Saturday, 27 June 2015

Deja vu, all over again!

Medicine is a science of uncertainty and an art of probability.

Deja vu all over again!
          I struggled through the full McGill accreditation report  and I wasn't surprised to feel I was reading through one of the old accreditation reports of the residency training program from the College of Family Physicians of Canada in the seventies when I was residency training director of the newly formed family medicine residency training program at the University of  Saskatchewan.   The accreditation recommendations of the Family Medicine residency in the1970s by the College of Family Physicians  of Canada sounded eerily similar to the recommendations of the McGill accreditation today.  The 2015 accreditation report for McGill College of Medicine would have humiliated me, as I am sure it did the Dean of that great medical school.   Not much seems to have changed in 45 years, but I was surprised at how little progress seems to have been made in  medical  education.   The deficiencies were many and if you want to review them all, the report is available.  I'm going to look at only a few before I move on to more entertaining topics.  
           Broadly, there are two categories of inadequacy.  First, there is 'compliance, with a need for monitoring '(i.e. trying, but not good enough).  Second there is 'non compliance with standards' (self-explanatory).
           There are many examples in each category so I am just going  to give you one or two examples from each category.
          Item ED-27.  A medical education program must include ongoing assessment activities that ensure that the medical students have acquired and can demonstrate on direct observation the core clinical skills, behaviours and attitudes that have been specified in the program's educational objectives.
           The findings of the credentialing committee are as follows: 
                            Direct observation of history and physical examinations has not been consistent across all core clerkship rotations. ( In other words students have not been consistently observed  doing the most important thing that they should be learning in their undergraduate years.   In  fact I have had a senior Internal  Medicine resident assure me that no one had ever observed him doing a complete history and  physical examination.)  The report particularly identified deficiencies in observation in the areas of  Emergency Medicine and in Obstetrics and Gynecology, areas particularly requiring skills and special examination techniques.
            Now let's move on to areas where there is  NONCOMPLIANCE WITH STANDARDS.
          Item IS-1.  An institution that offers a medical education program must engage in a planning process that sets the direction for its program and results in measurable outcomes.
           The committee findings:  The strategic plan should include a timetable for achieving the various milestones and have clear outcome markers.  This is a recurrent issue.
           Wow!  The senior and most respected medical school in Canada hasn't adequately engaged in a planning process that sets its direction and results in measurable outcomes?   What have they been doing for the last hundred years?
            I was going to give some other blatant examples, but I find it too depressing.  You get my drift and if you are interested the report is available on the internet.
            Meanwhile if McGill would like to give me a call I would be glad to help them out on a pro bono  basis.

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