The Shape of Training report – let’s get the basics right but not at the expense of excellence

06 November 2013

Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Honorary Secretary for the BGS. She tweets at @geri_baby ShapeOfTraining

I’m really not quite sure what to make of the Shape of Training report which was issued last week. A lengthy consultation has taken place, to which I responded with the assistance of the BGS Education and Training committee and Trainees council.

Independent, written by Professor David Greenaway, and with the aim of  ‘…making sure we continue to train effective doctors who are fit to practice in the UK, provide high quality care, and meet the needs of patients and the public,’ its outcomes have been hotly anticipated by anyone concerned with higher speciality training, or implementing recommendations and outcomes from documents such as the Future Hospitals Commission and the Francis report.  Dr Laura Daunt, a trainee geriatrician from Nottingham and member of the BGS Trainees Council, interviewed Professor Greenaway, and the video of this is available as part of the supporting materials.

 Securing the Future of Excellent Patient Care The Shape of Training Review: Securing the Future of Excellent Patient Care

Some of the recommendations are, at face value, hard to argue with. If fully implemented, however, they could lead to changes in the services hospitals deliver, together with phenomenal changes in the skills and experience possessed by both junior doctors and consultants.

The report suggests that foundation training remains unchanged, however full GMC registration will take place at the point of graduation from medical school. There is acknowledgment that this will need legislative changes, and also modifications to the ways in which universities deliver teaching and training. After foundation posts, doctors enter a broad based training programme in the area they wish to pursue a career in. Suggested categories are amongst others, women’s health, child health, mental health and medicine. So far, so similar.  However, following this the system starts to look very different from what we have in place now.

Doctors will spend between four and six years in core training, gaining broad training and experience in their chosen field. Individual posts will be longer than the current four-month rotations, to provide continuity and better training. There will be an option to take a year out of programme during these early years in order to gain management and leadership qualifications, develop academic interests or explore a different speciality.

Following this, a doctor will reach the end of their post-graduate training and receive a Certificate of Speciality Training (CST). I wonder if this actually a misnomer, as no speciality training has been received up to this point? The report goes on to state “… some speciality training and all sub-speciality training will be acquired through credentialed programmes once doctors have completed their postgraduate training.” There is no mention of postgraduate membership exams, and little reference to pre-existing curriculums and assessment methods.

The focus on broader training is, from a geriatrician’s perspective, welcome.  Frail older patients need, as the report states, “more doctors who are capable of providing general care in broad specialities across a range of different settings,’ who have the skills required to work in multidisciplinary health and social care teams, and will be expected to care for those with complex conditions.  It is important, however, that developing this new brand of highly skilled generalist is not taken as an opportunity to “dumb down” geriatric medicine. The highly specialised knowledge and skills in falls, movement disorders, cognition, stroke medicine, continence, orthogeriatrics, surgical liaison and rehabilitation that comprise the geriatrician’s armoury must continue to be recognised as highly important and desirable specialist skills.  Advanced skills in geriatric medicine must continue to hold their place amongst the credentialed post-generic training proposed under the new model.  This way we can continue to train the cadre of world-leading specialists that has led to the recognition of Britain as a centre for excellence in medicine of older people.

The report has been kept deliberately vague on specific details. The plan will now go forward to the bodies involved in its commissioning for the meat to be put on the bare bones. The BGS must play a strong role here. We must work to ensure that our trainees not only continue to exist, but are seen as the absolute cream of the crop. We must also use this opportunity to influence curriculums and syllabuses for the full range of doctors, from medical school through to surgical specialities to ensure that good, basic care of older people is an essential skill possessed by all.

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