Policy responses and statements
- Name of organisation:
- MMC Inquiry
- Name of policy document:
- Response to recommendations in the Tooke Report
- Deadline for response:
- 20 November 2007
Background: The former Secretary of State for Health, Patricia Hewitt, invited Sir John Tooke to lead an Independent Inquiry into Modernising Medical Careers (MMC) in the wake of the problems surrounding MTAS, the process used for selecting trainee doctors for specialist training. The review is being conducted independently of the four Health Departments and has its own independent secretariat.
This consultation is about the recommendations of the Tooke Report.
COMMENTS ON
RCPE RESPONSE TO THE RECOMMENDATIONS IN THE TOOKE REPORT
The Royal College of Physicians of Edinburgh welcomes the Tooke report and the conclusions at which it has arrived. In particular, the College strongly supports the actions that suggest there should be:
- A single voice for the profession.
- Importance in defining the role of the doctor.
- Encouragement and reward of excellence.
- Competitive selection into specialty.
- Greatly improved workforce planning.
- Clear contracts for funding training.
- Focus on increasing the flexibility of training programmes to suit the needs both of the individual trainee and of the service.
- Better management of the bulge in trainee numbers. This bulge has disadvantaged many current trainees through no fault of their own.
- Assimilation of PMETB into the GMC.
The College’s responses to the recommendations of the report are outlined below:
Recommendation 1 : The principles underpinning postgraduate medical education and training should be redefined and reasserted, building on those originally articulated in ‘Unfinished Business’ but in particular emphasising flexibility and an aspiration to excellence. In devising policy objectives the interdependency of educational, workforce and service policies must be recognised
Strongly agree.
Recommendation 2: Policy development should be evidence led where such evidence exists and evidence must be sought where it does not.
Strongly agree.
Recommendation 3: DH should formally consult with the medical profession and the NHS on all significant shifts in government policy which affect postgraduate medical education and training, workforce considerations, and service delivery and ensure that concerns are properly considered by those responsible for policy and its implementation.
Strongly agree.
Recommendation 4: Changes to the structure of postgraduate medical education and training should be consistent with the policy objectives and conform to agreed guiding principles.
Strongly agree.
There would, however, have to be clarity with regard to the policy objectives and guiding principles.
Recommendation 5: There needs to be a common shared understanding of the roles of the doctor in the contemporary healthcare team. Such clarity must extend to the service contribution of the doctor in training, the certificated specialist, the GP and the consultant. Such issues need to be urgently considered by key stakeholders and public consensus reached before the end of 2008. Education and training need to support the development of the redefined roles.
Strongly agree.
The separation of certificated specialist and consultant both in this recommendation and in the diagrammatic representation of career progression must be clarified further, especially if this is an indication of the development of a new career grade in the NHS analogous to a sub-consultant role. The College notes that the diagram on page 99 of the report has been amended since publication. Consistent with this is the need for key stakeholder and public consensus to understand the role of a doctor in a contemporary healthcare team. The work associated with this must be regarded as a priority if the timescales alluded to are to be achieved.
Recommendation 6: DH should strengthen policy development, implementation, and governance for medical education, training, and workforce issues, embracing strong project management principles and addressing specifically a) clearer roles and responsibilities for a single Senior Responsible Officer, b) clear roles and accountability for senior DH members, c) better documentation of key decisions on policy objectives and key policy choices, d) faster escalation and resolution of ‘red risks’.
Strongly agree.
Recommendation 7 : The introduction of necessary changes stemming from this report should i) involve all relevant stakeholders especially professional representatives, ii) abide by best principles of project and change management include trialling where appropriate and feasible, iii) be subject to rigorous monitoring and evaluation.
Strongly agree.
Recommendation 8 : Recognising the interdependency of education, clinical service and research DH should strengthen its links not only within the Department and with NHS providers but also with other Government Departments, particularly the Department for Innovation, Universities and Skills and the Department of Business, Enterprise and Regulatory Reform. Ministers should receive annual progress reports on the development and functioning of such links.
Strongly agree.
