Education And Debate

What should be done about merit awards? Merit awards - the case for change

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6934.973 (Published 09 April 1994) Cite this as: BMJ 1994;308:973
  1. J E C Hern
  1. Aberdeen Royal Hospitals NHS Trust, Aberdeen AB9 8AQ.

    Many doctors vigorously criticise the merit award system in private, but to do so in a signed article in the BMJ is a very different matter. It exposes the author to the wrath not only of those who run the present system but also of those for whom it has brought high awards. Further, according to the level of his own award, it exposes the writer to the charge either of sour grapes or of ingratitude.

    What should we ask of a merit award system? Three things: it should identify merit; it should be, and be seen to be, fair; and it should encourage effort in appropriate directions. How does the present system perform against these criteria?

    Identifying merit

    From the start of the present system, awards were for those who had made exceptional achievements in clinical work, research, and teaching. At the start, achievement in “administration” was specifically excluded but this has now been corrected. By commonly used convention, the levels of attainment for A, B, and C awards have often been equated with, respectively, international, national, and local eminence. Such reputations are doubtless often justified, but in other cases they seem to be based more on faithful attendance on the international or national conference circuit than on the quality of work achieved. It is not unknown for a clinician to be attending an important international conference in some distant place while a colleague at home is correcting a clinical blunder committed by the “expert” within the very clinical field on which he is holding forth to the applauding audience.

    The problem in defining clinical merit is that much clinical activity is a private process between patient and clinician. Even within the same specialty, colleagues will often have very little idea whether …

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