Saturday, January 20, 2007

We don’t need no education (says MMC)

The Bulletin of the Royal College of Pathologists arrived this week with a slick new design and picture of a heart attack on the front cover (a prediction for the NHS in 2007?).

There were a couple of articles about training in it which got me thinking. There was another article that I’m going to blog about soon – but first I need to get down the hospital library and look a few things up (I thought this blogging lark was supposed to be relaxing, not work inducing!).

One of the articles (page 11 if you can get hold of a copy, it's not available online for non-members of the RCPath website) says that histopathology training is typically moving from 48 hours a week to 40 hours, with a slight shortening of the duration and say that this could lead to a 25% reduction in training time. As I’ve already pointed out, histopathology training has shortened before under the Calman scheme, a change that many of my colleagues thought was verging on the unsafe in terms of producing consultants fit for independent practice. The article goes on to discuss ways of trying to train to a reasonable standard in the shortening time available, concentrating on e-learning (for those of us who have broadband at home, since we won’t have time to do it work by the looks of things).

As I flicked through I saw a second article on training (page 22) and spotted in bold type ‘CBT is a process not a product’. My first thought was that trainees now needed cognitive-behavioural therapy to deal with MMC but it appears that it also stands for competency-based training. The RCPath have produced a curriculum for histopathology training, which is nice as now we know what we’re supposed to know and be able to do. The author points out that the curriculum doesn’t really help in terms of things like assessing competency and the potential for independent reporting by trainees. At this point it’s worth saying that currently independent reporting by trainees is a rather mixed up area. In some hospitals trainees are not allowed to report specimens independently (without the consultant checking the slides as well) until after they have passed part two of the MRCPath exam (the part 1 is written only and doesn’t test practical skills) which is only taken as a more senior trainee. In some hospitals there are structured schemes to enable more junior trainees to report certain types of specimen if the consultant thinks they are able to do so. In some hospitals there are similar, but more informal arrangements.

In this article it says that independent reporting would have to be based on objective and clear assessments of a trainee’s ability and that such a scheme could improve training but if it is inappropriately applied could result in demotivation and concentrating on the minimum acceptable standard. I’d like to think that competency based training would motivate us trainees and help us to learn as much as possible in the short time available but with MMC, reduced working hours and understaffed departments where consultants have little time for teaching I’m worried that demotivation and dumbing down may be coming.


At 14:11, Blogger Dr Grumble said...

Wouldn't it be possible to have something like the Personal Performance in Mammographic Screening, (PERFORMS) which consists of a number of recent challenging breast screening cases (including normals) that are amassed nationally and distributed bi-annually to mammogram film readers.
Mrs Grumble does this twice a year. From it she knows her own specificity and sensitivity compared to the gold standard (the final pathology and also the opinions of 5 top radiologists).

At 21:50, Blogger Dr K said...

There is a similar scheme (EQA) for consultant pathologists, with regular slide circulations. Trainees can usually see the slides (if they happen to be at the hospital you're at) but we don't get formally assessed on them. It is a useful thing to do but for training I think we need something a bit more intensive.

A lot of regions run regular slide seminars for trainees but it can be difficult to find time to see the slides beforehand if you're based at a different hospital.

Seeing a lot of slides myself and then going through them thoroughly on a multi-headed microscope with a good tutor is, for me, the best way to learn surgical pathology. Incorporating that into reduced hours and departments with overstretched consultants is very difficult.

At 18:39, Blogger DrShroom said...

In general, it seems to me that the Govt is trying to sneak the Senior Reg back in, under another name. By shortening training, both in hours per week and years, we will produce a cohort of undertrained consultants... these would be perfect for a "junior" consultant grade, and might be leaned upon to do more in the way service provision for lesser remuneration, until a "senior" consultant dies, or retires.

At 10:17, Blogger Dr K said...

Sadly I think they will have less experience than the old senior reg. Ridiculous.

At 13:21, Blogger Chromatin said...

"Seeing a lot of slides myself and then going through them thoroughly on a multi-headed microscope with a good tutor is, for me, the best way to learn surgical pathology. Incorporating that into reduced hours and departments with overstretched consultants is very difficult."
This is the way we try to train trainees but it does require a lot of time. To be done properly needs enough time for the junior to see the cases, preferably the consultant to have a look and then go through them together. This isn't easy with the time constraints we have and I often end up working an extra hour each day I have a trainee around in order to make sure we have gone through the cases thoroughly.
Although I'm not actually a doctor I'm heavily involved in this training and it's really enjoyable and rewarding.
There's not many of the trainees that I would be happy for them report alone, precisely because they haven't had enough time previously doing double-header sessions, seeing how the reporting decisions are made and getting the feedback.
As far the MRCPath Part 2 for gynae cytology goes, I think it's really like passing a driving test. After that is when the real learning starts.
We're trying to work towards regular assessments that would help build a profile of how someone's progressing but I agree totally that if it's not handled correctly it would be very demoralising.


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