The precise nature of the links that are to be made must be clarified so that lines of accountability remain clear. We would hope and anticipate, however, that the links with the College structure will also be strengthened as part of this development.
Recommendation 9 : At a local level Trusts, Universities and the SHA should forge functional links to optimise the health:education sector partnership. As key budget holders SHA Chief Executives should have the creation of collaborative links between local Health and Education providers as one of their key annual appraisal targets.
Strongly agree.
Recommendation 10 : All four Departments of Health in the UK and the four Chief Medical Officers must be involved in any moves to change medical career structures. In many instances it seems likely that the Department of Health in England will continue to have a lead role but from time to time, collective agreement may determine that lead responsibility for specific issues passes to another Health Department and/or its Chief Medical Officer. Regardless of which Department leads, accountability should be explicit and every effort made to acknowledge the views of the four countries.
Strongly agree.
While the College firmly endorses this recommendation, it also believes that it is vitally important that a UK structure for regulation is sustained. Uniform systems across the four nations must exist for the monitoring of quality assurance/quality management with specific College input.
Recommendation 11 : DH should have a coherent model of medical workforce supply within which apparently conflicting policies on self-sufficiency and open-borders/overproduction should be publicly disclosed and reconciled. The position of overseas students graduating from UK medical schools needs to be clarified with regard to their eligibility for postgraduate training.
Strongly agree.
As above, the College believes that this should apply to all 4 DHs.
Recommendation 12 : DH Workforce should urgently review its medical workforce advisory machinery to ensure that it receives integrated and independent advice on medical workforce issues to inform/complement SHA and local deliberations. Both national and devolved work streams must be adequately resourced. The medical workforce advisory machinery should also take account of national policies impacting on the workforce such as the shift of more care to the community. Revisions to the current arrangements need to reflect the following principles:
- Medical workforce planning needs to embrace the consensus view of the role of the doctor referred to in Recommendation 5.
- Plans should be based on robust information on available and projected medical specialist skills, requiring relevant databases.
- Whilst recognising that doctors are just one part of the workforce, sufficient attention and resource need to be devoted to medical workforce planning reflecting doctors’ crucial roles and the expense involved in their development.
- A national perspective needs to be integrated with regional requirements, particularly with regard to the maintenance of sufficient subspecialty expertise to meet the needs of the nation, and the overall health of clinical academia. Consideration should be given to the creation of an arm’s length body, a National Institute for Health Education, NIHE, mirroring NIHR to undertake commissioning of higher specialist training that is not required in every locality. The criteria for the award of such training positions should reflect the Trust’s performance in relation to training, innovation and clinical outcomes.
- Professional advice to the medical workforce advisory machinery needs to include that from doctors at the cutting edge of their discipline with the foresight to project potential developments in healthcare.
- Regional workforce plans should be subject to a national oversight and scrutiny advisory committee with service, professional and employer representation. Such oversight should encourage local responsiveness and acknowledge issues facing the devolved administrations whilst ensuring national consistency on roles and standards.
- Modelling capacity should be enhanced by drawing on the expertise in the University sector, e.g. health economists, epidemiologists, modellers etc. The assumptions underlying projections should be subject to professional scrutiny and regular review.
Strongly agree.
The proposal to create an arm’s length body, the National Institute for Health Education, may help in the development of small specialties where there have been specific problems in the past, but the College would not wish to see the commissioning and quality management of training taken away from the postgraduate deans/SHAs for the majority of medical specialties.
Recommendation 13 : The Panel recommends that DH should work with the GMC to create robust databases that hold information on the registered/certificated status of all doctors practising in the UK. This will provide an inventory of the contemporary skill base and number of trained specialists/subspecialists in the workforce as well as those in training for such positions to inform workforce planning.
Strongly agree.
Recommendation 14 : The content of higher specialty training and the numbers of positions will be informed by dialogue between the Colleges, employers, and medical workforce advisory machinery to allow finer tuning of the nature of the specialist workforce to reflect rapidly evolving technical advances and the locus of care.
Strongly agree.
