Do we need just what the doctors ordered?

6th December 1996 at 00:00
I travel a lot in my present job, mainly between Stoke-on-Trent and places such as Warrington, Huddersfield and even, last week, Penrith. Such journeys are necessary but are not usually, in themselves, either enlightening or productive (although the awesome number of students frequently trying to work on cramped trains is a powerful performance indicator of something or other in our further and higher education system, including the apparent need to return home each day or each week).

However, my flight from Munich to Moscow was of a different order, partly because of its distinct Le Carre feel and partly because the highest international incidence of luggage theft is on such flights.

On this occasion, the real enjoyment and interest came from my fellow-passenger, a Lichfield doctor, not of the Dr Johnson kind, more of the medical tendency. For more than two hours he was relentlessly quizzed by me, once I had realised he was a perfect source of intelligence concerning medical education. He is an accredited trainer of GP principals (or trainees) and both he and his group practice have been required to meet quite stiff conditions in order to assume such a responsibility. Only one trainee GP is allowed each year, per practice. Comparing this with our nearest equivalent, the School-Centred Initial Teacher Training Scheme (SCITT) was quite an eye-opener.

In his practice, there are seven partners and it is clear that the quality of their own continuing medical education is part of the group's accreditation as a training practice, as is its regular involvement in the development of evidence-based practice; a systemic feature of the group's effectiveness and the partners' professional development.

Several concerns and trends, affecting both policy and practice, straddle our two professions but there is no contest when an assessment is made of which profession, medicine or education, is the more self-governing and advanced in its own training systems.

The essential question is how we can move towards the best and most appropriate elements of the medical paradigm, which include: Royal Colleges and General Medical Council exercising a powerful gatekeeper role in terms of professional standards and, simultaneously, actively promoting innovation and development;

* the Royal College of General Practitioners ensuring that it operates both as a buffer between GPs and the Department of Health and, simultaneously, acting when necessary, in advance of central government. Recently, this has included developing re-certification systems, to protect all of us from out-of-date or incompetent doctors;

* strong regional education networks based on universities, but administered by fully representative committees for medical education. While a regional dean for post-graduate medical education is funded by the Department of Health, the certification and professional development of doctors, dentists, consultants and community practitioners is mediated and confirmed through a complex web of professional partners. "Clinicians all" is the organising principle;

* all GPs have an additional annual salary allowance of more than Pounds 32,000 when they have completed at least five days of approved professional development. A regional adviser on general practice, and a group of local course organisers (who remain in their substantive posts in general practice for the six years of their contract) ensure that such approval is broadly based and supported;

* the local course organiser - in this case, covering South Staffordshire - actively liaises with universities so that, for instance, research findings or enquiries from general practices and community and hospital trusts are supported and disseminated. He or she is also responsible for ensuring that GP trainers are properly trained so that they can, in turn, contribute to the certification of tomorrow's doctors. Continuing medical education (CME) is a further responsibility, usually organised in partnership with post-graduate centres in universities and their medical schools.

The formal structure outlined here is worthy of further scrutiny in terms of its internal checks and balances and its arm's-length, but sufficient, accountability to the larger, public, political system.

However, the spirit and the dynamics are less easily defined and described, but are certainly what I found most attractive and resonant on that flight to Moscow. For example, the evident enjoyment and expectation of shared learning that comes from membership of the "Burton group". This is a self-managing group of 11 training (general) practices and four hospital training consultants in the Burton-on-Trent area, meeting every week for their own professional development seminars.

There is also the UK Association of Course Organisers, with its 400 members. They are excited by having learnt so much from the pedagogy of Adult Education and from the Tavistock Institute in terms of the group dynamics of adult learning. They are glad to have "filched", from the Royal College of Nursing, the concept and practice of portfolio-based and experiential learning. Mentoring is also gaining ground, but not linked to appraisal (Office for Standards in Education, please note) and their exchanges of innovatory good practice have led them to use casework as the linchpin of their weekly half-day sessions with trainee GPs. (Remember our qualified teacher status induction systems when a similar area support programme was in place?)

Research training fellowships have also been introduced, especially as incentives to trainee practitioners in the inner city, so that GP-based training is combined with a related academic research post in a university department of primary medical care.

Parallels clearly exist between some of these practices and those we use in the initial training of teachers and in honing the professional skills and knowledge of practising teachers. The TTA is aware of these and one senses they would like to see more of them in place. But can any arm of central government, Conservative or Labour, hope to achieve the professional vigour and enthusiasm I encountered on that Munich-Moscow flight? Somehow, I rather doubt it.

Professor Margaret Maden is director of the Centre for Successful Schools, Keele University

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