Læknablaðið - 01.06.1972, Síða 61

LÆKNABLAÐIÐ
41
not mandatory requirements. They also now have regional advisors
on training in their own fields.
In general the training programmes anticipate a sequence of
hospital or academic posts, involving increasing responsibility in the
wards or the laboratory and becoming more selectively specialised as
they proceed. With the age of qualification at 24 to 25, such pro-
grammes envisage the completion of a specialty training by the age
of 32 or 33. In general practice the period is shorter and the age of
establishment may in future be at or just before the age of 30. Here
too the emphasis is on practical experience under tutelage but with
rather less emphasis than in the specialties on the disciplines of
research. The training programmes are longer and more precisely
defined than those usually adopted in the countries of the EEC and
it remains to be seen whether British entry into the EEC will lead
to any modification. Since the circumstances of the Health Service
would lead to independent responsibility on appointment to a con-
sultant post in a hospital after the completion of training whereas
neither the Specialty Boards in North America nor Specialty Regis-
trations in Europe are likely quite so promptly to lead to the same
degree of independence, the differences may remain.
The organisation of hospital work in Britain is less hierarchical
than is usual in Europe and is only now becoming organised on a
divisional or service basis such as those which have commonly existed
in North America for twenty years. Because most of specialty practice
in Britain is within the Health Service, it is possible to have an or-
ganised group responsibility without trespassing in any way on private
practice or personal responsibility to a patient. In this the situation
is nearer that of Scandinavia than North America but without the
hierarchical organisation of specialty departments. This organisational
pattern to a considerable extent determines a relatively loose de-
finition of specialty trainings. The existence of competition for appoint-
ment to a consultant post provides some safeguard against inadequate
training or experience in the individual given this responsibility and
there are always outside assessors. The absence of competitive private
practice as a major factor in earnings also takes away patient dis-
crimination or colleagues’ selective referral as a means of determin-
ing professional success.
The organised system of the National Health Service requires
closer review of professional standards than the open market situation.
So far the Health Department has avoided involvement in these pro-
fessional assessments of quality, but pressure is mounting to ensui-e
that there is some assessment and it will be necessary for the pro-
fession to meet that demand within itself if it is not to have scrutiny
imposed upon it from outside. I believe myself that it will do this
and the development of divisional organisation of specialties in all
district hospitals rather on the lines of the service type of organisation
in the best North American hospitals will provide this sort of mutual
intra-professional scrutiny.
The learning of medicine in any branch is not a complete episode.