‘Incompetent’ junior doctors ‘putting patients at risk’
Hospital patients are being put at risk by “incompetent” junior doctors who have not had enough hands-on training because of a clampdown on their working hours by Europe, fellow medics have warned.
Too many now have inadequate experience of accident and emergency or surgery, say doctors arguing for reform of the current training programme.
They say consultants are given little incentive to train up their less senior colleagues, and many are put off doing so by a mountain of paperwork.
They also say “tick-box” assessments mean sub-standard junior doctors are being passed as fit to practise when they should not be.
A survey of 615 foundation level doctors, results of which are published in British Medical Journal Careers, found 87 per cent believed that “incompetent trainees could obtain satisfactory results from workplace based assessments”.
Dr Ben Dean, an Oxford-based orthopaedic registrar who set up the survey, wrote in the article: “The current regulation of medical training is producing professionals who invariably look competent on paper but are not necessarily competent and confident in reality.”
Speaking to The Daily Telegraph, he said juniors were judged using “tick-box” forms, with some being assessed like this 40 times a year.
He said: “The problem is, there’s no evidence they work. People just tick them off and nobody ever fails them. They are not a mark of how good you are.”
He thought it was “far more important” for junior doctors to have a committed consultant supervisor, but said: “The consultants get no reward for doing this, just a load of paperwork to fill in.”
Furthermore, he said many juniors were not getting the hands-on experience they needed, particularly in acute medicine and surgery.
He said: “The paperwork has proliferated and makes doctors look competent, but in actual fact is this the case?
“Experience levels are significantly down due to reduced hours, partially due to the European Working Time Directive, and a lot of foundation stage jobs have little or no exposure to acute medicine and surgery.
“There is too much of a focus on chronic disease and trainees and not being routinely given the bread and butter experience they need in the common medical and surgical emergencies.”
He accused the General Medical Council of failing to regulate medical training effectively, saying it had not withdrawn a single medical training post since it took on the responsibility.
Ian Eardley, a consultant urologist involved with training at the Royal College of Surgeons, said the idea behind the assessments had been to provide juniors with regular feedback to improve.
But he said: “It’s in doctors’ nature that everything that’s an ‘assessment’, we have to pass.
“As a result they have been used as a tick-box exercise.”
However, the system was now being amended, so formal assessment was separated from day-to-day feedback.
He added: “Juniors certainly get less experience than they used to, partly because they spend less time at work, which is tied in to the European Working Time Directive.”
This affected rotas, which meant some doctors ended up on many night shifts, when fewer senior staff were around to learn from.
Dr Tom Dolphin, chairman of the BMA’s junior doctors’ committee, said the issue of tick-box assessment “has been addressed”.
While the directive, which limits the working week to 48 hours, had hit experience, he said: “This is not something we can go back on, and we know that tired doctors make more mistakes.”
He also claimed Remedy UK, which carried out the poll six months ago, did not represent the views of most junior doctors, and pointed out the organisation had just closed down.
Niall Dickson, chief executive of the GMC, said: “The GMC took over responsibility for post-graduate training in 2010. Since then we have put in place a number of improvements in our monitoring and inspection regime.”
While he said there was “unacceptable variations in the quality of training and supervision,” the GMC saw removal of training posts as “a weapon of last resort”.
A Department of Health spokesman said: “Our education and training reforms focus on quality. They have been widely welcomed by stakeholders, the Future Forum and the recent Health Select Committee.
“We want to make sure that the best medical training is available for our NHS workforce so that they can deliver the best care to patients and the wider population.”
Another desperate Leftist attempt to escape obvious reality
In yet another of their implacable attempts to deny the reality of racial differences, they make some quite surpising assumptions — such as the immutability of institutions and the inability of poor people to change or benefit from example
There is absolutely no doubt that institutions matter but why different people have the institutions they do will astound you. They apparently have no choice in the matter. But I won’t go on. Let Steve Sailer tell the story:
MIT’s Daron Acemoglu is a rock star among economists, one of the ten most cited in his profession. This is largely because of the paper the Istanbul-born Armenian cowrote in 2001: The Colonial Origins of Comparative Development. Other economists have found that it provides a suave way to finally answer the embarrassing question of why, in the 21st century, some countries are rich and some are poor.
