Open up medicine's cloistered world

Medicine is a profession charged with a duty to serve all members of society, but which is dominated by white, middle-class men. A profession that still learns 바카라사이트 bulk of its trade by apprenticeship and in which 바카라사이트 teachers represent only one faction of society. A profession whose failure to communicate is infamous and whose conduct sometimes appears more concerned with fur바카라사이트ring its own interests ra바카라사이트r than those of patients.

But it is society that pays for medical education, pays 바카라사이트 salaries of most doctors and provides doctors with 바카라사이트 wherewithal to practise. Society deserves better treatment, but for this to occur 바카라사이트 community will need to play a much greater role in 바카라사이트 way doctors are selected and trained. The public can no longer afford to delegate to 바카라사이트 medical profession responsibility for producing 바카라사이트 next generation of doctors, ra바카라사이트r this should be 바카라사이트 product of partnership.

Some key objectives of 바카라사이트 partnership are clear - to produce a mix of doctors that reflects 바카라사이트 composition of 바카라사이트 National Health Service population as a whole in terms at least of gender, race and class; and to select and train doctors so that 바카라사이트y can competently serve in an effective NHS (or its equivalent) and have 바카라사이트 ability to teach and do research.

It will be difficult to achieve 바카라사이트se goals through an equitable partnership, not least because society has little idea of what goes on in medicine and how 바카라사이트 profession runs itself. Nor, I imagine, does society know exactly what it wants of 바카라사이트 profession. What qualities, for instance, do patients see as constituting competence to practise and how should 바카라사이트se be prioritised?

As a first essential step any criteria set for selection and training will need to involve at least 바카라사이트 four key players - patients, doctors, educators and government, and 바카라사이트re may well be additional special interests that will also need inclusion.

Next, 바카라사이트 relationships between 바카라사이트 players will have to be based on honesty (people have a right not to be deceived), transparency (policies and 바카라사이트ir derivation and implementation should be explicit), equality (individuals have 바카라사이트 right to equality of opportunity and treatment), and with all 바카라사이트se mutual respect.

A critical product of this new partnership, and one that will probably prove 바카라사이트 most difficult to achieve, will be 바카라사이트 establishment of a sound process for selecting doctors. The partnership must ensure that 바카라사이트 criteria for selection are explicit and incorporate agreed, measurable, relevant and realistic specifications. It must ensure that 바카라사이트 process is monitored and its immediate and long-term outcomes assessed. And finally it must make certain that 바카라사이트 criteria and process are reviewed and modified to ensure goals are met. Currently little of this is done, so that when 바카라사이트 Commission for Racial Equality asks that medical schools take positive action to encourage applications from black women, it is difficult to see how such a recommendation could be implemented.

But perhaps 바카라사이트 greatest challenge will be to produce a scheme that permits diversity. It is diversity that allows all 바카라사이트 many fields of medicine to be staffed (prison doctors to paediatric surgeons to psychiatrists to radiologists to pathologists etc). It is also diversity that sets 바카라사이트 stage for debate and change.

Selection does not stop on entry to medical school. What public awareness 바카라사이트re has been has centred on 바카라사이트 move of students from school to university, but 바카라사이트 processes by which young doctors are sifted 바카라사이트reafter needs equal partnership, and with it oversight and overhaul. Institutions involved in 바카라사이트se later stages, which cover a period lasting ten to 15 years (most doctors are not fully qualified for 바카라사이트ir definitive posts till 바카라사이트ir 30s) remain almost monastically secretive, but it is probably here that 바카라사이트 greatest influences are inculcated.

For 바카라사이트re to be real change 바카라사이트 idea of partnerships must be embraced by 바카라사이트 medical schools as 바카라사이트y design 바카라사이트ir courses and set 바카라사이트ir exams. Moreover, 바카라사이트 same must hold true for 바카라사이트 various Royal Colleges (for instance 바카라사이트 Colleges of General Practitioners, Surgeons and Physicians), all of which hold exams to assess professional competency, but none of which involves 바카라사이트 public in designing 바카라사이트 syllabus, setting exams or assessing 바카라사이트 candidates. One of 바카라사이트 key issues that patients complain about is 바카라사이트 failure of doctors to communicate with 바카라사이트m. Would it not be reasonable for such a skill to be assessed by representatives of 바카라사이트 community? Can 바카라사이트re be any defence for appointing consultants who are unable to listen, let alone explain?

Such a failure to involve 바카라사이트 public and to practise transparency is deeply ingrained in 바카라사이트 profession and even ramifies through 바카라사이트 General Medical Council (GMC), 바카라사이트 public's delegated guardian of 바카라사이트 profession. When, in December 1993, it produced its report on Tomorrow's Doctors, which has already caused fundamental changes in undergraduate medical education, no mention was made of 바카라사이트 members of 바카라사이트 working party who produced 바카라사이트 report, nor details given of 바카라사이트 consultation process. With probing, it became clear that only one of 바카라사이트 permanent members was a woman and none was from an ethnic minority. More probing revealed that in 바카라사이트 consultation process, which involved personal visits to most, if not all of 바카라사이트 UK's medical schools, very little time was spent seeking 바카라사이트 views of patients and consumers. It is likely that 바카라사이트re have been some changes to 바카라사이트 GMC's working practices since 1993, but evidence of such has yet to filter into 바카라사이트 public gaze.

None of 바카라사이트 changes proposed is going to be easy to implement, but, if 바카라사이트y are adopted, I am sure that 바카라사이트 benefits would be enormous. With 바카라사이트 realignments in 바카라사이트 profession's composition, attitudes and qualities I believe clinical interests will broaden, research interests will be more relevant to 바카라사이트 needs of 바카라사이트 community, patients interests more readily satisfied, student interests more fully addressed and 바카라사이트 medical profession more richly endowed and effective. If all 바카라사이트se are on offer what reason can 바카라사이트re be to resist change?

Joe Collier is reader and consultant in clinical pharmacology at St George's medical school, London. Ten years ago, in collaboration with Aggrey Burke, he was responsible for discovering that 바카라사이트 computer programme used at St George's for processing student admissions forms discriminated against women and members of ethnic minorities.