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I don't know how many incompetent technologists there are out there but one thing going for regulation, on the face of it, is that the training and development associated with it should ensure that all registered technologists actually have to prove they are competent to work unsupervised in a responsible position rather than find out they're not up to it the hard way. Anybody can make a mistake but being allowed to take on a responsible role without anyone asking or being presented with reasonable evidence to back up what's said in an interview is ludicrous in my opinion.

Manni,

I understand what you're saying about the quality system being able to encompass the training and assessment of individuals and it's a valid point in my opinion. However, in my experience, all quality systems are tied to the organisation that the employee works for and each quality system is implemented slighty differently being tailored to the requirements of the organisation. Right down to the departmental level in fact where every department works differently and requires different skills, knowledge and experience.

Another problem is that not all departments in the NHS meet quality standards and if they did then the standard would be implemented differently in each department - the requirement for quality standards don't appear to be driven at a national level for the purposes of ensuring uniformity across the NHS. Anyhow the intention of quality systems isn't to guarantee individuals meet the same uniform professional standards nationally - it's about systems of work meeting relatively flexible quality standards at the local level.

External Assessors of a quality system (and there are quite a few) do not assess the competence of employees within a quality system they assess the system that's been created to handle training and development not the skills involved. What's required is a uniform, consistent, standard that is seperated from local systems and one that attempts to meet national NHS and HPC professional standards through recommendations from professional bodies.

What registration gives, in my view, is the potential for recognised evidence or "proof" of individuals' basic competence, wherever they work (or intend to work) or do within the remit of their protected title, as far as can reasonably be assessed, backed by a professional institution, that an individual has met and is continuing to meet the required standards.

Sorry Robert, can't let that one pass without comment, Mate.

In 30 years of erstwhile undetected, but dedicated, incompetence, I can't recall any “incident” where patient safety was compromised by the actions of any biomed tech that I've worked with (and I've worked in some real dives, believe me). However, you and I and everyone else who contributes to this forum, know all about the realities of clinical staff who are “too busy caring for the sick and needy” to bother about checking the users manual, not taking the time to apply electrodes correctly, not checking that the right patient is under the radio-therapy unit, or even caring to plug a unit into the mains power outlet etc. etc. etc.

How many “over-infusing” IV pumps were actually over-infusing? Funny how the equipment always get the blame, whilst the real problems go unresolved, eh? And don't even think about “misadventures” in the operating theatre!

I think we all need a little perspective here. If patients need “protection” from anybody, surely it's “the nurses”!

I'm interested in regulation as means of levering decent training and a proper career path for new entrants, those that want to develop and progress. Perhaps it will also be useful to keep out those that just fancy a change of scenery and think they're fully qualified from day-one when they start in the job, but they're not when it comes down to it. I can see the obvious benefits of the formalised Medical Physics Technician training I received via the regional HA and think that everybody coming into this job should have the same opportunity to receive some proper training to similar if not better standards.

Unlike Geoff I have seen problems of the sort he's described, through employing a dilettante or two, that would have reflected very badly on myself and my colleagues if it hadn't been picked up on and if there had been serious consequences i.e. an incident; but here's not the place to go into that. It's what doesn't get picked up on in our own departments that worries me Geoff - we need to sort our own backyard out and be recognised as professionals before we criticise other professions. Part of the benefit of professional status might then be that we are recognised as being in a position to give appropriate advice, when requested, to prevent others from getting into trouble with equipment before they try to use it.

Point taken, Richard Old Chap.

But have you never been in situations where the first time you see a bit of kit is when it appears in the workshop in pieces? Not good equipment management, I grant you. But “real NHS” just the same!

But what sort of techniques do you have in mind to “test for basic competence”? In my experience, most biomeds start out as earnest young technicians, keen to do a job that matters and all that. We don't want to put them off, surely?

