The 2005 Rose Prize Essay. GP Education in Northern Ireland 1920-1990. A study of the use and misuse of power.

The use and misuse of power has been demonstrated. It has been shown that GP education has changed very significantly between 1920 and 1990. Many excellent improvements have been achieved. Nevertheless, despite these gains, it is quite impossible to accept the hypothesis that there has been a constant steady improvement through history to the present perfect state (so-called Whiggism). Rather, it is clear that each and every one of the participants who provided GP medical education in Northern Ireland have made mistakes, of varying magnitude. However, the hypothesis of the conflict perspective is proven--the inevitable competition for power and the struggle for control were ever-present, and have been illustrated. This paper acknowledges that it is axiomatic that the medical profession should teach both its 'apprentices' and CME. For the medical profession to achieve a more independent position in this provision, the powers of state and the pharmaceutical industry would have to be curbed or controlled--in short, realigned. To reach this goal the medical profession's future planners would need to change. The various cliques would have to become a unified force. Only then would they have sufficient power to orchestrate and achieve the profession's proposals for GP education. An armistice could be agreed by the warrior bands (hospital consultants, the multiplicity of royal colleges including RCGP, and medico-political bodies such as the BMA) to allow this to happen. At this point, successful renegotiation of the conditions for GP education could become a real possibility. As a postscript, it must be acknowledged that there have been a great many significant developments in GP education since 1990; some are listed in Table II. These will require research elsewhere. Nevertheless, even after a further 15 years, the hypothesis remains sound; the competition for power and struggle for control are constants, and the schisms within medical education continue unabated.