Back in 2007, when Modernising Medical careers was fresh and found to be pretty flawed, the reliably insightful Nigel Hawkes wrote a piece in the BMJ wondering:
a. Why did we make this change (see my other post here)?
b. What are the colleges actually for?
He had a point. He still does. A colleague and friend of mine who has spent years labouring for a distinguished college - and attaining high office - recently told me he wasn't sure, other than postgraduate examinations, what his college was for any more. There was a lot of business class overseas travel, and fine wining and dining, but...
Most surgical postgraduate education doesn't need college input, and ultimately one could envisage examinations being dealt with effectively by other bodies, too. The historical precedents set by the colleges are not set in stone. My own experience, and observations from wider practice, are that they are not great at advising government either.
Hawkes' piece is probably more relevant than ever, particularly with the ongoing success of specialty bodies like the British Orthopaedic Association, imperfect though it is. He absolutely gets the mindset:
The purpose of MMC, it
seems to me, was to wrest control
of higher training from the colleges,
and shape it in ways designed to suit
the employers. The colleges were
placated (a cynic might say bought
off) by allowing their exams and
their income flow to continue, at
the price of having little further
influence.
Many of those who take the exams
hail from overseas. The colleges did
not want this source of income to
dry up either, but nor did they want
foreign graduates to take up too many
of the training opportunities.
A pretty cynical state of affairs indeed. Read the paper - it doesn't take long
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