Competency based training is a framework for incompetence

At the beginning of one of my urology clinics, there came a knock on the door. A medical student holding a yellow notebook asked to attend so that she could do a scrotal examination, to sign off “scrotal examination” in her record book. It wasn’t because she particularly wanted to know the various pathological conditions that she may encounter in the scrotum; neither was it because she wished to be reminded of the beautiful anatomy of the inguinal canal. No; just as long as the book got signed, that was sufficient.

As well as the record book so loved by medical schools, a competency based training system is now entering all levels of British medical training. Our registrars must have their ability to perform a particular procedure assessed on a four point scale …