Position Statement: SHape of Training (SHoT) report by Prof Greenaway

The Shape of Training (ShOT) report is an independent review by Professor David Greenaway, Vice-Chancellor of the University of Nottingham and Professor of Economics. It sets out a number of recommendations regarding the provision and configuration of postgraduate medical and surgical training for the next 3 decades, with the aim of “securing the future of excellent patient care”. The review has had input from all the major stakeholders including the Royal College of Surgeons of England, the Academy of Royal Colleges and the Academy of Trainees Doctors Group (ATDG). BOTA has identified key recommendations that it supports and also those that it rejects. Trauma and Orthopaedic surgery as a specialty, has always trained surgeons to be capable and competent at providing a general clinical service as well as having subspecialty interests. The FRCS (Tr & Orth) examination and award of a CCT in trauma and orthopaedics supports the notion that a fully trained consultant is competent in delivering an excellent standard of both generalist and subspecialty care for patients. BOTA believe this model could be incorporated into other specialties in order to meet the demands for generalist training in a hospital care setting whilst still enabling doctors to be specialists and providing specialist care. With an increasing demand for musculoskeletal care services due to an ageing population, changes in population demographics such as obesity and an increasing patient’s expectation for a higher quality of life, the ability for trauma and orthopaedic surgeons to be able to manage both the trauma and elective needs of the population will continue to increase. The current trauma and orthopaedic curriculum reflects this need. The current training program has been developed over decades to provide a balance of service and training within the NHS structure, and European working time regulations. Newly appointed consultants who have gained a Certificate of Completion of Training (CCT) through the current training system are able to provide an excellent level of general trauma care having completed the process of competency and experience based learning as well as fulfilling FRCS examination standards.

Date: 29 January 14


Background Recommendations supported

Recommendations rejected Summary


Mr Jeya Palan Mr Marshall Sangster

On behalf of the BOTA Committee

About BOTA

BOTA is a democratically elected professional committee. It represents trauma and orthopaedic trainees across England, Scotland, Wales and Northern Ireland. BOTA has a current membership of over 1000 Specialty Registrars. Orthopaedic surgeons make up around 40% of the membership of the Royal Colleges and are the largest surgical subspecialty. BOTA are a separate and independent trainee organisation from the Association of Surgeons in Training (ASiT), representing the views of T&O trainees specifically. However, ASiT and BOTA have a very good working relationship, and work together on many issues to represent surgical trainees as a collective. Both the BOTA and ASiT’s response to the ShOT review are similar and the BOTA response is presented below. There are 19 recommendations that have been proposed within the ShOT review. This document reflects the BOTA viewpoint with regard to a number of the recommendations within the review.

Recommendations Supported

i) Recommendation 3: Appropriate organisations must provide clear advice to potential and current medical students about what they should expect from a medical career.

Medical schools should indeed provide a comprehensive and equal standard of career guidance to potential and current medical students. We support a clear and unambiguous delivery of information into how a medical career may progress. This must include a good understanding of the evolving nature of being a doctor, and potential for fierce competition for training posts. The personal cost of training to become a doctor should be highlighted to take into account the financial and potential emotional sacrifices one may need to take in order to follow certain career paths. BOTA therefore supports the recommendation that clear advice must be provided to medical students about their future career choices and pathways. It is disappointing to note that such a recommendation is still needed.

ii) Recommendation 8: Appropriate organisations, including employers must introduce longer placements for doctors in training to work in teams and with supervisors including putting in place apprenticeship based arrangements.

BOTA support the recognition that a minimum of 6 month placements is needed in order to improve training and continuity of care. Incorporating an apprenticeship model of training is to be encouraged. Despite the limitations of the apprenticeship model, having a specified trainer and team in which a trainee works, benefits the trainee, trainer, the wards and clinics etc. Trainees need “ownership” and a sense of belonging as part of a team and this helps provide the environment for team working and building relationships. This can only lead to improved patient experience and quality of care.

iii) Recommendation 9: Training should be limited to places that provide high quality training and supervision, and that are approved and quality assured by the GMC.

BOTA believes that training should be limited to places that provide high quality training and supervision, and that are approved and quality assured by the GMC. We wholly support this recommendation, training should be limited to places/units that provide high quality training and trainers should be limited to those who demonstrate both enthusiasm and ability to train. Furthermore, BOTA would support any measures designed to help units/trainers improve their training provision. The GMC needs to ensure that such units/trainers are fully supported and that training is incorporated into the employment contracts of trainees with an emphasis placed on trusts to ensure that such training is delivered. BOTA believes that the quality of training directly correlates to the level of service a trainee can provide to patients. Therefore, excellence in training should equate to excellent patient care.

iv) Recommendation 10: Postgraduate training must be structured within broad specialty areas based on patient care themes and defined by common clinical


BOTA supports the idea that foundation year programs should not have a mix and match set of placements, where a junior doctor may undertake placements in Trauma and Othopaedics, Psychiatry and Renal medicine for example which is purely down to service provision. Programs should be themed around general medicine, surgery and GP to allow generalist training in the early years with core surgical training being more focused. For example, if a trainee wished to pursue a career in orthopaedics, then a core training post should include placements in appropriate specialties that complement a primary theme, for example: trauma and orthopaedics, Emergency medicine, Plastics, Gen Surgery etc. This ensures that all doctors acquire general competencies in managing patients at FY1 and FY2 level and develop more specific specialty themed competencies based on their specialty career interests.

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