As the curricula that are presently in place for physician training have been informed by both service and public/patient involvement already, we strongly support this recommendation. We believe, therefore, that this College, in association with sister Colleges, should continue to play a significant role in defining the content of higher specialty training and, in discussion with stakeholders, determining the number of physicians that should be trained.
Recommendation 15 : Explicit policies should be urgently developed and implemented to manage the transitional ‘bulge’, caused by the integration of eligible doctors into the new scheme, with appropriate credit for prior competency assessed experience.
Strongly agree.
Trainees coming into the system at a time where there is a government driven change to training are being disadvantaged through no fault of their own. The probable excess of CCT trained doctors that is likely to occur must be viewed as an opportunity to develop the service and enhance delivery and quality of patient care. Commissioning services must be encouraged to develop more consultant-led services within the community and their local hospitals. This approach can also encourage a reduction in overall working hours of consultants consistent with the working-time regulation and the encouragement of part-time/flexible employment in line with trainee requirements.
Recommendation 16: DH should recognise the burgeoning supply of medical graduates it has commissioned and make explicit its plans for the optimal use of their skills for the benefit of patients. It is recommended that sufficient numbers of Core Specialty training posts (see Recommendation 33) should be made available to accommodate doctors successfully completing FY1 and the use of commissioning funds for this purpose should be monitored.
Strongly agree.
The College believes that there should be absolute clarity for all trainees to be aware of their chances of proceeding into both Core and Higher Specialty Training and also of the career pathways/routes that are available to them if these are not accessible. We believe that the majority of trainees will still wish, and will have the ability, to proceed to CCT. This must be the norm if we are to avoid able school students being discouraged from entering medical training.
Recommendation 17 : Career aspirations and choices should be informed by accurate data on likely employment prospects in all branches of the profession and the likely competition ratios based on historical data, supplemented by professionally agreed foresight projections. Such information should be updated annually by the redesigned medical workforce advisory machinery and made publicly available so as to inform would be medical students, students and trainees.
Medical schools should play a greater role in careers advice including i) information in prospectuses concerning career destinations and likely competition ratios, ii) offering selective components of the programme to allow experience in discrete specialties, iii) formal personalised advice/mentoring.
Strongly agree.
This College strongly believes that there is a need for strong careers advice throughout medical school to expand the understanding of career choice for students. This advice should continue into the Foundation and Core Training years.
Recommendation 18: The medical profession should have an organisation / mechanism that enables coherent advice to be offered on matters affecting the entire profession, including postgraduate medical education and training.
Strongly agree.
This College believes that the function outlined is fulfilled by the Academy of Medical Royal Colleges. It would be appropriate for this organisation to be both recognised as the source of coherent advice and resourced for this role.
Recommendation 19:There should be enhanced opportunities for training in medical management during postgraduate training years to fuel an increase in clinically qualified managers and an awareness of the interdependency of clinicians and managers in the pursuit of optimal healthcare
Strongly agree.
The College is aware that a leadership competency framework has been developed by the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement. When implemented, this will provide the opportunities suggested by this recommendation.
Recommendation 20 : Doctors in training should be better represented in the management structures of Trusts to ensure that they better understand service pressures and priorities and Trusts better appreciate their service role and training needs.
Strongly agree.
The College is fully supportive of this recommendation, but also suggests that the NHS must provide the opportunities for medical staff to develop their potential in leadership and management roles.
Recommendation 21 : A suitably qualified Director level lead for medical education within DH should be identified and act as the reference point for interactions with the medical profession including postgraduate Deans. The relationship and accountability of this lead to the following should be explicit: CMO, DH Head of Workforce, NHS Medical Director, and medical educational leads within devolved administrations.
Strongly agree.
The College strongly supports the requirement for a specific lead who should be at a senior level to ensure that medical training receives the priority it deserves. There is a case to be made that this person should sit on the Board of the NHS itself. The Director should have strong working relationships with the postgraduate deans and the regulatory bodies, but also knowledge and awareness of the Colleges’ role in PGME.