Acemoglu has a big new book out with James A. Robinson, Why Nations Fail: The Origins of Power, Prosperity, and Poverty, that makes his case at great length.
To understand Acemoglu’s professional popularity, you have to grasp how awkward the major features of global economic reality are to careerist economists. If you look naively around the world, you might get the impression that, say, Chinese territories such as Taiwan, Singapore, and Hong Kong have been economically dynamic because they have a lot of Chinese people in them. Moreover, the Overseas Chinese control much of business in Southeastern Asia, so we might assume that the Chinese tend to have a lot on the ball wherever they go.
The epochal conclusion that Deng Xiaoping, urged on by Singapore’s Lee Kuan Yew, drew from this in the late 1970s was that if all the Chinese folks in the world were getting rich except the Maoist Chinese, the problem must lie more in the “Maoist” than in the “Chinese” part. And, indeed, once liberated from Mao’s dogmas and whims, the Mainland Chinese responded with one of history’s greatest economic surges.
To an economist looking for invitations to conferences, however, the danger of adopting the Lee-Deng perspective is its flip side: Some other peoples, such as black Africans, New World Indians, and Pacific Islanders, have tended to lag notably behind Northeast Asians and Europeans, whether at home or abroad, and under all sorts of ideologies and institutions.
Acemoglu’s contribution was to come up with a regression analysis that, he claimed, showed that Third World poverty was the fault of those all-purpose bad guys, European imperialists. In colonies where early Europeans settlers faced low risks of dying from tropical diseases (such as Massachusetts), they set up good “inclusive” institutions. But in colonies where white men died like flies (such as Nigeria), they set up bad “extractive” institutions.
Institutions are (practically) everything, you see. If, say, the Central African Republic is poor, it’s not because it’s a republic in Central Africa (or because poverty is the default condition of humanity), but because it has extractive institutions. And that’s because Europeans didn’t set up inclusive institutions for the Central Africanese.
If Australia or New Zealand or Canada are richer than the Central African Republic, it’s not because Australia or New Zealand or Canada are full of Europeans, it’s because the Europeans hogged the inclusive institutions for the places they colonized. Or something. Acemoglu wrote: “These results suggest that Africa is poorer than the rest of the world not because of pure geographic or cultural factors, but because of worse institutions.”
According to Acemoglu, that’s pretty much all you need to know. From the abstract of his 2001 paper:
“Our estimates imply that differences in institutions explain approximately three-quarters of the income per capita differences across former colonies. Once we control for the effect of institutions, we find that countries in Africa or those farther away from the equator do not have lower incomes.”
Now, you might think that Acemoglu’s model for predicting national wealth in ex-colonies, such as the United States or New Guinea, is:
1. More white people means more wealth.
How dare you think such a thing! Instead, it’s a two-step process:
1. More white people hundreds of years ago means better institutions today.
2. Better institutions then means more wealth today.
Two steps are better than one, according to Occam’s Butter Knife.
In Why Nations Fail, Acemoglu and Robinson have extended their Inclusive Good/Extractive Bad dichotomy. If anything good ever happened anywhere in world history, it was due to “inclusive institutions” and vice-versa. Sir Karl Popper, the philosopher of science, would have torn his hair out trying to read Why Nations Fail. He would have found Acemogluism as unfalsifiable (and thus as unscientific) as Freudianism and Marxism.
Now, I’m a big fan of inclusive institutions and don’t like exploitative ones. But Acemoglu’s dogma strikes me as a tad superficial. For instance, he focuses on the border cities of Nogales, Arizona, and Sonora. Why is the American side richer? It must be because America has better institutions.
OK…but what makes for better institutions north of the border? After all, Mexico has had plenty of opportunity to study American institutions. Could the enduring differences have something to do with America having a lot of Americans?
What’s the real story behind good and bad institutions? Two brave economists from Africa, Isaac Kalonda-Kanyama of the University of Johannesburg and Oasis Kodila-Tedika of the University of Kinshasa, have tackled this question head-on in a new study entitled Quality of Institutions: Does Intelligence Matter? Their conclusion:
“We analyze the effect of the average level of intelligence on different measures of the quality of institutions, using a 2006 cross-sectional sample of 113 countries. The results show that average IQ positively affects all the measures of institutional quality considered in our study, namely government efficiency, regulatory quality, rule of law, political stability and voice and accountability. The positive effect of intelligence is robust to controlling for other determinants of institutional quality.”
