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Competency based training is a framework for incompetence

BMJ 2014; 348 doi: (Published 25 April 2014) Cite this as: BMJ 2014;348:g2909
  1. Jonathan M Glass, Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT

Excellent care for patients cannot be learnt by ticking off arbitrary numbers of activities, writes Jonathan M Glass. We should want to produce masters of our art, not technicians

At the beginning of one of my urology clinics, there came a knock on the door. A medical student holding a yellow notebook asked to attend so that she could do a scrotal examination, to sign off “scrotal examination” in her record book. It wasn’t because she particularly wanted to know the various pathological conditions that she may encounter in the scrotum; neither was it because she wished to be reminded of the beautiful anatomy of the inguinal canal. No; just as long as the book got signed, that was sufficient.

As well as the record book so loved by medical schools, a competency based training system is now entering all levels of British medical training. Our registrars must have their ability to perform a particular procedure assessed on a four point scale …

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