Recommendation 22 : Recognising i) the importance of linking workforce supply and demand, ii) the very recent devolution of workforce commissioning function to SHAs in England, we recommend that this situation prevails for the moment for initial Postgraduate Medical Training subject to the forging of closer links at all levels with the Higher Education sector. A formal review of the compliance with Service Level Agreements between DH and the SHAs relating to commissioning training and the functionality of the arrangements should be undertaken in 2008/9. Any deficiencies should prompt urgent consideration of a National Institute for Health Education (as outlined in Recommendation 12) assuming the commissioning function.
Strongly agree.
The College would not, however, wish to see any delays to the specialist training appointments for 2008 which might result as part of a review process.
Recommendation 23 : Funding flows for postgraduate medical education and training should accurately reflect training requirements and the contributions of service and academia. The current MPET Review should lead to a clearer contractual basis reflecting both agreed volumes and standards of activity and recognise the service contribution of trainees and the resources required for training
Strongly agree.
Any review must calculate the true cost of PGME including the time of NHS employees who play such a large role, and that Trusts are required to account for this. Thus, contractual relationships between commissioners of education (presently PG Deans) and educational providers (hospital trusts and others) should explicitly recognise the indirect costs of PGME.
Recommendation 24 : The Medical Postgraduate Deanery function in England should be formally reviewed to address whether i) the relationships and accountabilities are currently optimal ii) the present arrangements meet redefined policy objectives of optimal flexibility in postgraduate training and aspiration to excellence, and the NHS imperative of equity of access. Any new arrangements should conform to redefined principles, referred to in Recommendation 1, co-developed to govern postgraduate training
Agree.
The Deaneries have been reviewed frequently and recently. Further review must be timed appropriately and have a clear reason and objectives. The stresses that staff within deaneries have experienced within the last year or two have been extreme, and perhaps time should be allowed for the new systems to be developed before another review is implemented. When the review does occur, however, the relationships among deaneries and between deaneries and the DoH could be examined to identify whether greater co-ordination can be achieved.
Recommendation 25 : Postgraduate Medical Deans should have strong accountability links to medical schools as well as SHAs in line with Follett appraisal guidelines for clinicians with major academic responsibilities. Such arrangements will improve links with medical pedagogical expertise and will facilitate the educational continuum from student to continuing professional development
Neither agree nor disagree.
The College believes that Postgraduate Deans in England should have strong links with the medical schools and SHAs, but should be line managed by workforce directors within SHAs with professionally accountability to the new Director of PGME at the DoH.
Recommendation 26: Reflecting the fact that Postgraduate Medical Education and Training involves service, academic and workforce dimensions, it is proposed that the Foundation School concept be developed further as Graduate Schools, on a trial basis initially, where supported locally. The characteristics of such Schools, the precise nature of which would depend upon local circumstances and relationships, need to reflect the crucial interface function played by the medical Postgraduate Deanery between the service, the profession, academia and workforce planning/commissioning. Graduate Schools would involve Postgraduate Deans, Medical Schools, Clinical Tutors, Royal College and Specialist Society representatives and would have strong links to employers/service and SHAs. The Graduate Schools could also oversee the integrated career development of the trainee clinical academic/manager (see Recommendation 41), as well as NIHR faculty.
Strongly agree.
The College has been supportive of the development of “schools” within medicine (Medical Board within Scotland) sitting within the postgraduate deaneries. Within this structure, there is a Head of a School of Medicine who is responsible for the delivery of physician training programmes in 28 specialties. They oversee a board of heads of specialty training for each of the medical specialties who, in turn, are responsible for the specialty training programme within the deanery. These in turn report to the specialty advisory committees.
Recommendation 27 : To incentivise Trusts to give education and training sufficient priority they should be integrated into the Healthcare Commission's performance reporting regime.
Strongly agree.
The College believes that good training and good patient care go together, thus, there needs to be integration of quality assurance to ensure that both training and service issues are identified together, and that the appropriate responsible officers are involved.
Recommendation 28 : Responsibility for the local delivery of postgraduate medical education and training should form part of the explicit remit of Medical Directors of Trusts. Part of that responsibility should include regular reporting to Trust Boards on the issue.
Strongly agree.
