Sunday, September 05, 2004
EWD, MMC, GMC
One of the few benefits of attending the interviews I did was getting up to speed on current events, something someone in my current situation (studying for exam) doesn't do a great deal. My daily routine involves waking up in my hovel, playing a little with the computer while trying to persuade myself to work, and eventually going somewhere warm (eg park) and pretending to study for a bit. Needless to say I am far behind, and in 48 hours I am going to pay the price. (Ah, but after that, grand dreams of visiting Reading, the United States, and maybe even the moon)
Anyhow this is me fiddling with my computer.
The Britdunderheads politicians, ie Tony Blair and stooges have been pushing the European Working-Time Directive into effect. The British Medical Association, once the paragon of common sense (for doctors, by doctors and all that crap) appears to have taken a chapter out of the SMA's books and bravely parroted the idea, lauding it as a Good Thing - safer doctors! Safer patients! Happy people!
For those not in the know, the EWD stipulates a maximum working time of workers (doctors included) of 48 hours a week.
Initially as a med student I was grateful that the system here doesn't flog house officers as badly as the system back home (100 hour working weeks or more, etcetc) and that I was having it pretty easy in comparison. (although with this damn sense of responsibility, and some of the more obsessive urological registrars it was my displeasure to serve under, I wound up doing 100 hour weeks for 3 months anyhow)
The EWD is being implemented in stages since Labour hasn't got enough Indian doctors from the subcontinent to staff all the rapidly vacating posts (poor pay is only part of the problem...) and an overnight implementation of shorter working hours for all doctors obviously results in doctors having to work more often to cover the deficits... only we haven't got enough doctors. It's a little bit of a catch-22. At considerable inconvenience, hospitals are implementing shift-based work for all doctors in order to satisfy these new stipulations. At present there is a 58 hour target, which will fall to 56 hours in 2007, and ostensibly to 48 hours in 2009. (I think. figures may differ)
Another talking point has been the err. Wossname thingie. The judicial-type blokes in Spain ruled that any hours spent on-site in hospital - even if it was in the residences - be considered part of the above working hours. Meaning if a doctor is on-call and sleeping in his room, it still counts to his 48 hours.
Interestingly, the feeling on the ground is one of foreboding. Not because of the potentially increased frequency of shifts, since the mass exodus of Asian doctors trained in India is increasing at an apparently exponential rate, but because of the limited training we receive here in the UK.
Doctors here only train for a measely five years, before being unleashed unto the world. Training beyond this continues during the house-years under "supervision" by senior doctors (but legion are the stories of the new SHOs who are told to watch 1 central line, and then go off and do one unsupervised... and winding up with their fingers plugging the dams they've created in the carotid artery) and for some bizarre reason studying for membership exams is supposed to make you even cleverer and safer...
Amongst the surgeons, and the surgeon-wannabes however the thought is that surgery's gonna be a whole new ball game - with next to no prior experience in surgery, new candidates will face operating less frequently due to the shorter shifts and have fewer opportunities to actually learn.
Naturally,Labour the GMC in its wisdom has addressed the issue by coining a new term, which it seems particularly adept at. Enter "Modernising Medical Careers" or "MMC". (England seems to be fast-catching the TLA - Three Letter Abbreviation - sickness that has pervaded the United States and Singapore)
The MMC is supposed to ensure more intensive, focused teaching that achieves superior results in a quicker time, by examing all aspects of teaching. So far it has come up with Problem Based Learning, or PBLs which one "official" website appeared to be quite proud of.
I was a product of the Old System, but recall the PBL pilots they tried on us with some amusement. It mostly involved students sitting around looking bored. Someone would be appointed scribe, a scenario would be read, and then we'd just wait for The Brain (there's always one...) to answer all the questions. After five minutes of twiddling our thumbs thereafter (and for the more conscientious students, writing down quotes from The Brain) we'd adjourn for coffee. Sure beats lectures - oh that coffee buzz. Tenth cup today... bzzzzthowsatlookittheprettytablesandchairsifeelslightlyfunnynow.
The other thing the MMC makes a mockery of is the fact that medicine has been around for several centuries now...
my take on it is that if they can't get teaching right within this time, they will never be able to, regardless of how often they go back and re-examine their teaching processes. And believe me, clinical teaching in the central London hospitals is by and large best described as "shite". Firsthand experience here. Proud smile.
