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Report calls for major shake-up in medical education

Demographic shift and multiple co-morbidities mean doctors need to be trained to provide more general care across different settings

Mark Gould

Tuesday, 29 October 2013

Doctors need to be trained to provide more general care in broad specialities across a range of different settings according to a GMC co-sponsored review of medical training.

The Shape of Medical Training review chaired by world-renowned economist Professor David Greenaway says medical training needs a major shake-up to cope with the ageing population, the growing number of people with multiple comorbidities, health inequalities and rising patient expectations.

While Prof Greenaway says the NHS will continue to need doctors trained in more specialised areas based on local patient and workforce needs, postgraduate training "must adapt to train doctors in the general areas of broad specialties in order to prepare them to deliver safe and effective patient care over the next 30 years".

He also concludes that medicine has to be a sustainable career and as such requires opportunities to change roles and specialties throughout doctors’ careers. But he stresses that "local workforce and patient needs should drive opportunities to train in new specialties or to credential in specific areas".

The review also recommends:

  • Doctors within academic training pathways need a training structure flexible enough to allow them to move in and out of clinical training while meeting the competencies and standards of that training.
  • Full Registration should move to the point of graduation from medical school, provided there are measures in place to demonstrate graduates are fit to practise at the end of medical school. Patients’ interests must be considered first and foremost as part of this change.
  • Implementation of the recommendations must be carefully planned on a UK wide basis and phased in. This transition period will allow the stability of the overall system to be maintained while reforms are being made.
  • A UK wide Delivery Group should be formed immediately to oversee the implementation of the recommendations.

The BMA agrees with the majority of the report suggestions, including more flexible training and improving careers advice for medical students. It supports the concept of broader-based training around speciality themes such as women's health or children's health which incorporates generic capabilities and greater flexibility for trainees, and agrees that medical training should be responsive to changing demographics and patient need. However it says there are less disruptive options available to achieve this goal.

And it is concerned that proposal to move to full GMC registration to the end of medical school places the onus on medical schools to demonstrate that graduates are "capable of working safely in a clinical role".

Although the BMA agrees it is crucial for doctors to be properly prepared and safe to practise at full registration, it says this is at odds with the idea of removing a whole year of education and experiential training by bringing forward the point of full registration. It is also concerned about the effect this change could have on workforce planning, with additional scope for applicants from many more EU member states to an already oversubscribed Foundation Programme.

The BMA supports the suggestion that training should be limited to places that provide high-quality, GMC-approved training and supervision and to increase the length of placements to at least six months.

But it worries that recommendations to move the achievement of highly-specialised skills outside the scope of postgraduate training, will lead to a sub-consultant grade. The "certificate of specialty training", which would replace the current "certificate of completion of training", must remain at the end of postgraduate training and demonstrate that doctors are competent to work in their chosen field.

It says that a complete overhaul of the training programme structure should not happen without a commitment to a comprehensive consultation on or assessment of the changes.

GMC chair Professor Sir Peter Rubin, said the GMC was pleased with Professor Greenaway’s focus is on the changing demographics in the UK, "and especially on the ageing population and growing number of people with complex medical conditions".

"We particularly welcome the idea of a more flexible training structure for doctors and for doctors to be able to change roles and specialties throughout their career so we can continue to attract and retain the best doctors in the profession.

"Some of the recommendations will require further discussion, including the suggestion that full registration should be awarded at the point of graduation from medical school. But overall we are confident that these recommendations will help to improve the way doctors are trained and provide clear benefits for patients and the public within the health service now and in the future.

"The key is to ensure that we are able to make steady progress towards these reforms while maintaining some stability in a system that has already been subject to a great deal of change and pressure in recent years."

NHS Employers welcomed the report and its "emphasis on patient needs and expectations". Chief executive Dean Royles said: “The NHS Employers organisation looks forward to participating in any further work taking forward these recommendations.”

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