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Ahead of the Government’s response to the Shape of Training review, we, alongside 15 other trainee organisations have written to UK Health Ministers to express our concerns about the proposals.
This unprecedented show of professional unity reflects the strength of feeling amongst doctors in training that our collective voice has not been heard. Trainees have not been adequately involved throughout the stakeholder engagement process and our concerns have not been listened to.
If the Government is truly committed to improving postgraduate medical training, attention must be paid to this important statement and the concerns of trainees must be addressed before steps are taken to implement any future change.
We await the Government’s response.
Tell us what you think of our recommendations on Shape of Training
Read the consensus statement on Shape of Training at the end of this post and tell us whether you agree with our recommendations; if not, tell us why in the comments below. We want the Government to pause the implementation of Shape of Training and listen to the profession. Your views will add weight to that call.
For more information on the Shape of Training Review take a look at our summary information.
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 They introduce new, untested risk and cost, and propose solutions that have largely been superseded in England by the Five Year Forward Plan for the NHS, which sees the answer to these challenges in greater whole-system integration and making the best use of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 TraineesAssociation of Clinical Pathologists trainees groupAssociation of Otolaryngologists in TrainingAssociation of Palliative Medicine trainees groupAssociation of Surgeons in TrainingNational Dermatology Trainee CommitteeBritish Junior Cardiologists AssociationBritish Medical Association Junior Doctors CommitteeBritish Orthopaedic Trainees AssociationBritish Society of Gastroenterology Trainees' CommitteeOncology Registrar ForumRoyal College of Obstetricians and Gynaecologists Trainee CommitteeRoyal College of Ophthalmologists Ophthalmic Trainees GroupRoyal College of Radiologists Junior Radiologists ForumYoung Diabetologists' and Endocrinologists' Forum
Learn more about the Shape of Training review
Really pleased to see such a wide swathe of support from trainee organisations to this statement. There are many concerning aspects to Shape of Training and to date the trainee voice seems to have been ignored - this was the same at the time of MMC and the organisations involved in trying to drive Shape through need to be cognisant of that.
The creation of a sub-consultant grade (in reality if not name) purely to staff the acute medical take will do nothing to help with dealing with the issues facing the NHS. It also once again completely misses the point that to be an excellent generalist requires more training, not less.
The UK already has a better integration of general internal medicine with subspecialty training than most other countries (dual accreditation of medical registrars) , and with exposure to other specialties before entering final specialty training (Foundation Programme, Core Training Programmes).
Waiting times for new appointments proves how there are shortages of specialists - the public wants to be able to see a neurologist without waiting 4 months, or see a diabetologist to manage their diabetes not by a GP who may have only been on a few training days.
In terms of increasing skills in generalism, this should be done by improving the resources of general medicine training to improve teaching and educational value of doctors' time spent in general medicine jobs (in most hospitals currently focused on discharging patients and flow management in AAU's rather than true education). Reducing training time and de-accrediting doctors' training will not achieve any of these aims. And... has nothing been learned from the chaos from the reorganisation of MMC??!! Proposers of national reorganisations always overstate the benefits and ignore the serious failings and risks of their plans. Also, doctors have to want to do these proposed training programmes or they will simply vote with their feet. The government vs trainees all over again, really is this really necessary??!
It would be a bad move to make speciality training even more generalist than it is now. I support the BMA's views on preventing The Shape of Training being implemented.