Shape of Training is an independent review into whether changes are required in postgraduate medical training to ensure it continues to meet the needs of patients and health services in the future.
The Shape of Training report made 19 recommendations for change. The BMA supports certain recommendations, such as more flexible training and improving careers advice for medical students, but there are a number that cause concern.
In February 2013 the BMA responded to the review's call for evidence and ideas, after asking for views from our members. The response included seven key principles and two main areas of concern for the BMA and in March 2014 we responded in full. We have now engaged with the four governments of the UK to tell them our views ahead the publication of their plans for implementation.
While we welcome the broad thrust of the report and its move toward broad-based training, our two areas of concern - around the CST programme and the point of registration with the GMC - remain.
Our key concerns
1. Shortening training for specialism
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 specialty. This does not mean that length of training can be shortened without compromising the quality of specialty training.
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.
2. CST Programme
The BMA does not support the development of a broad based training scheme that is delivered through shorter four to six-year programmes. The Shape of Training report argues that doctors who are awarded a Certificate of Specialty Training (CST) must be trained to 'the same level of competence' as a current Certificate of Completion of Training (CCT) holder. It makes no attempt to explain how doctors can be trained to this skill level in a shorter training programme which has, at the same time, been expanded to include more generalist training.
Post-CST 'credentials', which will consist of specialty competences currently gained pre-CCT, will only be available according to local population need. This could create a workforce where only a small number of doctors will be highly trained specialists on a reactionary basis. An increasing number of patients would therefore be cared for by doctors who are not as well trained as today's consultants.
There is a real risk that a cohort of trained doctors who are less well trained than the consultants of today will be produced. Instead of training doctors to CST level, we believe that patient care in the NHS should be led by highly trained and highly skilled consultants who have obtained a CCT.
3. Point of GMC registration
The report recommends moving the point doctors are registered with the General Medical Council (GMC) to the end of medical school. However, unless the length of medical school programmes were extended this would result in the cramming of training and clinical experience currently provided by the F1 year into the undergraduate curriculum. The BMA is not convinced it is possible to produce doctors who are fit to practise under these conditions.
We are also concerned about the workforce implications of this recommendation, as it will increase competition for the Foundation Programme by opening it up to doctors from an additional 16 EEA member states.
Read the full joint statement (PDF)
We are asking the governments of the UK to:
- Pause the implementation of the Shape of Training recommendations
- Further evaluate the impact of Modernising Medical Careers before considering a further overhaul of training
- Recognise that with improved resources, enhanced GP training and a significant expansion of workforce UK general practice can help address the pressures
- Conduct further research and gather more evidence on the balance between generalism and specialism within hospitals before shortening specialist training
- Fully engage with stakeholders including those delivering healthcare locally
BMA council chair, Dr Mark Porter has written to the UK Government outlining doctors' concerns about some of the recommendations in the Shape of Training review.
The BMA has submitted a consensus statement, together with 14 other doctors associations in the UK, highlighting our concerns about the Shape of Training review of medical education and training.
Read the full joint statement (PDF)