In a world where the needs of patients are changing, we must regularly review the way that we train doctors. And, where necessary, we must make changes to existing structures. The Shape of Training report makes a valuable contribution to the debate about the future of postgraduate medical training and we support many of its recommendations. However, we do have concerns about how some of the more fundamental changes proposed by the report will work in practice – especially those which would effectively shorten the length of training and redefine the meaning of certification. Our concerns are detailed in this paper together with our views on the report’s more minor recommendations, many of which we support.
Statement on Shape of Training
1. The Shape of Training report correctly identifies the huge challenges faced by the NHS in delivering a high-quality health service to a changing patient population in the decades ahead.
2. These challenges are real and serious but 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.
3. They introduce new, untested risk and cost, and propose solutions that have largely been superseded in England by the Five Year Forward Plan for the NHS, which sees the answer to these challenges in greater whole-system integration and making the best use of the professions we have, rather than trying to reform them.
4. It is perfectly feasible for a well-trained doctor to be simultaneously a good generalist and specialist. The early years of training could be improved to provide doctors with a more general grounding in their speciality. This does not mean that length of training can be shortened without compromising the quality of speciality training.
5. Producing such a doctor takes time and experience. Replacing parts of specialty training programmes with generalist content will have a negative impact on the provision of specialist care to patients.
6. We are sceptical about the division of broad-based specialty training into “themes” that do not make intuitive sense as a way of organising the training of doctors or of providing care for patients with complex conditions.
7. Whilst accepting the need for generalist skill, there is little evidence, and we do not accept the premise, that the UK medical workforce has too many specialists or that training curricula have become too specialised at the expense of generalism.
8. The case has not been made to shorten training programmes, nor to replace the certificate of completion of training (CCT) as a step within continuous lifelong learning, with a lower-level certificate of speciality training (CST). 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.
9. We are concerned that Shape of Training will have an adverse impact on medical academia. With specialty programmes truncated, doctors may enter academic pathways as a route to obtaining specialist knowledge rather than in the genuine pursuit of academic interests.
10. Credentialing may have a role in areas which are not currently covered by comprehensive training programmes. It cannot be a replacement for high-quality structured speciality 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.
11. We therefore reject the current direction of travel for Shape of Training and call for:
11.1 a pause in any implementation of the Shape of Training recommendations;
11.2 a full evaluation of the impact of Modernising Medical Careers before considering a further overhaul of training;
11.3 a recognition that with improved resources, enhanced GP training, and a significant expansion of the workforce, UK general practice can help to address the pressures posed by changing demographics and rising co-morbidity;2 January 2015
11.4 further research and evidence on the balance between generalism and specialism within hospitals, before any consideration is given to the proposed shortening of specialist training; and
11.5 full engagement with stakeholders including those delivering education locally. The following organisations endorse the views expressed in this statement:
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
British Medical Association 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