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We live in an era where the terms ‘change’ and ‘progress’ are often used interchangeably. Within the UK National Health Service we have change managers and symposia titled ‘managing change’, all presupposing that ‘change’ is beneficial. However, we all know that ‘change’ often just means ‘change’, and quite often for the worse. In addition, changes that are made for what seem like very good reasons can have unintended consequences (although many unintended consequences are not unforeseen). Unfortunately, when trying to sort out these unintended consequences, the reasons a change was made in the first place are often forgotten.
Neurological training has been subject to dramatic changes since 1997 and Dr Nachev's article focuses on only one aspect—competency assessments1. However, as will become apparent, this is part of the solution (but just one part). First let us consider a little history which will clarify the debate (see box).
Box The thesis Dr Nachev proposes can be summarised as two separate arguments
The ‘good old days’
Generally the ‘good old days’ are considered as the period in the UK when there were registrars and senior registrars, prior to the introduction of the Calman reforms in 1997. Aspiring neurologists had to complete general medical training and pass the membership examination of the Royal College of Physicians (MRCP). They then usually applied for a senior house officer job in neurology. If successful, they perhaps did registrar locums, maybe for a year or two, before applying for a research post to do an MD or PhD postgraduate research degree. From there they applied for a registrar post, often with a contract for just 1 year, and then reapplied for another second year, possibly a third or even a fourth. The interviewers ranked the candidates on their previous experience, often embellished by formal and informal references (their current consultant was expected to contact members of the panel), their publication and …
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