Cliff Reid wrote:
> Training programs in A&E medicine should produce specialists in >emergency
medicine who are the "experts in the initial management of any >illness or
injury from minor to major" that Craig describes. I can count >the number of
times in my SpR training that I had useful shop-floor training from a
consultant on the fingers of one foot. It's time that >changed so that we're
judged by the letters 'FFAEM', rather than which >Royal College financially
skinned us alive when we were SHOs.
Adrian Fogerty wrote:
>Like PP I'm appalled that you have not received much shop floor training
>Cliff, I hope my own registrars don't feel like that.
Having recently passed the FFAEM, but not yet in a consultant job, I have
found myself looking back over the last few years with a critical eye. I have
worked with several very different consultants, in various settings, many of
whom have been excellent clinicians and good managers. Many have been
excellent teachers, in situations such as SHO teaching sessions, ATLS, APLS
etc. What they have not been, in any way, is proactive in SpR teaching,
especially on the shop floor.
The concept of shopfloor teaching seems as if it should be central to a
speciality like ours, with all the vast variety of pathologies that we see,
and is essential to train competent generalists. This fact, however, seems to
have passed most people by when it concerns middle grade staff. I find it
intriguing that when a vital part of a middle-grade job description is
hands-on SHO teaching, there seems little recognition of how valuable this
would be for us.
Having said this, it is not really surprising in a speciality where there is
no clear curriculum for the exit exam, which itself considers clinical
expertise so unimportant that only a gesture is made towards examining it. All
of us have come through a system that requires a postgraduate speciality
qualification before commencing higher training, therefore we have all
experienced the bowel loosening qualities of the clincal exams. This method of
testing may have its faults, but I find it much more credible in examining
whether a clinician is actually good at history, examination and diagnosis
than a bunch of x-rays and ecg's.
I hope I have the time and energy to do better by my registrars (when I get
some).
Paul Middleton
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