Knowing how Labour works, I suspect they'll appoint a committee for overseeing the overseeing of MMC and the GMC, and the EWD after the systems fail to produce any beneficial outcome (and instead begin, as they always do, to flounder).
The system is perfect, it's the implementation of it that's wrong.....
Sound familiar? Only the tune we're accustomed to dancing to is more upon the lines of "The System is perfect. It's you sheep who are at fault, but don't worry, listen to us, reproduce on demand, and we'll get through all this together!"
Anyhow this is me fiddling with my computer.
The Brit
For those not in the know, the EWD stipulates a maximum working time of workers (doctors included) of 48 hours a week.
Initially as a med student I was grateful that the system here doesn't flog house officers as badly as the system back home (100 hour working weeks or more, etcetc) and that I was having it pretty easy in comparison. (although with this damn sense of responsibility, and some of the more obsessive urological registrars it was my displeasure to serve under, I wound up doing 100 hour weeks for 3 months anyhow)
The EWD is being implemented in stages since Labour hasn't got enough Indian doctors from the subcontinent to staff all the rapidly vacating posts (poor pay is only part of the problem...) and an overnight implementation of shorter working hours for all doctors obviously results in doctors having to work more often to cover the deficits... only we haven't got enough doctors. It's a little bit of a catch-22. At considerable inconvenience, hospitals are implementing shift-based work for all doctors in order to satisfy these new stipulations. At present there is a 58 hour target, which will fall to 56 hours in 2007, and ostensibly to 48 hours in 2009. (I think. figures may differ)
Another talking point has been the err. Wossname thingie. The judicial-type blokes in Spain ruled that any hours spent on-site in hospital - even if it was in the residences - be considered part of the above working hours. Meaning if a doctor is on-call and sleeping in his room, it still counts to his 48 hours.
Interestingly, the feeling on the ground is one of foreboding. Not because of the potentially increased frequency of shifts, since the mass exodus of Asian doctors trained in India is increasing at an apparently exponential rate, but because of the limited training we receive here in the UK.
Doctors here only train for a measely five years, before being unleashed unto the world. Training beyond this continues during the house-years under "supervision" by senior doctors (but legion are the stories of the new SHOs who are told to watch 1 central line, and then go off and do one unsupervised... and winding up with their fingers plugging the dams they've created in the carotid artery) and for some bizarre reason studying for membership exams is supposed to make you even cleverer and safer...
Amongst the surgeons, and the surgeon-wannabes however the thought is that surgery's gonna be a whole new ball game - with next to no prior experience in surgery, new candidates will face operating less frequently due to the shorter shifts and have fewer opportunities to actually learn.
Naturally,
The MMC is supposed to ensure more intensive, focused teaching that achieves superior results in a quicker time, by examing all aspects of teaching. So far it has come up with Problem Based Learning, or PBLs which one "official" website appeared to be quite proud of.
I was a product of the Old System, but recall the PBL pilots they tried on us with some amusement. It mostly involved students sitting around looking bored. Someone would be appointed scribe, a scenario would be read, and then we'd just wait for The Brain (there's always one...) to answer all the questions. After five minutes of twiddling our thumbs thereafter (and for the more conscientious students, writing down quotes from The Brain) we'd adjourn for coffee. Sure beats lectures - oh that coffee buzz. Tenth cup today... bzzzzthowsatlookittheprettytablesandchairsifeelslightlyfunnynow.
The other thing the MMC makes a mockery of is the fact that medicine has been around for several centuries now...
my take on it is that if they can't get teaching right within this time, they will never be able to, regardless of how often they go back and re-examine their teaching processes. And believe me, clinical teaching in the central London hospitals is by and large best described as "shite". Firsthand experience here. Proud smile.
Knowing how Labour works, I suspect they'll appoint a committee for overseeing the overseeing of MMC and the GMC, and the EWD after the systems fail to produce any beneficial outcome (and instead begin, as they always do, to flounder).
The system is perfect, it's the implementation of it that's wrong.....
Sound familiar? Only the tune we're accustomed to dancing to is more upon the lines of "The System is perfect. It's you sheep who are at fault, but don't worry, listen to us, reproduce on demand, and we'll get through all this together!"
