Thursday, 4 October 2007


Working with patients is, mostly, straightforward. It's what I've been trained to do, for years. Working with managers is, mostly, straightforward. Again there's training but mostly it's because our manager is ace. Working with nurses is, mostly, straightforward. My teams are fantastic and genuinely work collaboratively with me. Working with students is, mostly, straightforward. They are usually inquisitive, bright young things full of enthusiasm and keen to engage in training opportunities.

Powers that be are making my life less straight forward.

I do a fair bit of teaching. I do all the medical student teaching and, unlike colleagues with Staff Grades, I've always had a "training grade" junior doctor and rigorously undertake formal weekly supervision and informal teaching.

This is largely for the love of it, and to help our next generation of medics, since there's no additional resources for the time invested and just as the junior doctor's getting up to speed they leave . . . hence the enthusiasm for stable Staff Grade doctors in many camps.

Now I am becoming stuck.

To get around possible inconsistancies in training (which I've yet to find any evidence for) and to make training shorter and cheaper (where evidence tragically is legion) we've now got Workplace-Based Assessments to do.

We objectively assess trainees in blah. To prevent favouritism and prevent rubbish/dangerous doctors becoming Consultants and prevent untrained doctors progressing this necessitates a series of assessments that I am to do with my trainee.

I have read what I can but am still none the wiser.

For years I've had structured RITA assessments for SpR's and almost identical start/mid/end point appraisals with SHO's but now that's jettisoned in favour of these new fangled workplace whatnots that nobody's written or spoken to me about. Neither informed about nor trained in this, what am I to do?

I am stuck.


Jan said...

Stick to basics: has trainee got a trail of corpses or complaints in his/her wake, that kind of thing. One has to do one's best, even in the absence of definitive information.

The Shrink said...

In this brave new world that's not good enough since :
- doctors I pass who then are rubbish share blame with me
- doctors failed will need objective evidence to show why they failed but their peers passed
- there can be no impression of bias or favouritism so subjective, sensible, common sense judgements can't count
- the standards aren't clear. Heck, they aren't even mentioned. It's not possible to pass comments on aptitude when you've no notion what the standard should be (which matters when you'll be held directly accountable for being too lax or too harsh)

So it goes.

Jan said...

My comment was ironic, Shrink. I believe fully in transparency and accountability, and this can only be achieved against a background of prescribed standards (I trained in engineering before I got into this weirdy mental health business, you need something to measure against). I find it surprising that in a world that is seemingly standard-mad, this process so visibly lacks them.

The Shrink said...

I'm aware I have higher standards than some and although oddly I've had excellent feedback from junior doctors (when they don't need a reference or anything) I've much higher standards on the objective assessments than my peers.

I put a lot of time in to teaching and training but equally expect a lot back. Our speciality should aspire to excellence rather than good enough.

Given this bias we all have to be softer/harsher than peers, you're right that standards need to be agreed to mark against or it all becomes at best a lottery and at worst an old boys network.