Intended for healthcare professionals

Analysis And Comment

Criteria, competencies, and confidence tricks

BMJ 2006; 332 doi: (Published 26 January 2006) Cite this as: BMJ 2006;332:233
  1. Richard Wakeford, vocational training scheme organiser (
  1. 1 Hughes Hall, University of Cambridge, Cambridge CB1 2EW
  • Accepted 14 October 2005

Baker proposes that focus groups of professionals, managers, and the public should be convened to detail the minimum standards expected of doctors regarding their fitness to practise.1 Although the intention of this proposal is laudable, it is unrealistic and unworkable for several reasons: the medical profession is too complex and changeable to characterise in this way; the standards, criteria, and thresholds may be contentious and unacceptable if they are too concise (see examples below) or too lengthy to allow “ownership” by the profession; long educational checklists are not helpful in practice.

Firstly, the work of doctors is highly complex and case specific (box). It develops along with the doctor's own professional expertise, and it cannot be analysed by simple lists and straightforward criteria.2 This may frustrate people like Baker, who argues that if there is a lack of clarity about what is unacceptable, “How can patients decide when a doctor should be reported for investigation, and what …

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