The College believes that training is an explicit remit of Medical Directors of Trusts. If not, it should be, or there should be a specific board level appointment for this specific remit.
Recommendation 29: Training implications relating to revisions in postgraduate medical education and training need to be reflected in appropriate staff development as well as job plans and related resources. Compliance with these requirements should form part of the Core Standards
Strongly agree.
This is recognised by the College as an area of specific concern that has yet to be addressed.
Recommendation 30 : PMETB should be assimilated in a regulatory structure within GMC that oversees the continuum of undergraduate and postgraduate medical education and training, continuing professional development, quality assurance and enhancement. The greater resources of the GMC would ensure that the improvements that are needed in postgraduate medical education will be achieved
Strongly agree.
The College recognises that the amalgamation of undergraduate and postgraduate regulation under a single body is sensible. The roles and functions of PMETB, however, would need to be preserved within the new regulatory authority.
Recommendation 31 : Under the Medical Act, Universities already have responsibility with regard to FY1. By breaking the linkage with FY2, it will be possible to guarantee an FY1 position in the new graduate’s local Foundation School subject to prevailing local selection processes. The linkage between FY1 and FY2 should cease for 2009 graduates.
Disagree.
The College believes that breaking the link between FY1 and FY2 will lead to the gradual demise of the Foundation curriculum, a genuine success story for MMC. There should certainly be a continuing guarantee of an FY1 place for all UK graduates and, if the benefit of the Foundation Programme is to be achieved, this needs to be mapped to an FY2 post. We believe that there should be a review of the success of Foundation programmes by engaging with the trainees who have undertaken this form of training before there is a break of the linkage.
Recommendation 32 : FY1 should be reviewed to ensure that i) harmonisation with year 5 is optimised; ii) the curriculum more clearly embraces the principles of chronic disease management as well as acute care; iii) competency assessments are standardised and robust. In future, doctors in this role should be called Pre-Registration Doctors
Agree.
The College agrees that FY1 should be harmonised with year 5. The Foundation curriculum outlines the major purpose of the Foundation Programme as ensuring all doctors can manage acutely ill patients. This purpose must not be lost, although this is not inconsistent with the curriculum embracing management of long term conditions. To facilitate this, we support the standardisation of assessment processes supported by an E-portfolio.
Recommendation 33: Foundation Year 2 should be abolished as it stands but incorporated as the first year of Core Specialty Training. The current commitment to FY2 GP placements should continue as part of Core Specialty Training and developed further as resources permit. Doctors in Core Specialty Training should be called Registered Doctors.
Disagree.
Before abolishing Foundation Year 2, there needs to be adequate consideration of alternative pathways that may tailor Foundation Programmes to the needs and wishes of individual trainees. For the trainees who have already determined their career choice by the time of the Foundation Programme, it should be possible to deliver a programme that reflects their interests and provides experience that will be directly relevant to their career aspirations. This would be equivalent to a start in a core training programme. For others, however, where the career choice has not yet been established, the opportunity to experience a broad based Foundation Programme may help their choice, but will also help fill posts in specialties where the undergraduate experience may be limited. If foundation year 2 is abolished, some of the competencies determined by the foundation curriculum will require amendment to sit in Core Specialty Training. Also, the timing of recruitment into Core Specialty Training will be critical, as the application process may be an unwelcome distraction in the early months for trainees focusing on new responsibilities in their first postgraduate year.
Recommendation 34: At the end of FY1 doctors will be selected into one of a small number of broad based specialty stems: e.g. medical disciplines, surgical disciplines, family medicine, etc. During transition, ‘run-through’ training could be made available after the first year of Core, for certain specialties and/or geographies that are less popular than others. Core Specialty Training will typically take three years and will evolve with time to encompass six six-month positions. Care will be taken during transition to ensure the curricula already agreed with PMETB are delivered and the appropriateknowledge, skills, attitudes and behaviours are acquired in an appropriately supervised environment
Neither agree nor disagree.
