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Is herd thinking in medical training leading us astray?

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4297 (Published 21 September 2017) Cite this as: BMJ 2017;358:j4297

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An open discussion about medical training, as requested

Dr. Glass is to be congratulated for courageously raising the problems in current medical training.[1] I would like to answer his call for an open discussion. I sympathise with the dissatisfying comments made by his colleagues regarding their trainees. But I question how many of his colleagues did anything to change the ways the juniors are trained. For instance, did these surgical consultants give their foundation year doctors and medical students enough hands-on experience and one-to-one teaching on suturing patients? Many medical students and foundation year doctors are keen to practice advanced clinical skills, such as suturing and intubation. Very often, they are declined being given these opportunities, and receive comments such as “you are just a med student / FY1.” Eventually, their enthusiasm is worn down, and their focus becomes achieving the minimum competence in their portfolios and top decile in their medical school and royal college exams. It is unrealistically expected that these juniors will magically pick up their skills when they reach the senior levels.

I agree with Dr. Goh’s comment that many trainers have a mentality of "I have done my bit and it is someone else's fault" whenever things goes wrong.[2] It is ironic that NHS doctors, who are paid to be in a teaching hospital, do not think it is their responsibility to improve the training of their juniors. Rather, they complain how the juniors were not well trained prior to starting in their units. I have seen medical students being refused to join ward rounds because the seniors think students can slow down the workflow. I have also seen foundation year doctors being refused to join ward rounds because the seniors want them to just do the IV cannulas and discharge letters. Similarly, some NHS service users have the same mentality, in which they refuse to let medical students practise taking a history, and expect to be directly managed by consultants.

Dr. Glass has also called for an open discussion in medical and surgical forums. These forums do exist in hospital and at regional levels, in which many trainees have raised their concerns. But what do people do with the concerns raised? Quite often, near the end of their placements, the trainees are still complaining about the same things because no changes have been made. Then, another group of trainees rotate to the placement, and raise the same issues again. The conclusion in these forums could be “that is just how much resource we have” and “it is your responsibility to deal with it.” Eventually, these forums become checkbox exercises to show that the workplaces have addressed trainees’ concerns on a regular basis.

An open discussion is not enough to improve medical training. What we also need to change are the attitude and mentality of the stakeholders of medical training.

References
1. Glass J. Is herd thinking in medical training leading us astray? BMJ. 2017;358:j4297.
2. It is easy to dodge our responsibilities, but we cannot dodge the consequences of dodging our responsibilities. London: British Medical Journal; 2017 Sep 28; cited [Oct 15 2017]. Available from: http://www.bmj.com/content/358/bmj.j4297/rr-3.

Competing interests: No competing interests

15 October 2017
Eugene Y.H. Yeung
Doctor
Royal Lancaster Infirmary
Ashton Road, Lancaster, LA1 4RP, UK