Professor Field commented on the Tooke report in the April Journal.1 He suggests it is good news for general practice because it emphasises excellence and recommends an extension of GP training to 5 years.
Am I the only GP who qualified in the late seventies or early eighties who is slightly bemused by this?
We were trained by the age old ‘roteregurgitation’ system (learn by rote, regurgitate in exams). Most of us attended half-day release in our post-graduate years — only if ward work allowed (quite right too!). There was often little or no departmental teaching. By modern educational standards a poor system.
So why do we need 5 years of training? It must be because we are not good doctors, patients do not value the service we give, and we have not coped with change.
Yet, we are the generation who learnt maths on slide rules (I still have mine!). We have seen massive changes in the practice of medicine, in general practice, including the arrival of practice nurses, computers, contract changes, clinics, and the devolving of clinical work from hospital to general practice. We still have the respect of the general public.
The European Working Time Directive has reduced doctors' hours — yet we are reliably informed that the excessive hours of yesteryear were very detrimental to our health and provided poor quality learning environments — so I guess we learnt little from those experiences. The modern system should be better as the doctors are wide awake and enthusiastic, rather than drained, stressed, and exhausted as we were.
Am I the only doctor who thinks that general practice is maybe a bit easier? Since we qualified the BNF has been introduced in its present excellent form, there are amazing numbers of experts who tell us what to do. There are mountains of guidelines and of course, QOF. Evidence-based practice has come into being, and opinion rightly takes second place to evidence. Within seconds you can get reliable information from your computer — even during a consultation. The patients present in much the same way, with much the same problems, and are often easier because they are better informed.
Modern medical education has mushroomed into ever-increasing activity. There are plethoras of diplomas and courses about teaching. So why can it not deliver in 3 years? Is there good evidence that new educational systems are that much better than the old? Is it possible that modern education actually dis-empowers young doctors, rather than empowering them?
When I was a course organiser and trainer, it seemed that there were some doctors who need extra time and help, the great majority who managed quite well, and a very few who should not have got as far as they did. The vast majority do not need an extra 2 years of training. Can the NHS afford it? (Especially if we factor in increased consultation times which the College is championing). Are we moving toward a system of consultant GPs — maybe with lists of 5000, with most work being done by lesser qualified individuals? Does this increasing cost of GPs herald the demise of personal doctoring, long-term relationships, and actually lead us right into Darzi polyclinic general practice?
There is a well known phrase ‘the map is not the territory’, to which we should maybe add ‘theory is not reality’!
- © British Journal of General Practice, 2008.