Dear Editor,
It has long been recognised that it is easier to prescribe than to de-prescribe.(1) Even in the very last days of life patients can be encouraged to continue taking medication for which there can be little deemed benefit.(2) Stopping medication that has been prescribed by another specialist creates staff uncertainty and it is often easier to continue than to reflect on the potential benefit or harm by so doing.
As with prescribing so with mandatory training. The growth of mandatory training for doctors has been rapid and appears to have not been managed with any overarching curriculum perspective. The lack of oversight of the curriculum has resulted in demands on Doctors which impacts on their availability to deliver clinical care. Deprivation of liberty training, GDPR training, EDI training, lifting and handling training, ACLS, Internet safety training, fire safety training, haemovigilance training, are just some examples of what Doctors are required to complete in addition to their annual appraisal. Each training is sponsored from the best of motives and often reactive to a confirmed need or incident. However, does this multi-million pound training work? Is there evidence that these programs produce better, safer doctors who deliver improved outcomes for patients?
Trying to mitigate risk often creates risk in other areas. The unplanned growth of mandatory training in an NHS struggling with workforce gaps is surely a significant risk factor for patients and for service delivery.
How much time is it reasonable to allocate to a modern Doctor to complete mandatory training in a year, – one day, a week, a month?(3)
There needs to be a cost benefit assessment of the total mandatory training curriculum to decide at what point the volume of mandatory training has become too significant a risk for patients and services. For the increasing number of Doctors who work part time the percentage of their working lives devoted to such training is even greater.
As with medication it is easier to prescribe more mandatory training than to reduce the number of programs or the length of training which is necessary.
It is time that a more holistic approach to mandatory training is taken at a national and at a trust level, but as with deprescribing who has the courage to take the lead?
Professor Max Watson
Palliative Medicine Consultant
Western Trust, Omagh
References
1. Duncan P, Duerden M, Payne RA. Deprescribing: a primary care perspective. Eur J Hosp Pharm. 2017 Jan;24(1):37-42. doi: 10.1136/ejhpharm-2016-000967. PMID: 31156896; PMCID: PMC6451545
2. Magnolia Cardona, Paulina Stehlik, Peter Fawzy, Oyungerel Byambasuren, Jarrah Anderson, Justin Clark, Shelley Sun & Ian Scott (2021) Effectiveness and sustainability of deprescribing for hospitalized older patients near end of life: a systematic review, Expert Opinion on Drug Safety, 20:1, 81-91, DOI: 10.1080/14740338.2021.1853704
3. Rao, Sandhya K. MD; Kimball, Alexa B. MD, MPH; Lehrhoff, Sara R. MS; Hidrue, Michael K. PhD; Colton, Deborah G. MSW; Ferris, Timothy G. MD, MPH; Torchiana, David F. MD. The Impact of Administrative Burden on Academic Physicians: Results of a Hospital-Wide Physician Survey. Academic Medicine 92(2):p 237-243, February 2017. | DOI: 10.1097/ACM.0000000000001461
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