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Training review a shocking 'assault' on standards

A planned overhaul of medical training is a shocking ‘assault’ on standards, say doctors.

Medical students and doctors rejected proposals contained in the Shape of Training review as ‘not fit for purpose’ at the BMA annual representative meeting.

The moves would produce consultants who did not have enough training to meet the needs of patients, the profession and the service, they agreed. 

London specialty trainee 7 in anaesthetics Tom Dolphin was on the review advisory group with the Department of Health and the GMC.

He said: ‘I told them you cannot overestimate how strongly the profession will act against this proposal.

‘There is no point selecting the best and brightest, training them up at great expense for a role and then not letting them meet expectations.’

Doctors opposed: 

  • Training being shortened
  • The certificate of completion of training being replaced by a CST (certificate of specialty training)
  • The possible creation of a ‘subconsultant’ grade.

The Shape of Training review is sponsored by organisations including the GMC and the Academy of Medical Royal Colleges, and chaired by Nottingham University vice-chancellor David Greenaway.

It also proposes making training more broad-based.


Weapons against the profession

Dr Dolphin said employers had been touting plans for something similar to the Shape of Training review for years.

He added: ‘[The review] is only one of many weapons being lined up against the profession right now.

‘We have fought this off before, we can fight it off again, but it is going to be tough this time. We have to engage on all fronts.

‘This is an egregious assault at the heart of medical standards, we cannot allow it to proceed.’

Oxford GP trainee Amar Latif said the review had ‘some good’ in it and he was prepared to discuss the idea of broad-based training.


In other debates

Cut professional development costs

Concerns were raised about the increased cost of training and professional development for doctors. 

The BMA was called on to:

  • Lobby faculties, royal colleges and education providers to cut the costs of exams and courses
  • Seek a ‘consistent ruling’ from HMRC that these costs would be considered as professional expenses for tax purposes. 


Drive out difference in foundation programmes

Doctors backed a call for action to ensure fit-for-purpose academic foundation programmes for junior doctors.

Edinburgh clinical teaching fellow Stuart Fergusson said that the variation in course across the UK was unfair.

Some offer time set aside for research, he said, while others ‘offer nothing much apart from an academic supervisor or opportunity for informal training’.

The differing levels of research opportunities could give some trainees an advantage when competing for specialty training posts.

However, Mr Fergusson said he did not want all programmes to be the same.

London SpR in public health medicine Iain Kennedy said it was important to allow local variation in academic foundation programmes.

But doctors agreed change was needed and that programmes should become more equal in terms of content and protected time for academic work.


Childcare demands

‘Every effort’ should be made to help doctors in training find out-of-hours childcare.

The BMA will ask the government and NHS Employers among others to provide more resources to support doctors in training who are obliged to provide out-of-hours cover.

In particular need are single parents who have no other unpaid childcare options.

BMA public health medicine trainees subcommittee chair Lucy-Jane Davis said: ‘Childcare is really expensive — in my area it is between £50 and £60 per day, per child.’

She said new doctors may be earning around £22,000 and be carrying a significant debt.

‘As a general doctor working less than full-time, you pay more in child care than you earn.’