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EDITORIALS: Robert F Woollard Continuing medical education in the 21st century BMJ 2008; 337: a119 [Full text]

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LIttle Less Than a Revolution Required

Graeme Mackenzie   (31 August 2008)

Stones and glass houses

Paul W Keeley   (4 September 2008)

White Knights in Medical Education

Bernard Anthony Shevlin   (12 September 2008)

LIttle Less Than a Revolution Required 31 August 2008
Graeme Mackenzie, OUT OF HOURS GP North Cumbria Send response to journal: Re: LIttle Less Than a Revolution Required	Every consultation can produce several possible issues for continuing education. If we assume at every step of our decision making process that we are likely to be ill informed, the possibilities for continuing education are virtually infinite. The NHS still (rightly in my view) values productivity in doctors. Without that productivity the system would grind to a halt. The levels of productivity required in the NHS are incompatibile with the possible levels of continuing education described. With internet access through PCs and PDAs, continuing medical education and reference to evidence databases are possible during each consultation. Accessing internet based medical information during most consultations is incomptabile with the levels of productivity required in the NHS. Case based continuing medical education with references added to medical records can demonstrate adequate learning in individual doctors. Presentation of medical records with evidence of learning through patient contact is a reasonable way to present evidence of continuing learning and competence. This combines demonstration of quality of care and continuing learning, if references were added to medical records. Patient contact rates in the NHS would have to signficantly reduce for any of the above to be acceptable. Finally, confident doctors may have less self awareness as regards possible failings, but they do make the current system work! Competing interests: None declared
Stones and glass houses 4 September 2008
Paul W Keeley, Consultant Palliative Physician Glasgow Royal Infirmary, G4 0SF Send response to journal: Re: Stones and glass houses	Just how many Big Pharma adverts were there in this particular edition of the BMJ? Competing interests: None declared
White Knights in Medical Education 12 September 2008
Bernard Anthony Shevlin, regional post-graduate tutor home (semi-retired) ST10 4HB Send response to journal: Re: White Knights in Medical Education	I have had the privilege of organising the post-graduate medical education for the past 14 years in Stoke-on-Trent. In this time we have attracted some of the most authoritative and inspirational speakers in the English-speaking world (see www.medicalmasterclass.com) and this has been reflected in the attendances by the doctors - usually 60 - 100 - at each lunchtime meeting. The choice of topic and speaker has been predicated by the educational needs of the doctors, though the meetings have been financed solely by the pharmaceutical companies, whose quid-pro-quo is to have a stand at the meeting and a couple of minutes with the doctors who chose to visit their stand. In 35 years of General Practice, the true revolutions in quality of patient care have been delivered by these much maligned companies, and the more up-to-date and informed a G.P. is, the more likely he is to implement these advances; ergo, Drug Companies do have a vested interest in Post- Graduate Education at a very high ethical level. Sadly, support for our meetings is now declining from pressure on companies and the disempowerment of G.P.s. who are now largely the box- ticking apparatchiks of botched governmental re-disorganisations. Good medical meetings are not just educational: they are empowering and morale- boosting, with meetings and exchanges between colleagues being almost as important as the main lecture itself! Such benefits do not produce a tick in any box which "matters" and it seems that the golden age of General Practice has been slowly strangled to death. As we become increasingly de-skilled and demoralised by political incompetence, I mourn the demise of the "White Knight" of ethical pharmaceutical sponsorship; the "Black Knight" of Whitehall's meddling has much to answer for. Bernard Shevlin Regional post-graduate tutor Competing interests: None declared