The way I see it

Inside job

Authors: Johann Malawana 

Publication date:  10 Dec 2008

When I first started on the Modernising Medical Careers (MMC) Programme Board for England in September 2007, everyone warned me that it was a poisoned chalice, especially for a junior doctor. There was a feeling that positive outcomes simply may not be possible after the disaster of 2007. Early in the life of the board, there had been a lot of discussion about the principles under which it would work. The main principle that I felt vital was one of transparency.

My experience of the medical profession makes me think we have a tendency to translate and extend the principle that is so important to patient care—confidentiality—to situations where it is neither warranted nor justified, especially in the world of medicopolitics where there sometimes seems to be a culture almost of secrecy. My experience before joining the board was framed by my feeling that many of the problems I had seen in the previous two years had surrounded very poor communication and a sense that only those at the very top ever had access to all the facts. Although this could be understandable when important decisions are being made, it can be taken too far when we should be trying to engage with a profession of intelligent and articulate adults.

When I joined the programme board, I, like several of my colleagues, was very aware of the need to learn lessons from 2007. The board was very different from many committees I had previously experienced. It balanced some very disparate views and objectives, attempting to broker solutions in situations where different parties sometimes felt almost as though they were pulling in opposite directions, despite having similar goals.

The key to the success of the board has been the ability to be very open about the views of different stakeholders and to work to find solutions that take all the parties forward together. To get to these solutions, though, the observed spirit of openness and critical evaluation of the proposals has been vital. Open and transparent communication has played an important role, ranging from the programme board notes produced by the BMA representatives after each meeting and disseminated widely, to stakeholder events across the country organised by the Department of Health.

The board is now in a critical phase of its life. The development of the much anticipated NHS Medical Education England has the potential to enhance the work of the board by developing cohesive educational policy across the healthcare professions, while allowing the board to carry on the work of delivering the agenda of postgraduate medical education and training in England, with true professional engagement. The danger lies in duplication of work and not having effective lines of responsibility and communication, as well as working with poorly defined objectives or not engaging with the profession as a whole.

My hope for the future of the programme board and NHS Medical Education England is that we see the two bodies working together effectively to develop both the strategic vision for education and development of all staff in the NHS, with detailed accountability and work on the management of the medical careers structure and delivery of training in medicine. It’s essential that the board continues to uphold the important principle of transparency around decision making, with full disclosure of information to the profession—who will, after all, be the ones delivering the education and training to their colleagues. From a personal perspective, I hope we also continue to have an effective, robust and independent voice for junior doctors: not just simply be present in the room ticking a box, but leading the discussions where appropriate and being seriously considered in all decisions made.

Competing interests: Johann Malawana is also a board member of the General Medical Council and the Postgraduate Medical Education and Training Board.

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Johann Malawana specialty trainee 2 in obstetrics and gynaecology; deputy chair, BMA Junior Doctors Committee

 Jmalawana@bma.org.uk