Call for pause in medical training reforms

FIFTEEN organisations representing trainee doctors are calling for a pause in a major programme of reforms to medical training.

They are demanding a temporary halt to the implementation of recommendations made in the 2013 Shape of Training report, highlighting a number of concerns about their potential impact.

The Shape of Training review, led by David Greenaway, proposed a number of big changes to the way medical training is run.

Measures include bringing forward full GMC registration from the end of foundation year one to the point of graduation and an emphasis on more generalist skills.

The organisations’ statement acknowledges the “real and serious” challenges facing the NHS in delivering high quality care to a changing population in the coming years.

But it states: “The remedies suggested by Shape of Training do not offer the right solutions for patients and could risk all that currently works well in high quality medical education.”

The organisations fear the Shape of Training recommendations “introduce new, untested risk and cost” and that the report has been largely superseded in England by the more recent Five Year Forward Plan for the NHS.

They also take issue with the extra emphasis Shape of Training placed on generalist skills and believe “it is perfectly feasible for a well-trained doctor to be simultaneously a good generalist and specialist.”

They accept early medical training could be improved to provide doctors with a more “general grounding in their specialty” but “this does not mean that length of training can be shortened without compromising the quality of specialty training.” They are concerned that replacing parts of specialty training programmes with generalist content “will have a negative impact on the provision of specialist care to patients.”

Other concerns relate to replacing the certificate of completion of training (CCT) with a “lower level” certificate of completion of specialty training (CCST), saying: “Patients want to be seen by a doctor who can deliver the best possible outcomes. Training doctors to a lower level of expertise will not achieve this.”

Proposals to introduce a credentialing system, the statement says, “cannot be a replacement for high-quality structured specialty training. The proposal to replace latter parts of (sub) specialty training with a loosely-defined system of local accreditation risks undermining workforce planning and does not offer reassurance about the proposed shortening of training.”

The document closes with the organisations rejecting the “current direction of travel for Shape of Training” and calls for a pause before any further changes are made.

The statement was signed by:

• Association of British Neurologists Trainees

• Association of Clinical Pathologists Trainees Group

• Association of Otolaryngologists in Training

• Association of Palliative Medicine Trainees Group

• Association of Surgeons in Training

• National Dermatology Trainee Committee

• British Junior Cardiologists Association

• BMA Junior Doctors Committee

• British Orthopaedic Trainees Association

• British Society of Gastroenterology Trainees’ Committee

• Oncology Registrar Forum

• Royal College of Obstetricians and Gynaecologists Trainee Committee

• Royal College of Ophthalmologists Ophthalmic Trainees Group

• Royal College of Radiologists Junior Radiologists Forum

• Young Diabetologists’ and Endocrinologists’ Forum