The ability to select trainees impartially into core training programmes at the end of FY1 remains a difficulty that has yet to be adequately resolved. Ranking of trainees does not presently take place and unless this occurs at the end of the undergraduate career would not be possible. Such a ranking exercise at that time could not be a test of applied knowledge, and therefore would not test many of the characteristics that are required by physicians. An applied knowledge test could take place in the second year after graduation and would reflect some of the competencies that have been acquired during the trainees working life.
The development of specialty stems has, of course, been suggested before as MMC developed. The precise number of stems and their content has been a stumbling block in the past and would need to be overcome. While the medical specialties would have no problem with this concept, it has not been embrace by other specialties.
The specification of timescales for training does not accord with the belief that training should be competency and not time based. We recognize, however, the need for an experiential component of training. The Federation of Physicians Colleges believes that, on average, core medical training (CMT) can be achieved within 2 years, but some may take 3-4 years to achieve CMT. We further believe that the core achievement of CMT should be the passing of the MRCP (UK). We would expect physician trainees to achieve MRCP prior to entry into their higher specialty training.
In the past, many trainees who had ambitions to enter other specialties (eg anaesthetics, radiology etc) undertook core medical training programmes and MRCP(UK) as a grounding for higher training. We continue to think that such an approach has been justified.
Recommendation 35: For those doctors who do not know to which Core Specialty to commit at the end of FY1 there will be the capacity to take up to 2 years in hybrid rotations allowing experience in four main Core areas. Experience in the subsequently selected Core area will count towards the completion of Core Specialty training subject to successful competency assessment.
Neither agree nor disagree.
The need for hybrid core training will be dependent only on the breaking of linkage between FY1 and FY2. A tailored approach to the Foundation Programme should obviate the need for hybrid core training programmes, especially if there is flexibility in the physicians’ training programmes that accommodates trainees with aspirations other than the physician specialties (as above)
Recommendation 36: Colleges should work together with the Regulator and service to devise modularised curricula for Specialist Training to aid flexibility/transferability. They should also devise common short-listing and selection processes that have been standardised across the country to allow sharing of assessments between Deaneries. This work should be completed within two years.
Agree.
This College is already working with others to devise modularised elements of curricula but this work has been put on hold because of insecurities produced by MMC. Clearly there is more work to be done, particularly with regard to our general practice colleagues.
Recommendation 37: Satisfactory completion of assessments of knowledge, skills, attitudes and behaviours will allow eligibility for
i) selection into Trust Registrar positions* in the relevant area or
ii) selection into Higher Specialist Training.
Doctors in Higher Specialist Training will be known as Specialist Registrars, those selected into General Practice specialty training will be known as GP Registrars (equivalent to ST3 and beyond).
Agree.
This recommendation covers the transition of trainees from core training to further progression and, under that label, the College is in agreement with the recommendation. We think, however, that the term “Trust Registrar” will cause confusion for patients and other staff. These doctors have not been accepted into CCT training programmes and an understanding of the difference between specialist registrars and trust registrars may be difficult to achieve. There is also confusion in the term ‘specialist registrar’ rather than ‘specialty registrar’, and the College would prefer the latter term.
Recommendation 38: The newly named Trust Registrar position* (formerly termed Staff Grade) must be destigmatised and contract negotiations rapidly concluded. The advantages of the grade (accrual of experience in chosen area of practice, consistent team environment) need to be made clear. Trust Registrars should have access to training and CPD opportunities. They should be eligible for a reasonable limited number of applications to Higher Specialist Training positions according to the normal mechanisms and also to acquisition of CESR through the Article 14 route.
Agree.
See above. The College agrees with recommendation 38, but has concerns about the term “Trust Registrar”.
Recommendation 39: Doctors should be allowed to interrupt their training for up to one year (or by agreement longer) to seek alternative experience. The regulator in conjunction with the Royal Colleges will determine whether experiences should contribute to completion of training subject to appropriate competency assessment
Strongly agree.
The Gold Guide defines this as ‘out of programme experience’ and up to 3 years have been allowed with the permission of the Postgraduate Dean.
