Monday, 22 October 2007

The ferret's guide to Tooke: Part 6

"Recommendation 30
PMETB should be assimilated in a regulatory structure within GMC that oversees the continuum of undergraduate and postgraduate medical education and training, continuing professional development, quality assurance and enhancement. The greater resources of the GMC would ensure that the improvements that are needed in postgraduate medical education will be achieved more swiftly and efficiently. To this end the assimilation should occur as quickly as possible."

I don't think that this proposal would be very unpopular within the medical profession, it would be far better to have one organisation in charge and therefore accountable for their actions. This is the best recommendation of the lot for me.

"Recommendation 31
Under the Medical Act, Universities already have responsibility with regard to FY1. By breaking the linkage with FY2, it will be possible to guarantee an FY1 position in the new graduate’s local Foundation School subject to prevailing local selection processes. The linkage between FY1 and FY2 should cease for 2009 graduates."

Another sensible idea, back to a more house officer style of system.

"Recommendation 32
FY1 should be reviewed to ensure that i) harmonisation with year 5 is optimised; ii) the curriculum more clearly embraces the principles of chronic disease management as well as acute care; iii) competency assessments are standardised and robust. In future, doctors in this role should be called Pre-Registration Doctors."

I am not convinced by this, I believe the first year of pre-registration work should be the simple bread and butter. It should consist of six months of medicine and six months of surgery, and nothing else. It must be a good broad grounding in acute care that is a platform from which to spring.

"Recommendation 33
Foundation Year 2 should be abolished as it stands but incorporated as the first year of Core Specialty Training. The current commitment to FY2 GP placements should continue as part of Core Specialty Training and developed further as resources permit. Doctors in Core Specialty Training should be called Registered Doctors.

Recommendation 34
At the end of FY1 doctors will be selected into one of a small number of broad based specialty stems: e.g. medical disciplines, surgical disciplines, family medicine, etc. During transition, ‘run-through’ training could be made available after the first year of Core, for certain specialties and/or geographies that are less popular than others. Core Specialty Training will typically take three years and will evolve with time to encompass six sixmonth positions. Care will be taken during transition to ensure the curricula already agreed with PMETB are delivered and the appropriate knowledge, skills, attitudes and behaviours are acquired in an appropriately supervised environment.

Recommendation 35

For those doctors who do not know to which Core Specialty to commit at the end of FY1 there will be the capacity to take up to 2 years in hybrid rotations allowing experience in four main Core areas. Experience in the subsequently selected Core area will count towards the completion of Core Specialty training subject to successful competency assessment."

The wheel is being reinvented here, the outcome of the above would appear to resemble the old pre-MMC system.

"Recommendation 36
Colleges should work together with the Regulator and service to devise modularised curricula for Specialist Training to aid flexibility/transferability. They should also devise common short-listing and selection processes that have been standardised across the country to allow sharing of assessments between Deaneries. This work should be completed within two years."

There is good and bad in this, it is good for the Deaneries to pool ideas and knowledge, however why should things have to be standardised across the board? Diversity is the spice of life and without it I feel the pursuit of excellence will be hindered. The time limit may not be a good move either, we have seen how badly rushed reform can go.

"Recommendation 37
Satisfactory completion of assessments of knowledge, skills, attitudes and behaviours will allow eligibility for
i selection into Trust Registrar positions* in the relevant area or
ii selection into Higher Specialist Training.
Doctors in Higher Specialist Training will be known as Specialist Registrars,
those selected into General Practice specialty training will be known as GP
Registrars (equivalent to ST3 and beyond)."

This just states that registrars will continue to be registrars.

"RecommendatIon 38
The newly named Trust Registrar position* (formerly termed Staff Grade) must be destigmatised and contract negotiations rapidly concluded. The advantages of the grade (accrual of experience in chosen area of practice, consistent team environment) need to be made clear. Trust Registrars should have access to training and CPD opportunities. They should be eligible for a reasonable limited number of applications to Higher Specialist Training positions according to the normal mechanisms and also to acquisition of CESR through the Article 14 route."

I wouldn't argue with this.

"Recommendation 39
Doctors should be allowed to interrupt their training for up to one year (or by agreement longer) to seek alternative experience. The regulator in conjunction with the Royal Colleges will determine whether experiences should contribute to completion of training subject to appropriate competency assessment."

It wis essential that doctors are encouraged to gain a wide variety of experience.

"Recommendation 40
Selection into Higher Specialist Training to the role of Specialist Registrar
will be informed by the Royal Colleges working in partnership with the
Postgraduate training – Inquiry recommendations

The Panel proposes that in due course this will involve assessment of relevant knowledge, skills and aptitudes administered several times a year via National Assessment Centres introduced on a trial basis for highly competitive specialties in the first instance. A limited number of opportunities to repeat the National Assessment Centre tests following further experience will be determined. Candidates will apply via Postgraduate Deaneries or Graduate Schools.
Application will take place three times a year on agreed dates. Save in the most exceptional of circumstances, candidates will be restricted in the number of local programmes to which they may apply (and to the number of occasions on which they may apply).They will use a common national form with specialty specific questions and will provide their standardised
assessment score/ranking along with a structured CV. This will avoid the once a year appointment system with its inherent risks to service delivery. Graduate Schools linked to the 30 UK Medical Schools would reduce the size of Units of Application and address the family-unfriendly situations that arose therefrom. Shortlisted candidates will be subject to a structured interview for final selection."

I am scared by the mention of common national forms with specialty specific questions and standardised assessment scores, does this not ring alarm bells a la MTAS 2007? Why not allow there to be a bit of healthy regional variation to encourage diversity?

"Recommendation 41
The current Academic Clinical Fellowships in England allowing c25% of programme time for research methodology training and development of research proposals should be integrated with Core Specialty Training. There will be a need to ensure that those entering an academic training path in the devolved nations are not disadvantaged when moving between research
and clinical activities. Opportunities equivalent to ACFs should be competitively available for those wishing to develop educational, management, and public and global health skills, subject to available resource, through modular Masters programmes."

I am not sure what this means, Academic Medicine is a bit of mystery to me.

"Recommendation 42
Clinical lecturer posts in England will normally be coincident with higher specialist training (ST3 and beyond).

Recommendation 43
Successful completion of Higher Specialty Training as confirmed by assessments of knowledge, skills and behaviours will lead to a CCT. Higher specialist exams, where appropriate, administered by the Royal Colleges, may be used to test experience and broader knowledge of the specialty and allow for credentialing of subspecialty expertise gained post CCT and aid
selection to consultant positions."

Fair enough.

"Recommendation 44
To be eligible for a Consultant Senior Lecturer appointment, the applicant should possess a CCT in the relevant specialty area. Higher specialist College exams could be tailored to limited subspecialty expertise, recognising the narrower scope of practice that some clinical academics
may need to embrace.

Recommendation 45
The length of training in General Practice should be extended to five years, bringing it in line with specialty training and the other developed European countries."

The ferret fancier will shortly be releasing a concluding piece on the Tooke review, simply watch this space, I cannot promise that it will be coherent, however it will be under 100 pages in length.

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