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Devaluing clinical skills

BMJ 2000; 321 doi: (Published 25 November 2000) Cite this as: BMJ 2000;321:1350

Disparity of clinical skills is obvious

  1. Ian L P Beales, consultant gastroenterologist (
  1. James Paget Healthcare NHS Trust, Great Yarmouth NR31 6LA
  2. Centre for Inflammation Research, Department of Clinical and Surgical Science (Internal Medicine), Royal Infirmary, Edinburgh EH3 9YW
  3. Department of Psychiatry, University of Dundee, Ninewells Hospital, Dundee DD1 9SY
  4. Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ

    EDITOR—I congratulate Wilmshurst for his brave and accurate description of the crisis of clinical skills in our universities and the BMJ for publishing it1; it is a shame it was not given the same prominence as the apparent crisis in academic careers.2

    Anyone who has trained in general and teaching hospitals cannot help but notice the disparity of clinical skills. Without doubt trainees are being trained and taught by people with inadequate skills. I, like most of my peers, learnt clinical medicine in the district general hospital parts of rotations, learning from skilled clinicians providing direct patient care. My recent teaching hospital training included being told the reason for doing a certain investigation was “because this is a teaching hospital and we can do it.”

    I too am aware of doctors being accredited and appointed to senior academic appointments without having seen a patient for six or more years; such people cannot provide their trainees with suitable tuition and guidance.

    The issue has wider implications for those who practise clinical medicine away from “the centre.” Our specialist society is proposing revalidation by peer review. This includes visits from and being observed by outside validators. Are good clinicians going to be judged by those prominent individuals from university hospitals who have inferior training and skills? I hope not but fear it will be so. Those with and using the clinical skills should do the appraising, but it may be too much to hope for consultants at district general hospitals appraising senior academics.

    Wilmshurst's article deserves wider discussion; the lack of response from senior academics arguing their clinical cause is interesting. Are they feeling guilty? Are they worried they have been found out? Most worrying of all, they probably believe that they genuinely have the same (or probably better) …

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