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.