Sunday, March 05, 2006

No Human Touch

I approach commenting on developments outside of the US with some trepidation, but here goes...

A story carried by the Times (UK) noted there has been a drastic overhaul of how physicians will be selected for post-graduate hospital training positions (internship and house officer positions, or internship and residency, in the US terminology). A new system, called Modernising Medical Careers (MMC), requires that after applicants submit their usual application and CV (curriculum vitae), they must fill out an on-line form, divided into six sections each requiring two answers of 75 words each. The applicant must discuss his or her educational achievements, how well he or she "matches the General Medical Council's Principles of Good Medical Practice, his or her leadership qualities and abilities to participate in teamwork."

Points will be assigned to each answer by a panel. There will be no attempt to check the accuracy of any answer. Based on the points assigned an applicant, "a computer is used to match applicants with jobs." Applicants will not be interviewed.

This new system provoked a letter written to the Times, signed by 84 academic leaders. The letter stated, "under this plan, our house officers, now known as 'foundation trainees', are being selected anonymously by computer rather than by interview." The letter noted that under the new system, 660 of 6035 UK graduates have not been accepted into a training position. Thus, "our students are understandably bitter, angry, demoralised and confused by a process that has been implemented without adequate consultation and without regard to pleas from the medical profession to continue interviews to select candidates for training." Furthermore, "it is difficult to identify the logic behind MMC." It warned, "despite the obvious failure of this year's selection process, the Department of Health is steaming ahead to procure a new IT system which will be used to select foundation trainees, perhaps wasting 8 million [pounds sterling] of public money."

An accompanying editorial asked, "how can adjudicators possibly assess individuals' character and potential without coming face to face with them?" In addition, "so long as adjudicators are selecting blind, students can massage their answers and attempt to manipulate the system. For instance, applicants simply have to tick a box stating that their spoken English is good enough to communicate with patients and colleagues on medical issues." The results have been, "bright and well-qualified applicants are finding themselves without a berth. At the same time, hospitals have reported a worrying number of trainees turning up for duty with an inadequate command of English or with substandard skills."

Commenting with trepidation.... As the Times editorial noted, it is rather hard to assess an applicants' clinical communication skills just by reading their responses to a web-based form. I have interviewed quite a few internship applicants, so I recognize that it is hard to distinguish among many well-qualified applicants. I value the interview, however, because it does allow me to identify the occaisional candidate who has severe difficulties interacting or communicating with other human beings. Abolishing interviews, in my humble opinion, certainly risks rating candidates by their "ability to talk a good story," as the Times news article put it.

It seems that UK managers have the same fascination with computers that US managers and executives have. It seems so easy and rational to take creaky, human based operations and streamline them by basing them on the web. This removes the need to deal with people directly, and their pesky individual characteristics. It fits with the ideas popular in the 1980s that to improve health care, rational managers had to take over from all too human physicians. But replacing human judgments with computer programs may produce a system that does not respond to human needs.

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