Recommendation 40: Selection into Higher Specialist Training to the role of Specialist Registrar will be informed by the Royal Colleges working in partnership with the Regulator. The Panel proposes that in due course this will involve assessment of relevant knowledge, skills and aptitudes administered several times a year via National Assessment Centres introduced on a trial basis for highly competitive specialties in the first instance. A limited number of opportunities to repeat the National Assessment Centre tests following further experience will be determined.
Candidates will apply via Postgraduate Deaneries or Graduate Schools. Application will take place three times a year on agreed dates. Save in the most exceptional of circumstances, candidates will be restricted in the number of local programmes to which they may apply (and to the number of occasions on which they may apply).They will use a common national form with specialty specific questions and will provide their standardised assessment score/ranking along with a structured CV. This will avoid the once a year appointment system with its inherent risks to service delivery. Graduate Schools linked to the 30 UK Medical Schools would reduce the size of Units of Application and address the family-unfriendly situations that arose therefrom. Shortlisted candidates will be subject to a structured interview for final selection.
Disagree.
The College agrees that there should be an assessment of knowledge skills and aptitudes, but for physicians we believe that this function is best covered by existing College assessments, most notably MRCP(UK). The possession of MRCP(UK) in association with a structured CV with defined scoring scheme should be the mainstay of the selection process for higher specialty training in the medical specialties. As indicated above, the schools of medicine have already been formed in postgraduate deaneries and we do not see a role for new graduate schools linked to the 30 UK medical schools. Selection into specialty training programmes is the specific remit of Postgraduate Deans but collaborative working with other stakeholders, including the Colleges, has facilitated a more robust process of selection than that of MTAS.
Recommendation 41 : The current Academic Clinical Fellowships in England allowing c25% of programme time for research methodology training and development of research proposals should be integrated with Core Specialty Training. There will be a need to ensure that those entering an academic training path in the devolved nations are not disadvantaged when moving between research and clinical activities. Opportunities equivalent to ACFs should be competitively available for those wishing to develop educational, management, and public and global health skills, subject to available resource, through modular Masters programmes.
Strongly agree.
The College is strongly supportive of the academic posts that already exist, but believes that the academic competencies to be achieved during Walport posts should be better defined. Apart from this, academic trainees should also achieve the competencies that are defined by the various curricula relevant to the specialty for which they are training
Recommendation 42: Clinical lecturer posts in England will normally be coincident with higher specialist training (ST3 and beyond).
Strongly agree.
Recommendation 43: Successful completion of Higher Specialty Training as confirmed by assessments of knowledge, skills and behaviours will lead to a CCT. Higher specialist exams, where appropriate, administered by the Royal Colleges, may be used to test experience and broader knowledge of the specialty and allow for credentialing of subspecialty expertise gained post CCT and aid selection to consultant positions.
Neither agree not disagree.
The College, with its sister physician Colleges, is involved in the development of Specialist knowledge based assessments. These relate directly to the specialty curriculum and are therefore used to ensure that trainees have the knowledge competencies to achieve CCT. There is no College support for the concept of post CCT specialty examinations, but we do support the concept of credentialed components of curricula where consultant roles may change mid career in line with service needs.
Recommendation 44: To be eligible for a Consultant Senior Lecturer appointment, the applicant should possess a CCT in the relevant specialty area. Higher specialist College exams could be tailored to limited subspecialty expertise, recognising the narrower scope of practice that some clinical academics may need to embrace.
Neither agree nor disagree.
While the College supports the first sentence, there is considerable disagreement with the subsequent statement. We believe that patients have the right to know that academics are trained to the same level of competencies as other consultants. Thus, a senior lecturer in any of the physician specialties should achieve the same competencies as a consultant in the same specialty.
It is true to say that some academics might specialise in a very narrow scope of practice, and this is adequately covered by Article 14(5)(b) whereby academics can seek direct entry to the specialist register in a nominated small area of practice. They are then judged by their peers as to the quality of their academic achievement, and the appropriate recommendation made through to PMETB.
Recommendation 45: The length of training in General Practice should be extended to five years, bringing it in line with specialty training and the other developed European countries
Strongly agree.
The College strongly supports the extension of training in general practice to 5 years.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[20 November 2007] |
