Abstract
I read with interest the article ‘Medical progression: the missing link’ 1 in which the authors identify an apparent omission in the application process for higher and specialty medical training – that no points are awarded for clinical ability. First, this is not strictly true as the interview process includes a suitably weighted clinical scenario as well as assessing other important skills. More importantly, however, I would argue that their proposed solution – that clinical ability should be assessed throughout training based on anonymous feedback from random members of the multidisciplinary team – is flawed on the grounds that they have fundamentally misconstrued the purpose of feedback.
The role of feedback is not to evaluate individuals. Feedback is a learning exercise in which information is provided to individuals allowing them to reflect on and learn from their experiences. Effective feedback helps us to correct mistakes and develop approaches for improving performance. Many authors expound the role of feedback as a formative activity, emphasising that its function is not to pass judgement.2,3 To quote Chowdhury and Kalu, 3 feedback ‘is intended to improve skills and behaviour, rather than being an estimate of students’ worth’. If we translate feedback into a ‘grade’, as these authors suggest, then we have lost sight of its entire purpose.
The authors' proposed system would also be unregulated and unstandardised. It may create additional stress for trainees who may feel fearful of admitting mistakes or seeking help, and it could promote a culture of competition rather than support. The authors express concern that the current system causes problems for patient safety. However, this can perhaps be assuaged given that applicants must pass the rigorous requirements of the foundation or internal medicine training programmes before taking up higher posts, and must provide references from senior clinicians testifying to their suitability.
