Major Shake-Up in Medical Training, UK

Main Category: Medical Students / Training
Article Date: 13 Aug 2005 - 5:00 PDT

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A groundbreaking change in postgraduate medical training begins this week as thousands of medical school graduates begin their careers in the NHS as part of a new foundation training programme.

For the first time ever, all junior doctors who are starting their first year after medical school (previously known as the pre-registration house officer or PRHO year) will have to demonstrate explicitly that they are competent in a number of areas including communication and consultation skills, patient safety and teamworking, as well as the more traditional clinical skills. Around 4850 trainees are starting the Foundation Programme this week.

The two-year Foundation Programme replaces the existing PRHO year and first year of senior house officer (SHO) training and will give trainees exposure to a range of career placements across a broad spectrum of specialties. All trainees will also have access to an educational supervisor, as well as a clinical supervisor for each placement. The programme has as its focus patient safety: progression through the programme is based on the achievement of competence, rather than time served.

Deputy Chief Medical Officer Bill Kirkup said,

"At the heart of this new training programme is quality of medical care. By making the continuous development of skills and knowledge central to training, and by making explicit the standards of competence that doctors reach before they progress, the Foundation Programme will improve patient safety as well as medical careers. Because these changes have been introduced systematically across the health service, patients can be assured that doctors at each stage of their career have demonstrated their ability to practise safely and effectively at that level."

Health Minister Lord Warner said:

"I welcome the introduction of the Foundation Programme. This is just the beginning of a much wider ranging change in medical training, driven by the needs of patients and the NHS. As healthcare changes, the Foundation Programme will ensure that doctors going through the system have a good solid base from which to progress in the modern NHS which puts patients at the centre."

In the first year of the programme, foundation doctors will still undertake placements in medicine and surgery, as required for General Medical Council (GMC) registration. Many trusts are now offering three four-month placements, which means that in the first year, many trainee doctors will be able to experience an additional placement in another specialty. The foundation doctors' competence will be assessed against the standards set out in the Foundation Programme curriculum by senior healthcare professionals in their trusts.

Dr Cate O'Neill, F2 pilot trainee said: "I was part of a Foundation Programme pilot that was evaluating the new assessment methods. Initially, the thought of having consultants assess me was quite intimidating, but it became easier after the first one. The best part about the new assessment process is the opportunity for immediate feedback and the ability to bring up problems in a safe and supportive atmosphere."

Dr Laurence Gant, clinical lead at the Homerton Hospital said: "The Foundation Programme trainees will experience a co-ordinated training and teaching programme over the next two years which conforms to the national curriculum. This, together with ongoing teaching in the clinical environment, will mean that they reach a proven level of competency in a wide variety of skills and knowledge that will help to ensure optimum patient care and safety. The teaching programme recognises the multidisciplinary nature of the Trainees work environment and will also be delivered to, and with the help of, the nursing and allied health professionals.'

The second year of the programme will provide new opportunities for trainee doctors to gain experience in primary care, shortage specialties (those specialties that are actively recruiting) and in academic medicine. Assessment of doctors' competence will be required throughout their training in order for them to progress to further training in areas in which they wish to specialise.

Training will be organised and delivered by postgraduate deaneries through new foundation schools, which will bring together medical schools, the local deanery, trusts (mental health, acute and PCTs) and other organisations (e.g. hospices) to offer training in a range of different settings and clinical environments.

Each foundation doctor will have a dedicated educational supervisor who will be responsible for supporting them and ensuring they have appropriate learning opportunities. Each deanery will also ensure that foundation doctors have access to career advice. Modernising Medical Careers, the Department of Health initiative behind the training reforms, has just published a career management paper for medical schools, trusts and deaneries for their career advisors.

1. Some examples of the kinds of placements foundation doctors have undertaken in the pilot phase of this new programme are included in the Rough Guide to the Foundation Programme

They are:

Meena
F1 year: Acute medicine 6 months, surgery 6 months
F2 year: Histopathology 4 months, GP 4 months, A and E 4 months

Claire
F1 year: Dermatology 4 months, surgery 4 months, acute medicine 4 months
F2 year: ENT 3 months, neurology 3 months, orthopaedics 3 months, cardiology 3 months

Simon
F1 year: Urology 4 months, haematology 4 months, acute medicine 4 months
F2 year: Psychiatry 4 months, immunology 4 months, academic medicine 4 months

2. The wider UK MMC policy includes further changes to postgraduate medical training after the Foundation Programme. In the future, trainees will undertake basic specialist training. Reforms to the SHO and Specialist Registrar training grades will be implemented in 2007. Training opportunities are also being explored for Non-Consultant Career Grades (NCCG) doctors under MMC.

3. The Foundation Programme has undergone two years of successful piloting. The summary of pilot results is available on the MMC website at http://www.mmc.nhs.uk.

4. All the documents supporting the Foundation Programme are available at http://www.mmc.nhs.uk including:

a. The Rough Guide to the Foundation Programme b. Curriculum for the Foundation Years in Postgraduate Education and Training

c. Operational Framework for Foundation Training

5. A short history of medical training:

Ancient Greece

The Greeks develop a system of medicine based on reasoning and observation

9th century

The Moors establish the first European medical schools in Montpellier The oldest Christian school of medicine is founded in Montpellier in 1021

1540

'Regius Professorship of Physic' in the University of Cambridge is founded by Henry VIII

Renaissance

Hospitals in major European cities, such as Santa Maria Nuova in Florence, start teaching medicine

1785

Royal London Hospital opens England's first teaching school

1874

The London School of Medicine for Women is founded by Elizabeth Garrett Andersen - the first woman to gain GMC registration

1900s

More medical schools open as advances in treatment, such as the use of antibiotics, revolutionise medical training

1948

The establishment of the NHS creates a need for a greater number of fully-qualified doctors

1999-2001

Between 1999 and 2001 almost 2,150 new medical school places to Higher Education Institutes in England are allocated. This is the largest increase in medical school places since the NHS was established.

2001- 2004

Four new medical schools open and four new centres of medical education are opened. Medical school intake in 2004-05 is 6,326 compared to 3,749 in 1997

2005

Modernising Medical Careers launches 2-year Foundation Programme for all medical school graduates

This is a Media Release from the UK Dept of Health

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