“You teach a child to read, and he or her will be able to pass a literacy test.”

One of the most enjoyable things about listening to George W Bush torturing the English language is that no matter how confused his sentences get you can still understand almost exactly what he means. Widely derided as one of the worst presidents in US history, the constant malapropisms often reveal quite clear underlying goals. Many might say teach a child to read and you will set them off on one of life’s great journeys—starting perhaps with Paddington Bear and ending with Finnegan’s Wake—but for the former president the goal is a tick box—passing a literacy test. Is there a danger that assessment systems in medical schools will end with the same outcome? more…

Putting the horse before the cart always seems like a sensible idea. And so it is with funding initiatives—it seems sensible to invest in starting up sustainable projects that will have long term positive outcomes. This is largely the received wisdom in investing in healthcare professionals’ education—invest in the undergraduate education of healthcare professionals in poorer countries and in a few years time you will have a bigger, better, and more productive workforce. Although sound in theory this doesn’t always work in practice. Trainee health professionals drop out or emigrate to richer countries or the funding is invested in the production of professionals who follow a Western model and that does not always meet the needs of the local population. Production of tertiary care specialists in countries that need primary care professionals is not likely to be a helpful outcome. Healthcare professionals’ education is also by its nature a long term process—it takes ten years to produce a family doctor from scratch—by which time people have moved on, the agenda has moved on and funders have often moved on also. It seems like heresy to even ask the question, but is there something that we can do that would be short term, that would have immediate positive outcomes, and that would have high take up amongst healthcare professionals? more…

One of the latest thoughts to emanate from authorities in medical education is that investments in education will produce a tangible return on investment. The theory goes a bit like this: you invest in educational provision, healthcare professionals learn and put their learning into action, and this results in a return on investment. This return might be in the currency of clinical quality improvement or better still real currency (as a result of cost savings). Educationalists dismiss this pathway as too simple, too linear, and too much of a pathway—they think education is much more complex. They think that the addition of learner plus learning content can result in: more…

A running joke about revalidation is that its roll out is and always will be 12 to 18 months away. What will mandarins in Whitehall and the colleges chuckle about now that revalidation has finally started? Almost as important, will revalidation work and what impact will it have on the working lives of doctors, standards of medical care, and the safety of patients? Will it be worth the cost?

The answer is not completely clear. Revalidation is a form of assessment and so it should have high validity and reliability, it should be acceptable to stakeholders, and it should have a positive impact on the behaviour of those undergoing the assessment. It should also be low cost. How revalidation scores on all these criteria isn’t clear at present because it hasn’t started. However working from first principles there are some things that we can say about the utility of revalidation. more…

In the nineteenth century there were few standards in medical education. Students would often do an apprenticeship with a general practitioner and gradually gain experience in the trade. They had to pay for their education—which barred all but those from the privileged classes from becoming a doctor. For those who did persevere with their education there was the constant thought—am I getting value for money for my fees? more…

The age of austerity in the NHS has only just begun. The next few years will likely bring closed Casualty departments, downgraded district hospitals, longer waiting times, and rationed treatments. As Whitehall casts around for more targets for efficiency savings, will it look at the £5 billion spent each year on healthcare professionals’ education? Will this spend be frozen or cut back? Would Whitehall know what to cut back on?   more…

“Even in comparatively poor countries we find scientific knowledge and trained intellects regarded as sound public investments, and the popular voice applauding a liberal application of public money to secure them.”

Isambard Owen, 1904 more…