Inefficiencies in medical eduction are in part borne by students. They are also borne by patients. As a medical student, I ‘delivered’ around 30 babies; I also did some episiotomies with varying degrees of supervision. As a medical registrar I put 32 pacing wires in, inserted a number of chest drains and took pleural biopsies; and put various central lines in. One of the latter interventions, led to a major complication. Things may have changed since I was a junior, but my argument may also apply to lesser procedures: taking blood, suturing, and indeed any interaction with patients. Even a clumsy bedside manner or history taking. On the other hand, I was sometimes useful to patients. I did my elective here in Edinburgh in psychiatry on the late Prof Bob Kendell’s unit. I spent three months on PU2, and, both at the time, and looking backward, feel I contributed positively to the care of patients.
The issue about the cost of training — especially in practical matters — to patients is not easy. There is always a learning curve. We also know that in some situations a non-expert is all we can afford — think of the example of a single doctor on an Antarctic research base who might have been instructed how to pull a tooth or release a dental abscess, before they went.
The point I make is about whether procedures are genuinely part of a learning curve — that is, a curve in which the individual aims to get better and better, and will carry on with that technique throughout their professional career. Or whether the organisation of training takes little account of known career trajectories, in which case there is no learning curve, and the moral argument more suspect.
I was never going to be an obstetrician, I was never going to be a cardiologist, nor a chest physician. And I knew all that before I qualified. But I was going to need to take blood; and to do dermatological surgery at an intermediate level. Once somebody has decided on a final destination, the route has to change accordingly.