How can the right standards empower doctors?

Professor Namita Kumar, Postgraduate Dean at Health Education North East, writes about how the right professional standards can encourage doctors to drive improvement.

Imagine a world with no curriculum, no feedback, seemingly random career progression dependent on who you might know, limited clinical assessment with no feedback, and no explicit requirements to train in clinical areas.

Many of us can remember those days and medical education has moved on a long way since then. Much of this is due to the explicit setting of standards for postgraduate curricula by PMETB as the first regulator of postgraduate medical education in the UK.

Patient safety is paramount, but if we are excellent I hope we can reasonably assume that we are safe.

Regulation can be tricky: getting the balance right and making sure the standards set are in keeping with the needs of our patients, the needs of our learners and how modern health care is delivered.

In the spirit of quality improvement, which none of us should be immune from, standards are reviewed regularly. Hence, the GMC is running a consultation on their standards for postgraduate curricula and regulated credentials.

Making sure patients are safe by striving for excellence

People want the best care, not just safe care and we should all aspire to provide this for our patients. Patient safety is paramount, but if we are excellent I hope we can reasonably assume that we are safe. So, I am personally delighted to see ‘excellence’ taking prime position in the GMC’s draft [PDF] of the revised standards.

When I first started in the world of medical regulation, I remember concerns were often raised that training doctors was a risk to patient safety. This was damaging to the morale of junior doctors.

The Francis report has since highlighted that doctors in training are a valuable asset and can alert the rest of the healthcare system to wider safety issues.

As educators we must address differential attainment so we can make sure all our doctors are trained to be the best they can be.

Doctors in training are in fact fully trained doctors. I hope as we revise standards we value what these doctors can and should do, rather than valuing them for meeting an acceptable minimum.

Not every doctor wants a ‘craft’ specialty like surgery, where the clinical skills learned are practical, but we should allow those that do the ability to learn.

I am also particularly pleased to see the principle of fairness explicitly set out. As a profession we are aware that on average black and minority ethnic (BME) doctors and international medical graduates underperform academically compared to their white counterparts, a phenomenon known as differential attainment.

As educators we must address this so we can make sure all our doctors are trained to be the best they can be. This allows patients to get the highest quality care and taxpayers to get maximum benefit. Focusing on fairness also implies a level of pragmatism and, while statistics are important as a starting point for implementing assessments, they may provide a false sense of security.

Developing broader skills among the profession

Allowing us to fully develop the profession and provide a method of training that is more fluid and shorter in duration allows us to be more responsive to technological advances as well as the needs of the service.

To that end, the clarity of  credentialing, the process which provides formal accreditation of competences in a defined area of practice, allows flexibility that junior and many senior colleagues are keen to explore for the millennial generation [PDF] and in a modern NHS. This, of course, includes multi-professionalism and different ways of working – all things that the NHS is currently striving to deliver.

By the nature of how we select doctors, as a profession we have an inherent scientific curiosity and academic skills are highly regarded and taught often. We have also focused on the development of communication skills as a core general professional skill, which is essential to the practice of medicine and working within a team. However, doctors can and should be leaders and managers, as we often know how things can be done better, and the medical voice is often lost in the tiers of NHS structures created by the various reforms.

Doctors can and should be leaders and managers, as we often know how things can be done better, and the medical voice is often lost in the tiers of NHS structures created by the various reforms.

If we can train ourselves to work better, not only with other clinical professionals but also with those in management professions, such as accountants, we may stand a better chance of delivering the services we want to deliver. Having doctors participating in this way, and even leading, may result in more of us taking the top jobs. Currently many feel there is an undercurrent of deliberate exclusion of doctors and these standards may help reverse this.

Using standards to empower doctors

Having standards explicitly set out allows us to work in partnership with Royal Colleges and specialist societies, the health service and across the four nations. It allows us to have a shared and common understanding of what we as doctors might do and why.

Standards should encourage us to aim for excellence to ensure we can keep on improving.

As with any document such as this, there will be revisions as we learn from each other and remember that we all need to give ourselves the opportunity to improve. The right standards can help us all do this.

Standards allow us all to think about what we do, make sure we are delivering everything we need to, and think about how we can do things better. They should not stifle innovation. Instead, they should encourage us to aim for excellence to ensure we can keep on improving.

The GMC is now holding a public consultation on draft standards for postgraduate curricula and regulated credentials and would like to hear from anyone interested in medical education and training. The consultation closes on 28 October 2016.

Headshot of Namita Kumar, HEE North East

 

Professor Namita Kumar is Postgraduate Dean at Health Education England North East. She has been a Consultant Physician and Rheumatologist since 2006. 

4 responses to “How can the right standards empower doctors?

  1. Pingback: Round up: EOLC, professional standards, accountability and realistic medicine – Good doctors·

  2. Unfortunately Prof Kumar has allowed herself to drift into blanket criticism of much (?all) that has gone before- the ‘imagine a world ‘ paragraph followed by ‘many of us can remember those days ‘.

    As a 61 yr old who qualified in 1979 I definitely do not remember the picture described.

    I do remember many hardworking caring individuals-of a variety of backgrounds-striving to develop the various trainees under their supervision.

    I am not at all sure that the over bureaucratic tick box approach proposed in the GMC document offers a real prospect of improvement

  3. I graduated in 1976 from Calcutta, remember , our Professor-Director used to say , “If you cannot do good to a patient, you have no right to do bad , so do not do operations to all patients ” ,where I was Senior in department of surgery. Safety , comfort and excellence should be in order

  4. This article dated 13 Oct arrived in an email today, 9 Nov. I note the closing of ‘consultation’ on 28 Oct, and reading the various documents shows they are strong on rhetoric and assertion, but utterly lacking in quantifiable, meaningful patient outcomes.

    Will these empowered doctors with broader skills, striving for excellence, have a lower crude mortality of their patients than the doctors with no curriculum, no feedback, and seemingly random career progression? Will the mean BP of their hypertensive patients be lower, the glycated haemoglobin of their diabetic patients more stable, their anastomotic leakage rate lower? If so, by how much? What is the cost/benefit analysis, number needed to treat, or any measure other than a warm inner glow?

    Statements like “Doctors in training are in fact fully trained doctors” are logically fallacious, unless the GMC defines ‘fully’ as meaning ‘partially’. The objective evidence in surgery, from the thyroid to the wrist, is that trainees have a higher complication rate than consultant surgeons, just as newly licenced drivers have higher accident risks than experienced drivers. Interns don’t get IV lines in as expertly as anaesthetic registrars, just as trainee violinists hit the wrong note more often than professional orchestral players. I cannot see how ‘standards’ or ‘credentials’ can alter this basic fact of experience-based learning, that experience is beneficial.

    There is a difference between valuing what junior doctors do, and misleading patients by implying that all doctors have equal results. I share Dr Kelpie’s concerns that this may not be an improvement.

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