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THE PREREGISTRATION YEAR
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the patients with primary hyperparathyroidism. Pak and his colleagues concluded that this modified calcium-infusion test should be particularly useful in the diagnosis of primary hyperparathyroidism in patients who are normocalcxmic or slightly hypercalcsemic. This conclusion was based on the fact that the plasma-calcium concentration was normal in 10 of their patients with primary hyperparathyroidism and only slightly raised (less than 12 mg. per 100 ml.) in a further 8 patients. However, as with all tests based on urine phosphate excretion, this modified calciuminfusion test requires metabolic facilities, and, in particular, accurate collection of timed specimens of urine. (Timing difficulties have been partly obviated by expressing the changes in urine phosphate excretion with respect to creatinine.) This modified calciuminfusion test warrants further evaluation in the diagnosis of primary hyperparathyroidism, and especially normocalcaemic primary hyperparathyroidism.12
THE PREREGISTRATION YEAR "
THE problems of the intern year have not been solved. Does it need legislation ? Should the General Medical Council be given powers to inspect preregistration posts ? Are local measures needed ?" These are some of the questions Lord Cohen, president of the G.M.C., put to a conference organised by the Council on March 2. The story of the preregistration year is an unhappy In 1944, the Goodenough committee recomone. mended compulsory periods in general medicine and general surgery before full registration. " The house officer", said the report,13 " needs time for thought, for further study, and for the personal investigation of the social and environmental conditions of the patients with whom he comes into contact." The number of beds in the care of the house-officer was therefore to be small (not more than 30), and the medical school was to see to it that the appointment was suitable. These recommendations were inin the Medical Act., 1950, but later it became corporated clear that many of the posts being approved by the medical schools were unsuitable. In 1967, the General Medical Council proposed five criteria for a preregistration post, and the Junior Hospital Doctors’ Association has now done a survey to see how the jobs match up, five years later.14 The results are based on answers to a questionary, to which the response-rate was just over a third. The G.M.C.’s recommendation (a) was that posts should be in general hospitals with adequate pathology and radiology departments, and a working library. The survey showed that in 13-24% of posts radiology and pathology services were inadequate at night and at weekends. Recommendation (b) was that the consultant in charge of each post should have not less than four sessions a week in the hospital. This criterion was not met in 15% of the posts. Recommendation (c) was that each hospital department providing pre12. Wills, M. R. Lancet, 1971, i, 849. 13. Report of the Interdepartmental Committee H.M. Stationery Office, 1944. 14. On Call, Feb. 28, 1972.
on
Medical Schools.
registration posts should have at least one nonresident senior registrar or, failing that, one or more resident registrars. 25% of the posts had neither. Recommendation (d) was that the houseman should not normally look after more than 30 beds. 58% were looking after more than this. And recommendation (e) was that the educational nature of the post should be understood by all concerned; that each houseman should have at least six hours a week for educational purposes, apart from his free time; and that there should be an educational programme for holders of preregistration posts. 84% of the posts provided no time for education, and, where there was a programme, many were unable to attend. Dr. Jonathan Fisk, who was responsible for this survey, put these figures to the General Medical Council’s conference. Not one of the G.M.C.’s criteria was being fulfilled, he declared; why was the Council letting the matter rest ? Speakers from the medical schools had suggestions for tightening up the approval of preregistration posts. Prof. James Parkhouse wanted more control over combinations of posts; a random selection did not necessarily constitute adequate training. He also thought it was time for some experiments: why not, he suggested, try a two-year preregistration programme in one or two areas ? The first year could be abstracted from the undergraduate curriculum, and continued supervision would be possible right up to registration. Dr. M. I. A. Hunter thought it was no longer feasible to aim for a given range of experience in the preregistration year; responsibility was of equal or greater importance. Also, the quality of the post depended as much on the consultant as on the specialty (one speaker thought even more might depend on the senior registrar). Dr. J. E. Cates attested to the success of regional postgraduate centres, and urged extension of the postgraduate-tutor scheme to teaching hospitals. He thought much could be gained by making housemen more aware of the interest of the universities, and this might be achieved by devising a more searching certificate of service, which would imply that the consultant had taken responsibility for teaching. Others spoke of the value of matching schemes for house-jobs (computer-run or otherwise), and Dr. J. Revans showed that, in one region at any rate, it had proved possible to put all the G.M.C.’s recommendations into practice. What more should be done ? " Somebody must be in the position, when things are really bad, to step in. The G.M.C. should have reserve powers of inspection and authority to withdraw recognition of posts." This was the view of Dr. Frances Pigott, former president of the J.H.D.A. Mr. J. F. Martin, of the British Medical Students’ Association, also wanted a terrier (with teeth) to chivvy the universities into a more active stance. There seemed to be a responsive gleam in Lord Cohen’s eye. " The G.M.C. has no power to see that its criteria are enforced", he had said earlier. Now he asked, Should the G.M.C. seek powers for supervision of the preregistration year similar to those it has for the undergraduate years ?" And the conference gave him a resounding Yes. "
