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The British Geriatrics Society
The British Geriatrics Society (BGS) is the only professional association, in the United Kingdom, for doctors practising geriatric medicine. The 2,200 members worldwide are consultants in geriatric medicine, the psychiatry of old age, public health medicine, general practitioners, allied health professionals, and scientists engaged in the research of age-related disease. The Society offers specialist medical expertise in the whole range of health care needs of older people, from acute hospital care to high quality long-term care in the community.

Geriatric Medicine
Geriatric Medicine (Geriatrics) is that branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness of older people. Their high morbidity rates, different patterns of disease presentation, slower response to treatment and requirements for social support, call for special medical skills. The purpose is to restore an ill and disabled person to a level of maximum ability and, wherever possible, return the person to an independent life at home.

The Society is delighted to be given the opportunity to contribute to this debate and would comment as follows:

MMC

Positives
1. The Society has general support for underlying principles. Training should occur in well structured, managed, time-limited programmes, based on clear curricula driven by educational objectives.

Negatives
1. Lack of flexibility of Run –Through Training.

• Commitment to specialty occurs too early. The concept of run-through from ST1 fails to recognise the importance of a varied and broad training.
• Opportunities to move between specialties are severely limited
• Reduced opportunities to gain breadth of experience in core medical training - important in Geriatric Medicine where we are training “Expert Generalists”
• Loss of opportunities for those outside medical specialties to access core training in medicine e.g. general practice, radiology, anaesthetics. This is likely to be detrimental to the care of older people who are the most frequent users of these services.
• Out of programme experience at all levels is less easy to set up and more complex. This is a particular disincentive to research activity. The ability to appoint additional ST3 level trainees (as opposed to locums) to fill gaps of 1-2 years are required to ensure training programmes (and service delivery) are sustainable.
• Rule book is too complex
• Proposed assessment protocols are time consuming

2. Trainees will be less experienced
Emphasis is on gaining a breadth of experience but this is not the same as acquiring a broad set of skills and being generally competent.

3. Concern that there is no agreed selection process from ST2 to ST3.

4. Strong support for the maintenance of MRCP Examination as a valid test and should be prerequisite for entry into specialty training.

5. The rights of overseas doctors should have been sorted out before the new systems were introduced.

6. Manpower - Long-term manpower figures should underpin the new structures

• Despite promises of career advice underpinning the new processes, most trainees (and educational supervisors) had little or no idea of their chances of achieving run-through training and CCT. Trainees and senior staff must have explicit and realistic workforce data to make clear how many proper specialty training posts are available and an estimate of the proportion of trainees expected to enter “career posts”.
• Insufficient run through training programmes in hospital medicine

7. No acknowledgement that the new system will involve additional work for the current consultant workforce

• Time to undertake the multitude of assessments
• Time to give careers advice
• Time to undertake the additional clinical work that less experienced trainees and newly qualified consultants will be unable to take on.

These issues must be reflected in the consultant job plan.

To date there appears to have been little in the way of discussion between those involved in MMC and the Departments of Health (all nations), regarding the impact of these changes on Consultant time and hence service delivery.

8. Concern that there has been a loss of quality assurance/control of training programmes following the cessation of external college visits. New system is too broad brush to identify and deal with the complex and sensitive specialty training issues that can arise.

9. Older people are the biggest users of hospital and community services. Numbers of older people are increasing in both absolute and proportional terms. Any system of medical training should ensure that all doctors working in adult services (whatever the specialty) should have some training in core aspects of geriatric medicine. If MMC is to truly deliver a system which matches training with the health needs of the population, then recognition of this principle should be fundamental.

MTAS

Positives
1. A national online application system has considerable merit and could potentially be more efficient than previous systems.
Linking such a system to a database of information containing the details and content of all regional training programmes could have considerable benefit.

Negatives

1. MTAS was not adequately piloted and was far too immature to be nationally adopted. Computer system was unfit for purpose. Adequate time to develop a robust and acceptable system is required.

2. Application system was fundamentally flawed – “reductionist approach”. Many of the sections were open to plagiarism and copying. Many sections could only be assessed by face to face interview.

3. Short-listing process was insensitive and invalid. Many reports of trainees who were not short-listed first time round then doing very well at interview and vice versa.

4. Scoring system insensitive e.g. common problem was joint scores, no agreed process as to how to manage this. Often random selection.

5. Scoring system failed to adequately reward academic achievements and experience.

6. Reports of trainees being called for three sets of interviews in different regions on the same day.

7. Geographical constraints have been a source of huge concern for trainees
• What happens if appointed in one Deanery at ST1 and then no vacancies in ST3 in specialty of choice?
• What happens if appointed in one Deanery at ST1 and then wish to move to another Deanery at ST3 (family reasons, partner also medical etc)?

Geographical matching of trainee and Deanery preferences needs to be far more sensitive and sophisticated, as present arrangements may not act to the benefit of either party, especially for the smaller Deaneries.

8. One appointment round per annum will be insufficient

9. The views of trainees and those most directly involved in training should underpin any reworking of the application system.

The BGS Education and Training Committee undertake an annual SpR recruitment survey in June of each year. We have delayed this year’s survey until September because at the time of writing allocation of places at ST3 around the UK is incomplete.

Professor Peter Crome MD PhD FRCP FFPM
President
For and on behalf of British Geriatrics Society
24 July 2007