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At the heart of general practice since 1960

Garbage in, garbage out

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D’you know what? I passed my driving test first time.

Yeah. You can call me smug if you like. Twelve lessons in a beat up Ford, one test booking, nailed it. Of course, people who only passed at, say, the seventh attempt will drone on and on about how all the best drivers flunked their test.

Whatever. Put it this way: if you’ve failed to make the cut after half a dozen attempts then consider the possibility that you may have no natural aptitude behind the wheel. Take minicabs.

Which has nothing whatever to do with the announcement that graduates who fail assessments for entry into GP training are to be allowed to re-apply in the same year, rather than hanging around and wasting their time for twelve whole months getting more experience and a few more lessons under their belt before having another go.

If drivers who pass third time really are better, it might just be because they’ve had a prolonged period of training that compensated for their lack of innate ability.

There is no cause for alarm: the GPC assures us that the benchmark, the final assessment, will remain set steadfastly high; Health Education England asserts that there will be no drop in standards.

I don’t want to appear dismissive or cynical, but, seriously?

One or two candidates might have had an off day when it mattered, but the majority will have missed out on entry to GP training for the same reason I never played central midfield for Real Madrid - not being good enough.

But, as anybody who is involved in GP training will tell you, once you’re in the system it’s damned difficult to get thrown out.

I’ve seen a few brilliant GPs in training, some now referred to as ‘my partners’, but I’ve seen more than enough who were barely adequate and a couple of absolute shockers.

The ones where your reference would read, ‘I’d be delighted to see this young doctor in practice in Inverness, (or Truro, or Anglesey, or anywhere more than six hours drive from my family and friends…)’.

It would be outrageous to suggest that this was a politically-driven move, designed to pander to Daily Mail readers and artificially boost GP recruitment figures at a time of crisis. But, hey, that’s what I do, so that’s exactly what I’m suggesting.

And it will backfire like a hippo after a baked bean vindaloo.

GP training is like any other black box system, with one input and one output, and as such the GI-GO rule applies: Garbage In, Garbage Out. You can rub as hard as you like, but there are some things in life that you just can’t polish.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.

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Readers' comments (14)

  • A little harsh to describe MRCGP failures as garbage.
    Let's face it, neither the RCGP nor the MRCGP have little relevance to modern GP practice( or survival)

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  • This refers to assessment of entry to training... he is suggesting in three years some who pass the MRCGP will be garbage

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  • what utter gibberish.

    The entry assessment into GP training has no evidence to suggest it has improved the standards of those entering the profession.

    The RCP actually looked at the exam for one year and gave up on it realising it would turn away medical graduates.

    I think any issues with competence of medical graduates needs to be looked at within medical schools.

    If there are GP's coming out of training who are poor I suspect the MRCGP exam will have little relevance. Again it is an exam with no evidence. Those who argue in favour of it, need to demonstrate what improvement there has been in GP's from pre CSA/AKT era to the post era.
    My understanding is that there is no demonstrable difference or even anecdotal evidence. there is some evidence from surveys that the new batch of GP's are very different in terms of their resilience and ability to cope with pressure. One of the reasons that so few choose to do full time general practice and fewer to take on responsibilites as a partner.

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  • Hang on, there is a lot of truth in this at least for old guys ( med school entry 1987 + several qualification and Regitrierung zum Arzt 1993 ) ....
    Not saying that weeks of 120 hour on call were productive or taught one something ...HOWEVER:
    one can not teach, let along fake empathy , no amount of ICE - teaching ( yes ideas, concerns, ideations ...a blablabla ) will instil you with vocational drive, or instinct or well anything which will forever distinguish you , the doctor from a 'n'octor (notadoctor,buta wellpain specialist nurse for )......I did not have to take eMRCGP aka MRCGP light'...however I had to work six weeks after the death of my fiancée, had work 2 days after my best ( female ) friend passed away in peace ,whilst holding all our hands...Why : well , had to , no family support, no other financial income and taking more time off would have left me with too much time to grieve..
    Life was never designed to be fair - If in Germany you do pass the Baccalaureate ( Abitur ) you can study what you want ( the one's with the highest grad have first pick but if you wait a year or two you could start...you could be out after 2 years if you do not pass the Physicum at the third attempt...

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  • The distance related reference!

    My proudest achievement as a trainer? Guiding a particularly 'gifted' trainee to his long term home in rural New Zealand.

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  • welllll, we re-directed somebody with hardly-existing-language skills back to his/her country of origin without ever questioning his or hear competence , sorry, 'we' that is one of my GPVTS training practices

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  • And it will backfire like a hippo after a baked bean vindaloo

    Made my decade!

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  • It is the GP Trainers who select candidates for GP Training. The make blunders at the time of selection of some of the candidates and then blame the trainees.

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  • I do not think that you are being entirely fair. For the written answers part of entry to GP, you need to do quite a lot of reading up to get want they want. It is not a case of turning up and getting it right. if you fail the clinical/ oral part, then you have more of an issue. It also depends of where you trained, as different countries have different ways of approaching things.

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  • As an experienced nurse as some 40 years, I can spot a good doctor (or not) in seconds. Maybe you need me on your selection team.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder