Graduates should be fully registered doctors, report says

TRAINEES should be fully registered as doctors when they graduate from medical school rather than at the end of their first year of foundation training, according to an ambitious new report.

That is just one of seven recommendations made in Shape of training: Securing the future of excellent patient care, the final report of an 18-month independent review of medical training led by Professor David Greenaway.

The authors admit the move would require new Parliamentary-approved legislation as well as the implementation of a complex range of educational, legal and regulatory measures to ensure trainees were fit to practise.

The review goes on to argue that the current support and management of F1 trainees is “fragmented” and that they “have little or no supervisory relationship with their medical school”. By moving full registration to the point of graduation, it means “responsibility for F1 doctors will clearly be with postgraduate institutions”.

General Medical Council chair Professor Sir Peter Rubin welcomed the report but said: “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.”

The British Medical Association also highlighted proposals to move full registration as one of its three “major concerns”.

While the review appears happy for foundation training to continue in its current form, it proposes big changes for specialty training.

It states: “Patients and the public need more doctors who are capable of providing general care in broad specialties across a range of different settings. This is being driven by a growing number of people with multiple co-morbidities, an ageing population, health inequalities and increasing patient expectations.”

It calls for more flexibility in allowing doctors to change roles and specialties throughout their career and for training to be themed within particular patient groups. Specialties or areas of practice would also be grouped by patient care themes such as women’s health, child health and mental health.

It goes on to say that: “All doctors in specialty training will develop generic capabilities in key areas including patient safety; communication with colleagues and patients; teamwork, management and leadership; evaluation and clinical application of research.”

There will also be an optional year spent working in a related specialty or undertaking leadership or management work which can be taken at any time during specialty training.

The review has received a cautious welcome from within the healthcare profession, with concerns raised over the “unrealistic” timeline and the potential merging of some specialties.

As well as moving full registration, the British Medical Association’s other “major concerns” relate to “the complete overhaul of the training programme structure, without a commitment to first comprehensively consult or assess these changes”, as well as the proposed timescale.

It did however “support and encourage” proposals for more initial broad specialty themed training programmes, similar to the Acute Common Care Stem programme and the current Broad Based Training pilot, where doctors would then go on to undertake a specific specialty training programme.

The Royal College of Anaesthetists welcomed the report but highlighted the “absence of a realistic timeline”, questioned the feasibility of the proposed changes and called for greater clarity “to ascertain if and which specialties might amalgamate.”

The review has called for a UK-wide delivery group to now be set up to implement the necessary changes to postgraduate medical education and training.

Read the final report here  

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