Don’t expect Kalonda-Kanyama and Kodila-Tedika to get big career boosts from their finding.
I taught in a School of Sociology at a major Australian university for many years and did a lot of research while I was there. The one sociological fact that impressed me most during all that time, however, was something I saw during a trip to California in the ’70s. I was staying in Los Angeles and decided to take a day trip down to Tijuana, which was at that time much better known for brass bands than for drugs and crime.
I was impressed by the 8-lane American concrete highway leading all the way to the border but was astounded to emerge from border control onto a dirt track lined with barrels. A first-class American freeway suddenly gave way to a Mexican dirt track. I guess that the Mexicans have improved their side of the border since then but the contrast between the two sides of the border could not have been more graphic at the time and has stood in my mind ever since as proof of the importance of culture and its associated institutions.
And there is no difficulty in seeing why Mexican culture bears much responsibility for the state of Mexican roads. But with the tutelary example of a triumphant American culture visible just over the border, how do we explain the failures of Mexican culture today? Are Mexicans incapable of learning? That claim sounds rather like a racist statement in itself.
To attribute current Mexican culture to something Spaniards did hundreds of years ago rather that to what Mexicans are like today is something only a Leftist could believe. No doubt the conquistadores had a big influence in their time but culture is ever-changing and what it is at any one point in time has to reflect the choices made by people around that time.
Note just a few examples of rather rapid changes of culture within the same society. These days men rarely wear hats. Within living memory men were regarded as improperly dressed if they stepped outside their door at any time of the year without a hat on. I remember going to work with a hat on myself. And in the 19th century, beards were virtually universal on men. And less trivially, what has happened to the distinction between the deserving and undeserving poor that so dominated 19th century social thinking? One could go on about the decay of civility, manners, standards etc. The very idea of a static, immutable culture and its associated institutions is a towering absurdity.
And when it comes to differences between cultures, look, for instance, at whether in the given culture there is little general respect for impartial justice. In such a culture you will bribe the judge and the judge will take the bribe. And much flows from that
Furthermore, the claim that the British left behind some sort of malevolent cultures and institutions in Africa is itself malevolent. When the British departed places like Nigeria and Ghana they left behind well-organized countries with good communications and prosperous economies — plus standards of law, order and justice far higher than anything there today. In short, they left behind excellent foundations for the development of modern, prosperous and civilized societies. That no such development took place is the doing of the inhabitants, not the doing of the evil “colonialists”.
How Leftists hate that very word: “colonialist”! It seems to make them shake with rage, regardless of the reality it denotes. They are deeply irrational people. That there has never been in recent centuries a more rabid colonial power than Soviet Russia doesn’t count, of course
Facing relegation: Why Britain’s ‘undeveloping’ economy means the country could be about to join the Third World
The average Briton gets poorer with every year that goes by — and there is no end to that in sight. The relentlessly rising number of knees under government desks does not leave enough people to do the useful things that would be needed to maintain or improve Britain’s standard of living
Relegation, every football manager’s nightmare, now looms on a national scale. Countries, like football teams, can slide down the leagues, and for Britain the pending demotion is traumatic – from the ranks of the first world to those of the third.
Britain is an undeveloping economy, a submerging rather than emerging market. Not only will 2014 mark 100 years since the start of the First World War, it will also be a century since we were last an undisputed economic leader and superpower.
The signs are that this fight will be lost – and not simply because of the depressed state of our economy. More worrying are the indications that Britain is ceasing to be a developed economy and is now on course to swap places with one of the emerging economic giants.
Take our balance-of-payments problem. Britain last ran a current-account surplus in 1983. Since then, it has been in deficit. Worse, it has been borrowing money from countries such as China in order to buy goods made in, yes, China.
Then there is the steady sale of our commercial assets to foreigners. Overseas investors possess nearly £200 billion more of British assets than our investors own overseas.
Britain’s labour market is a mess – another sign of a relegation candidate. Many native workers, considered too unproductive and poorly trained to be of use, are paid beer money in the form of benefits to keep them quiet, while better qualified foreigners are recruited instead.
