Wednesday, 25 November 2020

Design is the key for human factors. Behaviour is a small bonus.

 Design is the key for effective human factors

In a recent famous case, one surgeon and two anaesthetists were said to be anaesthetising two patients at the same time; this would be risky and unnecessary for patients to be anaesthetised for longer than absolutely essential. It is unethical.

The question is: how did this even happen? There must be policy in place to prevent this. There must have been people who could and should have questioned this and prevented this. Sure. Let’s assume we had policies and people in place – do they prevent for sure two patients being anaesthetised for the same one surgeon at the same time? No.

It happened because there was the structure, infrastructure and facilities to do it.

In UK hospitals there is something called the anaesthetic room which is separate from the operation theatre. This means for one surgeon, there could be a patient anaesthetised inside the operation theatre and another patient anaesthetised in the anaesthetic room.

This is a fairly unique UK NHS practice. Historically, the subsequent patient was brought into the anaesthetic room and the process of anaesthesia began or anaesthesia given when the patient on the table in the operation theatre was nearly done. This was thought to be efficient. It worked when the so called ‘registrars’ both anaesthetic and surgical were experienced. This anaesthetic room concept was then followed by UK private hospitals.

The presence of the anaesthetic room means that it would be physically possible for two patients to be under anaesthetic simultaneously for a single surgeon.

Recently, when designing the theatres of a private hospital, we argued for not having an anaesthetic room and prevailed.

This means that in that private hospital which does not have an anaesthetic room, there is no possibility of two patients being under an anaesthetic at the same time for a single surgeon because there is no physical infrastructure/facility that enables/allows it. No policy or person(s) would have been able to achieve this.

We cannot design a problem to be built into a system and then expect policies and people to overcome it consistently.

Design is the fundamental for human factors – people and behaviours are simply an add on bonus.

© Hemadri

Saturday, 1 December 2018

UK postgraduate medical examination pass rates – what are your chances if you an IMG/BME?

The GMC annual survey report for 2018 is now published ( While the GMC’s focus seems to be on the training environment, it is important to delve into the online reporting tool ( ) where the detail resides.

I have a long interest in poor outcomes for discriminated groups and looked at the pass rates for postgraduate examinations. The results are still not that great or even for IMGs and BMEs. Overall, if you are a UK graduate with a white ethnicity – then the pass rate is 75.1% and if you are an IMG-BME the pass rate is 42.2% and if you are an EEA-BME then it falls to 37.2%. Basically if you are white UK graduate you have a 100% higher pass rate than some BME doctors. We can argue about the unfairness of this and have done so in the past.

However, let us focus on UK graduates alone for now. Overall there a white UK graduate has a 12 percentage point higher pass rate than a BME UK graduate. That is pretty gross. When you point this out, the classic false arguments based on sub-classification starts (schools in UK, candidates from abroad joining UK medical schools, etc) which essentially devalues the many years of UK medical school teaching and training.

Then if we start looking at how individual specialties are faring in their faculty and royal college pass rates, we find that most have an approximately 12 point difference biased towards white UK graduate doctors and biased against BME UK graduate doctors.

There are one postgraduate examination where UK white doctors and UK BME doctors have more or less even pass rates (with only a 3 percentage point lower for UK BME doctors) – that would be the Faculty of Public Health examination.


There is one postgraduate examination where UK BME graduates fare better than the UK white graduates by 10 percentage points. That would be the Faculty of Occupational Health Examination.

The biggest difference between UK white doctors and UK BME doctors is the RCGP examination where there is a 14.5 percentage point difference in favour of UK white doctors.

It is a sad fact of UK healthcare that such differences exist.

Overall if you are an IMG-BME you have a 57.8% failure rate in UK postgraduate examinations according to the GMC’s latest report.

Due to the medical staff vacancy crisis in the UK, the powers that be have increased the ‘MTI’ duration from two to three years with a view to attracting more IMGs to UK. The IMGs would hope to obtain some UK qualifications – though the reasons they are recruited is because they are already qualified specialists in the first place.

Make wise decisions.

Would you put your money in a scheme where you have a 57.8% chance of losing it? That is the downside. On the upside, you do have a 45.2% chance of not losing your money and in the bargain getting your qualification – what happens then? You need a more detailed analysis of what your chances of getting into a training post, chances of returning to the country of origin without a CCT/CESR, getting back to your country of origin with a CESR, etc.

As a doctor with a scientific qualification data based decision making would be recommended. Think deeply.

Also think deeply of the impact of the process, – knowing that you have a high chance of failing examinations, knowing about the realities of career progression – even if you were eventually successful in your examination or career progression.

Think deeply, very deeply. Make wise decisions. It is not easy but it does affect your life.


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