the patients with primary hyperparathyroidism. Pak and his colleagues concluded that this modified calcium-infusion test should be particularly useful in the diagnosis of primary hyperparathyroidism in patients who are normocalcxmic or slightly hypercalcsemic. This conclusion was based on the fact that the plasma-calcium concentration was normal in 10 of their patients with primary hyperparathyroidism and only slightly raised (less than 12 mg. per 100 ml.) in a further 8 patients. However, as with all tests based on urine phosphate excretion, this modified calciuminfusion test requires metabolic facilities, and, in particular, accurate collection of timed specimens of urine. (Timing difficulties have been partly obviated by expressing the changes in urine phosphate excretion with respect to creatinine.) This modified calciuminfusion test warrants further evaluation in the diagnosis of primary hyperparathyroidism, and especially normocalcaemic primary hyperparathyroidism.12
THE PREREGISTRATION YEAR "
THE problems of the intern year have not been solved. Does it need legislation ? Should the General Medical Council be given powers to inspect preregistration posts ? Are local measures needed ?" These are some of the questions Lord Cohen, president of the G.M.C., put to a conference organised by the Council on March 2. The story of the preregistration year is an unhappy In 1944, the Goodenough committee recomone. mended compulsory periods in general medicine and general surgery before full registration. " The house officer", said the report,13 " needs time for thought, for further study, and for the personal investigation of the social and environmental conditions of the patients with whom he comes into contact." The number of beds in the care of the house-officer was therefore to be small (not more than 30), and the medical school was to see to it that the appointment was suitable. These recommendations were inin the Medical Act., 1950, but later it became corporated clear that many of the posts being approved by the medical schools were unsuitable. In 1967, the General Medical Council proposed five criteria for a preregistration post, and the Junior Hospital Doctors’ Association has now done a survey to see how the jobs match up, five years later.14 The results are based on answers to a questionary, to which the response-rate was just over a third. The G.M.C.’s recommendation (a) was that posts should be in general hospitals with adequate pathology and radiology departments, and a working library. The survey showed that in 13-24% of posts radiology and pathology services were inadequate at night and at weekends. Recommendation (b) was that the consultant in charge of each post should have not less than four sessions a week in the hospital. This criterion was not met in 15% of the posts. Recommendation (c) was that each hospital department providing pre12. Wills, M. R. Lancet, 1971, i, 849. 13. Report of the Interdepartmental Committee H.M. Stationery Office, 1944. 14. On Call, Feb. 28, 1972.
on
Medical Schools.
registration posts should have at least one nonresident senior registrar or, failing that, one or more resident registrars. 25% of the posts had neither. Recommendation (d) was that the houseman should not normally look after more than 30 beds. 58% were looking after more than this. And recommendation (e) was that the educational nature of the post should be understood by all concerned; that each houseman should have at least six hours a week for educational purposes, apart from his free time; and that there should be an educational programme for holders of preregistration posts. 84% of the posts provided no time for education, and, where there was a programme, many were unable to attend. Dr. Jonathan Fisk, who was responsible for this survey, put these figures to the General Medical Council’s conference. Not one of the G.M.C.’s criteria was being fulfilled, he declared; why was the Council letting the matter rest ? Speakers from the medical schools had suggestions for tightening up the approval of preregistration posts. Prof. James Parkhouse wanted more control over combinations of posts; a random selection did not necessarily constitute adequate training. He also thought it was time for some experiments: why not, he suggested, try a two-year preregistration programme in one or two areas ? The first year could be abstracted from the undergraduate curriculum, and continued supervision would be possible right up to registration. Dr. M. I. A. Hunter thought it was no longer feasible to aim for a given range of experience in the preregistration year; responsibility was of equal or greater importance. Also, the quality of the post depended as much on the consultant as on the specialty (one speaker thought even more might depend on the senior registrar). Dr. J. E. Cates attested to the success of regional postgraduate centres, and urged extension of the postgraduate-tutor scheme to teaching hospitals. He thought much could be gained by making housemen more aware of the interest of the universities, and this might be achieved by devising a more searching certificate of service, which would imply that the consultant had taken responsibility for teaching. Others spoke of the value of matching schemes for house-jobs (computer-run or otherwise), and Dr. J. Revans showed that, in one region at any rate, it had proved possible to put all the G.M.C.’s recommendations into practice. What more should be done ? " Somebody must be in the position, when things are really bad, to step in. The G.M.C. should have reserve powers of inspection and authority to withdraw recognition of posts." This was the view of Dr. Frances Pigott, former president of the J.H.D.A. Mr. J. F. Martin, of the British Medical Students’ Association, also wanted a terrier (with teeth) to chivvy the universities into a more active stance. There seemed to be a responsive gleam in Lord Cohen’s eye. " The G.M.C. has no power to see that its criteria are enforced", he had said earlier. Now he asked, Should the G.M.C. seek powers for supervision of the preregistration year similar to those it has for the undergraduate years ?" And the conference gave him a resounding Yes. "