COUNCIL OF HEADS OF MEDICALSCHOOLS
AND DEANSOF UK FACULTIES OF MEDICINE
TheCouncil of Heads of Medical Schools (CHMS) agrees that there is a need toreform the SHO grade and supports the principles that underpin the proposedchanges. The concept of a trainingcontinuum for junior doctors that has a formal educational structure and acoherent training pathway beginning with a two year foundation programme iswelcomed. The alignment of Collegeexaminations with the appropriate stage of training and the emphasis on QA andconsistency in specialty assessments will bring significant benefits.
Theabsence of explicit recognition of the importance of training tomorrowsclinical academics is however disappointing.Research opportunities within training programmes are essential tofoster a cadre of future clinical researchers and teachers. The current shortage of clinical academicsis set to deteriorate further due to the demands of teaching the rapidlyexpanding medical student intake now entering hospitals and general practicesacross the country. Moreover, the increasedintensity of teaching on the four-year graduate course and the introduction ofthese new courses is also demanding on time and staff. For all these reasons, research experienceneeds to be integrated into the proposed two-phase training structure for thosejunior doctors who aspire to deliver an essential element of the NHS Plan, thetraining of tomorrows doctors.
TheCHMS sees great opportunities to address these important issues in the reformplans. Flexibility of the new trainingstructure, access to re-entry to training (for those doing PhD or MDs forexample) and the variation available in individual training programmes arewelcomed. These innovations will allowthe design of flexible training pathways to protect research time for potentialclinical academics. The CHMS would wishto work with the DoH to realise this important outcome.
Responsesto the 19 points identified in the document are set out below.
CHMS is broadly supportive of programme-basedreform but would wish to see a process, which monitors the flow of juniordoctors through the training continuum and measures the outputs.
8/9. Programme progression byassessment is supported but assessments must be based on specified outcomes foreach broad discipline, be of high quality and be competency-based.
10. Review and external accreditation of RoyalColleges examinations is supported and is, we understand, currently underdiscussion.
11. Programme directors accountable to PG Deans isagreed.
12. Support and training for trainers on the scaleproposed will require considerable resources not least due to the time lostfrom service provision, increasing numbers of female trainees and teaching ofthe expanding number of junior doctors.Has a dynamic model been constructed to study all the impacts of theproposal, especially on service delivery and displacement of the pooling ofSHOs further along the line possibly to create a new pool of career gradedoctors at a later stage?
13. Key information for trainees on programmes isessential.
14. PG Deans responsibility for programmeappointments will work well if the close relationship between the MedicalSchool and the PG Dean, enjoyed by some universities, is generalised as good practiceacross the country.
15. The SHO element of GP training programme shouldpreserve its unique features so as to encourage recruitment of GPs.
16. That the needs of non-UK qualified doctors shouldbe properly considered is agreed.
17. The need for urgent exploration of the concept ofspecialty specific run-through grades is recognised. The CHMS should be included in theconsultations so that the requirements for supporting clinical academictraining can be considered. There isconcern that implementation of this proposal may create rigidities that inhibitthe whole reform proposal.
18. The changes proposed for the CCST will shortenhigher specialist training leading to earlier opportunities for a consultantpost in a specialty. Great care willneed to be taken to ensure that these new consultants have the experience andcompetencies to act independently, particularly in the craft specialties. There is concern too that creating thesegeneralistic consultant posts will delay the completion of training for thehigher subspecialty trainees.
19. The review of the role, educational support,professional and career development should include consideration of the risk ofresolving the large pool of SHOs by increasing the flow into higher specialtyeducation. The model will, of course,require increased numbers of specialty training places. Dynamic modelling may help streamline theflow but there seems to be a long term risk of transferring the currentovercrowding in the SHO pool downstream into another pool of career gradedoctors whose re-entry into specialty training may create further logisticaldifficulties.
November 2002