The new UK internal medicine curriculum

Editor – I read Professor David Black’s article describing the new UK internal medicine curriculum with interest.¹ It would seem at long last there is a plan to simplify the greatly criticised ‘tick-box approach’ to medical training. This is hardly a new idea and this progress has been greatly hampered and delayed by the Joint Royal Colleges of Physicians Training Board (JRCPTB) themselves.

I, and others, were on the Royal College of Physicians Trainees Committee almost a decade ago telling Professor Black’s predecessor, Bill Burr, that we should be doing far fewer assessments and we should do them better. We also said at the time that the process of linking competencies (one consultant seeing you clerk someone with acute coronary syndrome, doing a case-based discussion and another consultant deeming you therefore ‘competent’) is academically absurd.

I hope Professor Black is genuinely planning to get a grip on this aspect of training. To speak frankly, as it stands the ePortfolio is a crushing piece of bureaucratic nonsense. If you set out to develop an education initiative with the sole aim of making training less enjoyable you would struggle to beat this. There is no doubt in my mind that the ePortfolio and assessments (and by extension JRCPTB) have been a large driver of falling morale among medical trainees. As things stand, there are too many assessments; yes, they are clunky and the IT is abysmal but the real enemy here is the ‘linking’, so while the focus on outcomes is welcomed, I hope this is also tackled. Currently, a trainee has to link evidence to each part of their ePortfolio, then write about why they are competent in that area and then ask their supervisor to countersign that they are. The idea that the linking process will highlight the failing trainee, or even contribute meaningfully to the training of good trainees, is laughable.

While I congratulate Professor Black on trying to improve things and reduce the tick-box culture (that his organisation was instrumental in creating), it might be prudent to consider why they were unresponsive to criticism for so long. Certainly when I argued for simplification of the system in 2008 I was treated as a wayward schoolboy who, perhaps by virtue of not having paid for a masters in medical education, was unenlightened. When future trainees bring up genuine concerns about the next curriculum iteration these can’t be dismissed so easily.

Conflicts of interest

The author has no conflicts of interest to declare.