<<General practice is in an invidious position.  We are the only specialty
where full recognition is not based on   attaining "membership" of
"fellowship" of the appropriate Royal College.  >>
Is this correct? I know things are changing with Calman etc but for the
last 20  years or more the system for gaining accreditation as a consultant
physician went this way----MRCP to get on registrar or senior registrar
training rotation depending on competition; senior reg training followed by
cert of competence (from some body or other) but in the NHS the cert of
competence was the important bit.  Certainly in Ireland it was possible to
become a consultant with enough years of experience and membership OR MD in
place of membership.   The MRCP in the UK system served as one of a number
of gatekeepers  well before end of training.  Then you had various certs of
competence in various specialties.    My point is that once in the SR
system the MRCP actually had nothing more to do with full recognitiion as a
competent end-product of that system and the certificate of competence was
roughly equivalent to our VT cert.  
I shall desist from making comments on how far removed the MRCP and FRCS
are from everyday clinical practice and I shall on no account make any
accusations about the royal colleges using said exams as fund-raisers.   If
you were a teacher or an examiner and you found 80% of good candidates were
failing your exams,  would you not do something about it? 

<<Membership of most Royal Colleges is based on attaining a level of
competence that is somewhere above the minimum.>>
No it's not.   Passing the MRCP (for example) has a lot more to do with
studying exam technique, showmanship and learning off standard cases which
are available for exam purposes.  Life in the typical DGH medical unit is
far removed from MCQs, short cases and vivas.   

<<If you disagree with the College because you think it is adopting the
wrong policies in its attempts to modernise and improve our profession then
argue your case, preferably as a member of the College and change those
policies.  >>
I passed MRCGP first time, I have been paying my dues since 1988 and I have
been a faculty rep since about 1993.   I have listened to our council rep
going on about how hard it is to get a handle on how council works and get
your spake in, how many meetings he has had to attend just to figure out
how the council system works----and I put that against the very reasonable
suggestions made by various college members that if I disagree then I
should work for change via the college system.   Well yes,  but how? In the
light of above.
But here is a good example of what I mean----maybe four years ago council
asked for suggestions, criticisms etc on improving the college journal.
Three of us spent some time drawing up a list and we sent it off on behalf
of our faculty---I am sure others did the same.  End result?   An anodyne
editorial commenting on the need for change and promising another two pages
per issue---or something equally irrelevant, nonsensical and stupid.  Get
it?  Council asked for suggestions, we made reasonable suggestions but it
was business as usual back at the presses.
And then---the total cockup senior college members made of the media
ambassadors scheme.   A brilliant idea, lot of work went into it but they
screwed it up in less than three hours.  Main reason for screwup?  They
would not listen to the suggestions of people who knew the medical media
world inside out (the main adviser was AFAIK not a college member but
willing to help) and they insisted on speaking as if they were speaking to
medical students.  A wonderful opportunity lost.
I expect someone will moan at me and accuse me of being a real throwback
luddite anti-change freako from the wilds.  But nothing could be more
wrong; I am a change junkie, I get bored easily, I have been critically
auditing my own work for over 20 years and every day I learn something new.
  Even now, despite being off sick, I am still learning. 
Let us cast our  minds back to one of the few truly brilliant thinkers of
the second half of this century---Ivan Illich.  Ivan would say that the
college is a classical example of an institution which pays more attention
to its own need to grow, to survive, to control its environment than to its
supposed reason for existing. Likewise its senior members----the needs of
the college as a socio-cultural organism and source of power use up a lot
of their time and energy.    The college has passed the point of doing more
good than harm;  it has now reached the stage where its activities are
causing problems for many of us frontliners. It's still a handy place to
stay in London!
Regards
Declan


%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%