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The ferret's guide to Tooke: Part 1

Posted Oct 07 2008 7:21pm


The Tooke review is a lengthy document and a little hard to get stuck into, therefore I have decided to break it up into bite sized chunks and bore you to death by giving my opinion on it. Every day shall see a new edition of exciting Tooke review analysis, I shall start with a clarification of policy objectives:

"Recommendation 1
The principles underpinning postgraduate medical education and training should be redefined and reasserted, building on those originally articulated in ‘Unfinished Business’ but in particular emphasising flexibility and an aspiration to excellence. In devising policy objectives the interdependency of educational, workforce and service policies must be recognised.

Recommendation 2
Policy development should be evidence led where such evidence exists and evidence must be sought where it does not.

Recommendation 3
DH should formally consult with the medical profession and the NHS on all significant shifts in government policy which affect postgraduate medical education and training, workforce considerations, and service delivery and ensure that concerns are properly considered by those responsible for policy and its implementation.

Recommendation 4
Changes to the structure of postgraduate medical education and training should be consistent with the policy objectives and conform to agreed guiding principles."

The principles of this sound well and good, there is nothing one would initially argue with at first glance. However if the same dysfunctional bodies and people are still in charge of medical education and training, how can Tooke ensure that this talk of adhering to principles actually comes to fruition, and isn't just ignored by the incompetents at the DoH? The talk of evidence is all well and good, however people must be careful not to become evidence based fundamentalists, by this I mean there are many things that are just plain common sense which have no hard evidence behind them; this doesn't mean that the old tried and tested common sense should be replaced by new techniques that do have evidence behind them. The key will be in ensuring that the power that be use their common sense and interpret evidence sensibly with common sense. The talk of consultation is also good talk, however how many times have we heard of government consultations that have been a complete and utter sham, I wonder what is the mechanism for ensuring that the government will genuinely consult us on more training reform? I just hope it doesn't involve government stooges and citizens' juries.

There is always a lot of talk of asserting 'principles' and adhering to them, but what does this mean? I struggle to understand sometimes. What is abundantly clear is that when Liam Donaldson set about reforming medical training with 'unfinished business', the real motives behind the reforms were not revealed, this has been proven with several Freedom of Information requests. Thus if the same hidden, arguably cynical, motives still exist; then what is the point of reasserting a set of principles? I am therefore slightly sceptical of how much good it will do to reassert principles, principles that may well have been a smokescreen for some rather cynical power grabbing government reform.
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