Why not going back to the previous system, Or (maybe better) leave the run through training as one option for maybe half of the trainees and give more flexible shorter training posts (for all levels!) for the rest of trainees enabling trainees to be flexible AND complete training up to the consultant grade. Furthermore, nontraining junior degrees, like trust grade or clinical fellows should not exist anymore. All should be entitled to some degree of training and have the chance of progressing! Competing interests: None declared |
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Max Priesemann, Paediatric SPR Poole BH15
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After CCT! If there would be to many doctors competing for consultant posts there would still be the chance to go abroad. This would be better then taking doctors away from poorer countries to fill our junior posts for service purposes! Competing interests: None declared |
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Max Priesemann, Paediatric SPR Poole BH15
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I would like to defend EWTD. There should be a limit to the hours we work per week. Patient care does not improve after working for more than 15 hours! And I did not learn anything better when I was tired! So, why should EWTD not hav improved hour training? Just working longer hours does not improve training! However, I do agree that there should be more flexibility and less rigidity about it. Service and training should not suffer from it. Competing interests: None declared |
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GEORGE Y CALDWELL, GENERAL PRACTITIONER 31 BALMORAL PARK, #18-33, SINGAPORE 259858
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It is far better and more dignified to pay a Doctor for the work he has done. A Salary based on the number of patients' cards held rather than on whether they have been seen and treated seems immoral. Money is being taken for work NOT done. Money is taken for patients who have left and gone abroad. Far better for each Doctor to charge a Standard Fee which could be credited to his account with the swipe of a Plastic Card. These "Medical Cards" can be issued to every patient in which would be encrypted the important details of the Patient's Medical Record. The doctor wherever will then EARN his fees. He will be paid for the work he has done. His "Professional" status will at last have been restored. Then he will be eager to open his Surgery doors whenever he finds it most convenient for his patients. He will be only too willing to see patients at the weekend and through the night, for an extra Fee. Wherever possible in Hospital Practice the same method could be applied. Payment according to the amount of work done. Competing interests: None declared |
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GEORGE Y CALDWELL, GENERAL PRACTITIONER 31 BALMORAL PARK, #18-33, SINGAPORE 259858
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The British system of Medical Education has a long and satisfactory history. It requires little alteration except some fine tuning here and there with the basics still intact. There should be no "pandering to the Press" and Media or the Legal Profesion. They should mind their own business. All modern developments can be mentioned en passant and will be studied and assessed more fully in Post-Graduate years. On completing his Finals Examination it would be far far better for the Graduate to be allowed to proceed at once, in fact directed into General Practice. Under supervision from his peers he will learn some humility, the background of his future patients and learn to communicate. That is where he wil learn his Communication Skills. Only after some three or more years, maybe five, will he feel like returning to hospital practice and perhaps Post-Gradutae Training and Specialisation. Competing interests: None declared |
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