At the latest count, four million of Britain’s 29 million workers were foreign-born. Two million Britons are registered as long-term sick, and 2.63 million are unemployed, using the broadest definition.
There is a permanent rumble of discontent from the customers of both State and private organisations. Public servants demand additional upfront payments, in cash or kind, before they will perform their tasks (police overtime, GP contracts).
A pseudo-competitive private sector in gas, water, railways and electricity conspires against the public, as companies conjure up ever-more inventive reasons to increase charges.
As with many countries in the developing world, there is chronic uncertainty about the authority of the State. In Britain, a separatist party is in control of a resources-rich region (Scotland), while the potential constitutional flashpoints are many and various: Westminster versus Brussels; Ministers versus the still-new Supreme Court ……
It has taken us 100 years to reach this sorry condition. Relative decline, against the United States in particular, may have been inescapable, but our pending relegation was never inevitable.
Let no one say demotion is impossible. Had the Group of Seven leading economies existed in 1945, Argentina would have been a member. But after decades of mismanagement, inflation and debt defaults, it no longer figures in anyone’s idea of the big league.
Yet Britain is in a state of denial, our leaders convinced that the economy is a winning side. The alternative is to accept that we are starting from scratch. Developing countries need a development model, and undeveloping countries such as Britain do too.
Two approaches are on offer. We could try to emulate the so-called Swedish model, with a social-industrial-government partnership and extensive public welfare, or we could aim to be an Atlantic Hong Kong, with minimum State interference, low taxes and only basic welfare services.
We must choose. It is our long-term refusal to do so that has led to our current predicament.
A new global elite is on the march
Comment from Britain
Have you come across “OES syndrome”? The letters stand for Overeducated Elitist Snob, and if you don’t know what that means let me draw your attention to the front benches of the House of Commons.
OES syndrome is an American term, coined by the US political scientist Charles Murray to describe the clustering of wealth, power and – crucially – intelligence at one end of the social spectrum. Murray’s new book Coming Apart: The State of White America is not as controversial as The Bell Curve, the 1994 volume in which he and Richard Herrnstein compared race and IQ. But its conclusions are every bit as alarming.
A hundred years ago, says Murray, most Americans in the top five per cent of cognitive ability had ordinary occupations. They were very clever shopkeepers, farmers, housewives and factory workers. But they didn’t somersault over their peers.
One reason is that they couldn’t marry very smart people. High intelligence was scattered evenly across America, so a gifted farm worker might have to travel 100 miles before he met a woman as bright as he was. Instead, he married an ordinary local girl, and their children, regressing to the mean, were only slightly cleverer than their schoolfriends.
The explosion of college education changed that. Universities plucked bright kids out of their home towns like a tornado and suddenly they found that they weren’t in Kansas any more. Young people hooked up with equally intelligent partners and passed on two sets of smart genes.
This mobility opened up Ivy League universities to competition from ultra-bright candidates. The old-money aristocracy at Harvard, Yale and Princeton shrank, but the average IQ at those universities soared – and with it the earning potential of alumni. The newly elite students married each other and the result, says Murray, is a hard core of Overeducated Elitist Snobs.
Members of this supercharged class don’t just separate themselves from the poor: they’re quarantined from “everybody who isn’t as rich and well educated as they are”. They also produce clever, rich children by marrying brains and money (which go together these days).
Remind you of anybody? We may tease David Cameron and George Osborne for being “toffs”, but they’re more than that. Although both inherited money, they’re also furiously ambitious academic snobs of the type Murray describes. In their meritocracy, the purpose of a superior brain is to amass money and power. Intellectual curiosity isn’t encouraged lest it jeopardise that project. Hence the anomaly of a prime minister with a brilliant First from Oxford who has never uttered a truly original thought in public.
Let’s not kid ourselves that the elitism of this Oxbridge-educated Coalition will disappear when it loses power. Labour has its own OES syndrome; so do politicians and business leaders from Palo Alto to Beijing. Free market capitalism forces the brightest people to the top. That may sound like good news, but it also creates an association between intelligence and living standards that, in the long run, will condemn stupid people to poverty.
