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I agree with almost everything Kieran Walsh says in this filler.
However, the idea that examinations that prepare us for general medical
take should mainly include questions about the average patient that is
seen on such a take needs further thought.
Does knowledge about the treatment of chronic bronchitis need to be
tested in an examination like the MRCP (which fits the bill of an
examination designed to test whether candidates would make good general
physicians)? The treatment of such a common problem should have been
drilled in and tested countless times by immediate senior colleagues and
consultant supervisors during foundation training. On the contrary,
porphyrias (as an example of the many possible rare diagnoses) may never
have been covered even after doing two or three years of regular medical
take. The focus of the MRCP on the esoteric meant that I learned a lot
about the "trivia" while preparing for the examination. Now, as a
consultant on a post take ward round, I find that only those people who
have passed the exam or are in the final stages of preparation for it even
recognise the myriad esoteric diseases that come through our Emergency
department doors. By focussing the examination on the commonplace, we run
the risk of ending up with doctors who only recognise the commonplace.
Rarer diseases will remain undiagnosed and under-reported. I know that as
a consultant who often has responsibility for making the final diagnosis,
I can only diagnose those porphyrias or other hens' teeth that do end up
on the ward because of the emphasis placed on them by the MRCP.
In contrast, the management of exacerbations of COPD and acute
coronary syndromes is carried out reasonably well by the vast majority of
trainees beyond the PRHO level - whether they are planning to become
career general physicians or not. I certainly had no difficulty learning
about these things and preparing for the MRCP did not help me in this
regard.
However, the whole structure of the MRCP may need to be changed.
Perhaps a simpler examination such as that described by Walsh is needed at
the MRCP 2 level, to determine competence for all physicians (e.g. those
who will end up specialising in palliative care, radiology, oncology, etc)
at a relatively early stage in their training. A further examination
testing the knowledge required for "difficult diagnoses" might then be
required for those who might become "consultant general physicians" -
perhaps an MRCP part 3 is the way forward.
Competing interests:
As a potential future patient (I hope not for many decades to come), I have an interest in future consultants knowing what they are doing.
Exams for General Physicians should not just cater for the average
I agree with almost everything Kieran Walsh says in this filler.
However, the idea that examinations that prepare us for general medical
take should mainly include questions about the average patient that is
seen on such a take needs further thought.
Does knowledge about the treatment of chronic bronchitis need to be
tested in an examination like the MRCP (which fits the bill of an
examination designed to test whether candidates would make good general
physicians)? The treatment of such a common problem should have been
drilled in and tested countless times by immediate senior colleagues and
consultant supervisors during foundation training. On the contrary,
porphyrias (as an example of the many possible rare diagnoses) may never
have been covered even after doing two or three years of regular medical
take. The focus of the MRCP on the esoteric meant that I learned a lot
about the "trivia" while preparing for the examination. Now, as a
consultant on a post take ward round, I find that only those people who
have passed the exam or are in the final stages of preparation for it even
recognise the myriad esoteric diseases that come through our Emergency
department doors. By focussing the examination on the commonplace, we run
the risk of ending up with doctors who only recognise the commonplace.
Rarer diseases will remain undiagnosed and under-reported. I know that as
a consultant who often has responsibility for making the final diagnosis,
I can only diagnose those porphyrias or other hens' teeth that do end up
on the ward because of the emphasis placed on them by the MRCP.
In contrast, the management of exacerbations of COPD and acute
coronary syndromes is carried out reasonably well by the vast majority of
trainees beyond the PRHO level - whether they are planning to become
career general physicians or not. I certainly had no difficulty learning
about these things and preparing for the MRCP did not help me in this
regard.
However, the whole structure of the MRCP may need to be changed.
Perhaps a simpler examination such as that described by Walsh is needed at
the MRCP 2 level, to determine competence for all physicians (e.g. those
who will end up specialising in palliative care, radiology, oncology, etc)
at a relatively early stage in their training. A further examination
testing the knowledge required for "difficult diagnoses" might then be
required for those who might become "consultant general physicians" -
perhaps an MRCP part 3 is the way forward.
Competing interests:
As a potential future patient (I hope not for many decades to come), I have an interest in future consultants knowing what they are doing.
Competing interests: No competing interests