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Should doctors train for less time?

Tagged In:  Government News, NHS
As Head of Sanctuary Doctors, I work closely with both qualified clinicians and NHS trusts. One of the hot topics for discussion amongst colleagues right now is the Shape of Training review on postgraduate medical education and training. Although the original report was published in October 2013, the Steering Group will soon be reporting its implementation recommendations. If the new government decides to proceed, this would be one of the most significant changes in medical training for many years.

Like many doctors and professional organisations such as the British Medical Association (BMA), General Medical Council (GMC) and the Royal College of Surgeons (RCS), I broadly support the aims of the review. But I also have concerns about two key recommendations: the shortening of consultant training and the registration of junior doctors immediately after medical school. Is it really possible to cut two years off the specialist training cycle without compromising the quality of patient care and safety? Will immediate GMC registration for medical graduates simply result in squeezing more training and clinical experience into the undergraduate curriculum?

Hopefully, the Steering Group will be able to answer these big questions. As the BMA points out in its response to the Shape of Training review, there's no clear explanation of how doctors can be trained to Certificate of Specialty Training (CCT) level 'in a shorter training programme which has, at the same time, been expanded to include more generalist training'. They're concerned that, rather than raising standards and improving patient care, the change will simply result in more doctors who are less well trained. As for letting recent graduates become GMC-registered straight out of medical school, the RCS wants assurance that 'graduates are capable of working safely in a clinical environment having had limited experience on hospital wards'. I think everyone would want that assurance – most importantly patients!

The Shape of Training website describes the review as 'the latest step on a journey to ensure UK medical education and training can support and respond to society's needs in the best possible way'. However, some medical professionals have questioned its motives, suggesting that it's more about the government being able to change terms of employment for new consultants rather than having to renegotiate the contract with existing ones. In a letter to the British Medical Journal in January 2014, Orthopaedic Registrar and Oxford Research Fellow Benjamin Dean said the review was 'another cynical, politically motivated disaster in the making, one that prioritises the short term needs of politicians over the short and long-term needs of both doctors and patients'.

At Sanctuary Doctors we're committed to working with highly trained medical professionals who can bring much-needed specialist skills and experience to NHS trusts across the UK. Therefore, we'll be closely watching how the new government responds to proposals from the Shape of Training Steering Group. The Department of Health has said that nothing is as yet cast in stone and that there would be 'appropriate consultation' before any changes are implemented. Let's hope that consultation process is open, effective and robust. As a spokesman for the BMA told the BBC, "Changes affecting the future medical workforce cannot and should not be rushed."

Are you a doctor or healthcare manager with views on the issues raised in this article? Please leave your comments below.

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