As a specialist registrar in cardiology within the hospital sector, four years of "training" away from reaching consultant status, my initial reaction, like many of my colleagues, to Donaldson's plan was one of cynicism.
Yet more destruction from a government that, in recent years, has not infrequently shown anything less than contempt towards the medical profession. I, like the overwhelming majority of doctors, would certainly welcome a robust and well-validated assessment tool that serves to improve patient care.
We take tremendous pride in the privileged position we occupy. Most members of the medical profession have worked extremely hard, aspired to excellence and made significant sacrifices, with many being uprooted every six months for "career progression". And let us not forget, like others in the public sector, our motivations and rewards have historically, and continue to, come from "satisfaction of the job itself" rather than financial gain.
I personally would embrace an opportunity to prove I am fit to practice, up to date and maintaining a level of excellence, through a variety of mechanisms that include competence and patient satisfaction scores.
If I were found to be deficient in a particular area, I would strive to constructively improve. This particular introspective and self-critical aspect of a doctor's nature is ingrained from medical school onwards.
It is clearly apparent that recently introduced "competency based assessments" or Annual Review of Competency Progression (ARCP) for hospital and GP trainees as part of Modernising Medical Careers (MMC) is fundamentally flawed, not fit for purpose, and demoralising for doctors.
Junior doctors are now required to produce forms to provide "evidence" of competence relevant to their particular stage of training.
It is the trainee's responsibility to ensure relevant forms are completed, which they then produce at the annual review. These forms only serve to represent a "snapshot" of a trainee in this context and are therefore not considered comprehensive and merely a tickbox excercise.
Recently, the Postgraduate Medical Education and Training Board (PMETB) published a summary report of a national survey of trainees. Some telling comments from junior doctors included:
" I find the whole set of formal assessments a farce. They simply involve finding a senior you're friendly with and getting them to sign them."
"I find the forms rather patronising. They are cumbersome and of very limited use and I do not feel that they are an accurate reflection of ability or skills. Logbooks filled in independently and countersigned are of far more practical use and can actually show the level of clinical experience to a procedure."
As Richard Smith very aptly points out in his article last week, the devil is in the detail.
What gives me greatest concern, which any supporter of MMC would dismiss at their peril is the following comment: "Above all other things (even including the long, antisocial hours I work), this portfolio-obsessed aspect of medical training and the climate of uncertainty and insecurity about future jobs and training places is the main factor which prompts me to frequently wonder if medicine is the right field for me, or whether I am consigning myself to a very miserable future and should bail when I have the chance."
It is therefore of no surprise that these so called "tools" of assessments have been greeted by most consultants and juniors as " meaningless", a bureaucratic waste of time, counterproductive and providing no evidence in improving patient care.
For the clinician, it is understandably difficult to reconcile such a process with the intrinsic nature of objective scientific analysis. With every clinical decision I make, I consider the evidence to support it, not only as a justification to my own conscience but most importantly as a duty and responsibility to my patients.
Government reforms of the NHS serve primarily to meet the aims of a political agenda. Although I don't wish to believe that it's been in their interest to malign the profession, a control freakery obsession with micromanagement from Whitehall undermines doctors and further weaken morale in the workforce. This is a recipe for producing a sub-consultant grade and Darzi GPs (proposed salaried GPs for polyclinics).
Following the Medical Training Application Service disaster last year, an independent inquiry carried out by Professor Sir John Tooke suggested replacing MMC with a system based on extensive consultation with medical professional bodies and practitioners.
Despite acknowledging that the Tooke report addressed "several flaws" in the government reforms of medical training, the Department of Health only accepted a quarter of the review's recommendations.
The whole journey of MMC remains without a promising destination and continues to have a negative contribution to trainee morale.
· Aseem Malhotra is a specialist registrar
