It is no secret the fact that one needs to score and or achieve A*s in some high yield science subjects in order to gain admission into the medical school worldwide, although there are exceptions in some economies. In the latter case, students will be required to show a remedial competence, otherwise, they are not ideally offered admissions to study medicine. The importance of achieving A*s in prerequisite courses in order to be admitted into medical education cannot be overemphasized. We know, however, that not up to a 10th of the chemistry, biology, mathematics or physics that you were bothered by that will be required by the bedside, when dealing with a sick patient. I dare to say that skills matter more than your IQ when it comes to delivery of quality care to the sick. Many an intelligent student has had to be withdrawn from medical training on account of inability to cope with the rigorous nature of the studies. Some of these students had straight A's in their school certificate examinations! Competence cannot be compromised in the field of medicine.
In order to be certified, one needs to show competence in various areas. For the initial degree, the MBBS, you need to get past the hurdles of MCQs and clinicals/short cases/Long cases. Then the battle begins.
If you choose to go through the postgraduate training pathway, you do need to show that you have achieved competences in the area of your chosen specialty. Many countries have different ways by which competences are determined. But for a human life to not be placed at risk, I am of the opinion that no compromises be accepted when it comes to determining the highest level of competence in any field of medicine. Compassion and character, although great virtues, do not in anyway compensate for competence.
It is not difficult to realize that competence is built based on practice and mentoring. If you are competing for any sport or event that matters to you, practice and more practice is the norm. To be certified to deliver the dividends of your specialty, the assessors do not need to allow any tinge of leeway in ticking the boxes for you. For all you care, the assessor may end up being on the receiving end of your care. Standardized rather than customized competences need to be put in place. Not the adhoc "organised, rushed maneuvering" of equipment that go on whenever some accreditation teams are visiting. Competence is thus a major backbone upon which compassion and character will ride for a medical career that will see good clinical practice outcomes.
An example of how competences need to be measured is given thus. For someone to be assessed to be competent in a procedure like gastroscopy for instance, centres of excellence would ensure the fact that its not only the procedure itself that matters, or its completion and rate of picking up correct diagnoses. The assessment of competence commences from when the patient is checked into the endoscopy unit- at which point, the patient is consented, given a chance to ask questions and the fact that they can ask for the procedure be stopped should they change their minds regarding the investigation.
The endoscopist's competence is assessed by several human factors that do not come off the pages of anatomy, physiology, chemistry or mathematical physics. The care that the patient receives from the time they arrive till the time they leave the unit is evaluated by the physician's character and compassionate conduct.
A typical gastroscopist is assessed by the following factors:
1. Adequacy of the consent process
2. The comfort score of the patient
3. The Completion rate of the procedure - based on preset values, in comparison to peers
4. The complication rate
5. Appropriate use of premedication and lack of complication from their use
6. Post procedure advice to colleagues and follow up plans
It is clear from the foregoing that competence, although, relevant, is not the all-in-all for a successful career in medicine.
Character will garnish one with ability to be truly courteous and not pretentious in care-giving. When you provide care out of necessity and not because you prefer and or you would not do otherwise, and it is desired that you are full of character, then you may find out that it produces a hellish experience for you. When the chips are down, the ugly beast inside would lose it and the true 'you' will scream out of the bottle. Character building is thus very essential for a competent care, out of a heart of compassion.
It is a common saying the fact that "practice makes perfect". I dare to say that PRACTICE MAKES PERMANENT. If your practice is without compassion, then you risk developing a generation of uncompassionate doctors; due to the fact that your protegees would think that your way of providing care is the way 'successful' doctors deliver care. We can provide a paradigm shift in the way doctors offer care in the next generation by developing a new way of caring for the body, soul and possibly, the spirit.
Thank you and God bless you.
N. Ladep, PhD in Hepatology
Director, Worthy Works Ltd