As I've mentioned (many times) before, what these guys need is mentoring (ie, by the old sweats). Back in the army (all those years ago now), we used to select them properly (a fundamental point, apparently given short-shrift in the NHS), give them a decent training, and then throw them in at the deep end, as it were. Yes, sink or swim – and most managed to tread water (and I know, as I was that soldier)! They had it drummed into them from the beginning that working in isolation, without supervision and often in “environmentally depressing” surroundings was part of the deal. All that went with the job, and if they didn't want that, or couldn't hack it, then they were “out”, and back to the tank-park, gun-park, or wherever. But that happened only rarely, during my time at any rate.

All this talk about “quality systems” is all very well, but (and again I repeat myself, without apology) what really matters is the character and calibre of the medical engineering technician. Core values, not superficial gloss.

So I take the opposite view - that a tech is deemed to be competent unless he screws-up. But if that happens, then it's “adios, amigo”!

Regarding Scotts original point we assume companies check competency of their staff but some certainly don't.

It's not just the NHS that has the occasional dud. I investigated the work of a contractor's engineer a few years back and as a result his company landed up saying "adios" to him.

The most valuable tool in getting to know what new staff are capable of is also an excellent training method; a long spell (months) of good old shadowing.

You get plenty of time to discuss technical matters and past experience while showing them the ropes. It works well here, but I doubt manufacturers have the time and money for much of that.

Marc

Yes Geoff

Marcel,

Shadowing is an excellent idea if you can spare the staff and it allows a two way exchange between supervisor and trainee allowing continuous assessment of the trainees capabilities whilst performing hands-on tasks.

Mentoring - shadowing - leadership. Peas in the same pod, surely? Leading to competence - confidence - taking responsibility - assuming ownership of each task, and seeing it through to completion. I could go on, but I expect you catch the drift, no doubt.

About sparing the time - what better way to spend your time than investing in the future (and dare I say, reputation) of your department?

Dear all,

Most of the points raised here are very interesting. But maybe competency is device specific and the most relevant fact is the device specific training. Another question is about who says that somebody is competent at the device specific level? I feel that the registration as proposed is unlikely to address these issues. There are many approaches to competency for example it may be linked to risk assessment e.g. where equipment is assessed as high risk, training from the company is essential prior to working on the devices. However, companies are reluctant to give a competence certificate; usually they will only supply an attendance certificate. If the manufacturer is not going to say we are competent how can we? So then how can the risks be indemnified?

So where does this take us? Ultimately accidents do happen, and device failure is often an easy first port of call. I feel that really we need evidence to show all the processes of risk assessment and device specific training has happened as far as reasonably possible. To an extent quality systems may be able to address this - if the system is developed to include these elements.

However, consider user training. How many company representatives train staff in the NHS? Isn't it more important that these staff are controlled and registered and the quality of user training monitored? Many problems occurring with medical devices are related to user training (or lack of it) and if we are going to consider the problems associated with medical devices, surely, this is an important area for all to focus upon.

All these are big issues and need working groups to discuss, assess, report conclusions and produce summary documents on these points. I have not seen much of this type of material on any of the professional institutions web or DoH web sites. There is the proposed registration of ‘Clinical Technologists’. However, I do not feel that this proposed registration addresses these issues and although a useful model for healthcare professionals, I am unclear and unconvinced that this registration will work for EBME engineers and external companies that work within the NHS. Ultimately clearer lines of responsibility may need to be developed.

On a really big scale, maybe we need European or international standards to specify how equipment is maintained and to ensure that equipment is designed to be maintained. How many bad manuals are there? How many devices that work well but are difficult to maintain. Do we need a good standard for technical manuals etc.? Maybe the level and how devices are maintained should be specified. Wouldn’t it be nice if when we purchased a device we new the maintenance level that it was designed to be maintained to, what was involved, what level of training was required etc.

These are just a few rambling thoughts but there are many serious questions that need a lot more consideration than I can give in an email or off the top of my head.

Regards all -

Kevin

Sealed looking at the clock and wondering how sad I am