The new marriage patterns do as much harm as good. Once bright people are taken out of the local gene pool, what does that leave? Our natural reaction is to say: “Let’s not go there.” But we really have no choice, because global capitalism is creating a cognitive hierarchy in front of our eyes – and, with it, inequalities just as cruel as the ones we thought we had abolished.
What the author above says is undoubtedly true but I doubt that much can be done about it or should be done about it. It may however lead to a generation of politicians with “the common touch” (Like economics graduate Ronald Reagan) and that may help preserve social peace and realistic politics — JR
British employers forced to take the role of schoolteacher
More than four in 10 employers are being forced to provide remedial training in English, maths and IT because school-leavers and college students lack basic skills when they start earning a living, it is shown in research published today.
Companies say they have little option but to set up classrooms to teach core subjects and equip young people with the basic knowledge to help them function in the workplace.
Almost two-thirds of the 542 companies surveyed by the CBI and Pearson Education complained that too many school-leavers were failing to develop vital skills such as self-management and timekeeping at school.
They struggled to write to the necessary standard, employ basic numeracy or use a computer properly.
The shortcomings identified in the report will add to growing concerns that the education system is failing to equip children for the demands of university and the work place. The findings show that the level of dissatisfaction among employers remains at around a third, the same level as a decade ago.
More employers are now trying to adopt a hands-on approach by forging closer links with schools to help students and teachers understand what skills are needed for working life. Almost 60pc now have ties with secondary schools and further education colleges.
Employers are also anticipating a drop in the intake of graduates because of the increase in tuition fees. More than a third expect to expand their recruitment of school-leavers with A-levels to provide an alternative to graduate-level training.
John Cridland, CBI director-general, said: “The UK’s growth will depend on developing a wider and deeper pool of skills so that our economy can prosper in the face of fierce international competition for business.”
The report suggests the current discontent among employers is likely to increase as companies look to increase workforce skills. In the next three to five years, employers expect they will need more people with leadership and management skills and fewer lower skilled.
Many employers believe primary schools should focus on the basics – reading, writing and maths – while secondary schools should prioritise developing the skills pupils will need for the world of work, as well as advanced literacy, numeracy and technology.
They also feel the none of the current education qualifications addresses the combination of literacy, numeracy and employability effectively and they want to see more emphasis on vocational subjects because of their importance in the workplace.
The CBI also wants a higher priority given to teaching foreign languages, one of the issues being addressed by Michael Gove, Education Secretary, in planned changes to the school curriculum. The UK is bottom of the foreign language proficiency league in Europe.
Boys as young as SIX are falling victim to anorexia as cases of eating disorder rise among both sexes in Britain
Is it any wonder after all the propaganda about “obesity” pumped out in the schools?
It’s widely known as a devastating condition that can destroy the lives of teenage girls. But new statistics show that anorexia is a growing problem among boys – and is affecting children as young as six.
Figures reported in The Sun show that 167 boys in England and Wales were treated for the disease between 2007 and 2011 – an increase of 65 per cent on the previous five years. Five of the victims were under the age of ten, including one six-year-old.
The eating disorder is also on the increase amongst girls. In the last five years, 1,662 sufferers under the age of 17 were treated, compared to 1,192 reported cases between 2002 and 2006. In the past decade 125 primary school age girls have been hospitalised, including seven nine-year-olds.
One sufferer told how he nearly died after his weight dropped to just four-and-a-half stone. Ollie Roche, 19, from Plymouth, Devon was just 16 when he was rushed to hospital three years ago. ‘My body had actually started to eat itself on the inside to keep me going and my heart was shrinking,’ Mr Roche, who has now made a full recovery, told The Sun.
A spokesman for eating disorder charity Beat added: ‘Boys nowadays are experiencing as much pressure as girls when it comes to body image. ‘There certainly needs to be more emphasis put on education in schools to build children’s self-esteem.’
Medical experts have previously blamed the surge in eating disorders among boys on an obsession with looking good by having bulging biceps and a six-pack stomach.
They say children who are increasingly exposed to unrealistic body images are more likely to develop dangerous eating disorders.
Last year GPs were warned to be on the lookout for the potentially fatal conditions, which include anorexia and bulimia, after a rise in the number of those affected.
It is thought that many men may be reluctant to admit they have a problem as the issue has until now been seen as something affecting mainly teenage girls.