Posted by: Witch Doctor | October 12, 2008

Go on – share the consternation of Ferret and Grumble!

The Ferret thinks medical training is in the dustbin.

Dr Grumble has been told off by the high and mighty of the medical profession.

Now then, here is a novel idea.

Not The Witches’ idea of course. We are much too clever to think this one up.

Why not let patients train doctors?

The bold italics highlighting the strange bits are mine.


* A clinical placement lead who is contractually supported should be appointed with responsibility for ensuring:
– there is adequate time and resources for staff input into clinical placements
– all staff are aware of the need to facilitate patient contact with students
– the learning mission is promoted to patients and staff
– that premises have suitable space and amenities for education, and that these are incorporated at the planning stage for new buildings.

* That the UK health departments work in partnership with medical schools and NHS organisations to ensure resources and systems are in place for adequate patient contact on clinical placements.

* The use of simulated patients and real patients for the purposes of learning and assessment should be integrated from the first year of the undergraduate medical course. The decision to use real or
simulated patients should be determined by local circumstances and the requirements of the learning or assessment process.

* Medical schools should ensure that teaching of long-term medical conditions is integrated into the undergraduate medical course through dedicated educational programmes. These should allow
students to experience patient contact and continuity of care over a suitable length of time and in appropriate settings.

* Further research should be undertaken into the factors that affect patient attitudes to, and acceptance of, medical student participation.

* The PMETB should work in partnership with the GMC, the royal colleges and faculties, and the postgraduate deaneries to ensure communication skills teaching is integrated throughout postgraduate medical training.

* The GMC should work in partnership with UK medical schools and healthcare organisations with responsibility for training to:
– ensure patients, learners and individuals involved in teaching are provided with clear guidelines on participating in medical education. This should include information on what is expected of the
patient, what is expected of the student, trainee or learner and matters relating to consent and confidentiality

– share good practice approaches to patient involvement, consent and confidentiality; among medical schools, NHS Trusts and healthcare institutions.

* Patients should be actively involved in the development, review and implementation of undergraduate and postgraduate medical curricula. This process should be monitored and patients should receive adequate training, resources and support.

* Patients should be actively involved in teaching during undergraduate and postgraduate training. This process should be monitored and patients should receive adequate training, resources and support.

* Consideration should be given to the use of patients as assessors in undergraduate and postgraduate assessments. This process should be monitored and patients should receive adequate training, resources and support.”

Ahem…. But didn’t doctors always learn form their patients during every single consultation?

Was that not always the case?

It was called “The Sentinal Patient.”

That meant that every time a doctor was with a patient there was some time during and afterwards spent in contemplation over that particular patient’s problems, looking up the journals if necessary, seeking the wisdom of colleagues informally over lunch and coffee, refreshing one’s memory even about common conditions.

It meant wisdom was collected around every consultation.

It meant every patient was special.

It was doctoring, training and continuing professional development at its best.

All rolled into one.

Of course if Sir Charles George, Chair, BMA Medical Education Subcommittee has his way, in order to be fair, honest and ethical in “employing” patients as trainers, they will all need to be paid since a doctor learns something new or reinforces his/her learning during every consultation.

Yes, lets pay all the patients a Senior Lecturer’s salary pro-rata every time they are seen by a doctor!

Yes, lets return their National Insurance and Income Tax contributions to them in this way in order to get our doctors trained!!!

Trouble is, the surgeries and clinics will be flooded with the Worried Well and the Client Entrepreneurs making a bit of cash on the side!

The poorly patients won’t get a friggin look in!

Please Sir Charles George, listen to Dr Grumble, (who I think is an experienced consultant at the coalface), The Ferret Fancier (who I think is a junior doctor training to be a consultant at the coalface).

And also listen to The Oldest Sage Witch (who has seen and heard everything that there is to see and hear at the coalface):

“Medical students and doctors at every stage in their career just need to spend adequate time with patients. Their brains and aptitudes and enthusiasm and commitment and ingenuity will do the rest.

Hands off!”

However, The Oldest Sage Witch has downloaded the full report “ROLE OF THE PATIENT IN MEDICAL EDUCATION” and will read it in due course since it will, I’m sure, contain something worthwhile among the dross.


  1. politely, what on earth are the BMA up to?

    these so called recommendations appear to be completely out of touch with reality,

    it sounds like yet more paperwork generating waffling hogwash that will do nothing to improve training,

    training is simply not a priority in hospitals these days,

    until training is made a priority, until hospitals and trainers are forced to ensure that any doctor in training gets a decent exposure to the clinical stuff that they need, then things will continue to fail,

    in both medical and nursing training the problem is that the students, nurses and doctors are getting less and less hands on experience with patients thanks to waffling bullshit like this,

    more and more committees, more and more bureaucracy and more and more chatter,

    resulting in nothing of bloody use to anyone except the committee dwellers

  2. The BMA are doctors, members of the medical profession.

    The Deaneries are members of the medical profession, as are the colleges.

    The problems we are seeing with training lies wholly within the medical profession.

    I despair of the medical profession.

    Those in management/educational posts are all becoming civil servants – like the CMO (the difference being he knows he’s one.)

    The ironical thing is that the doctors sitting on these committees were themselves not trained in this way. Were they badly trained? Are they dangerous doctors because of this? They will blame EWTD of course, and say things are different now.

    I think you are spot on about committees – most need to be ditched, and some other way found. A way that harnesses common sense, attention to detail, cost, and a realistic concept of where each new idea may lead both for better and worse. And once a new idea is introduced the eye should never be taken off the ball in case it takes the “worse” route.

    None of this is happening.

  3. Could I volunteer as a simulated patient, do you think, Witch Doctor?

    I have some experience in medical education, I used to do amateur dramatics at school and can do funny voices, as a middle aged hypochondriac I have been a patient in various primary and secondary care settings, and as a veteran public sector worker I have experience of deciding just how much of the truth to reveal (or not).

    And finally – I need the money. I’m betting these folk will earn more than my standard hourly rate for “facilitating” PBL tutorials…

  4. I have just started to read the whole document and indeed they do want simulated patients as well as real ones. So you’re right in there – especially since you can do funny voices.

    After all, doctors shouldn’t be allowed to work in London or Glasgow unless they can converse in broad Cockney or Glaswegian. Both competencies are important for a good patient experience in these parts of the country.

    You will probably be in great demand and will be able to retire from the other job!

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