Carol Black On modernising medical careers

Published: 15/07/2004, Volume II4, No. 5914 Page 25

The first principle of The Next Steps, published by the Department of Health in April, is that high-quality patient care depends on sound education and training. It emphasises the explicit link between education and training and service delivery.

Given the shortage of doctors in the UK, there is pressure to shorten the period of postgraduate training necessary to achieve specialist competence, deferring some elements of specialty training until the service requires them. Therefore another aim is to require achievement of those competences and experience more efficiently and more effectively than hitherto.

Training programmes must have defined learning outcomes.

Increasingly they will be developed jointly with the specialties concerned, the trainees, patients, public and the service.

They must include a wide range of generic subjects, as expected.

What is new is the expectation that these topics be covered formally in medical education and training. However, reform has resource consequences and coincides with further implementation of the European working-time directive.

The foundation programmes will aim to allow full registration by the end of the first year and readiness for entry into specialist or general practice training during the second year (F2).

F2 programmes will be based mainly in settings that give experience of acute care, including mental health and general practice.

Selection for entry to specialist training will be competitive, beginning before the end of the foundation programme. If sound career-shaping decisions are to be made so early in training they must be supported by rigorous assessment, career counselling and mentoring.

But there are obstacles. Given the changed conditions of work and training, for trainees and those who train them, we cannot be confident that training, particularly at the specialist registrar stage, can be completed in the shorter periods now envisaged.

Trainees are also objecting to the idea of abbreviated training that might limit professional fulfilment, and are apprehensive that career flexibility and the training opportunities to make it real will be unduly subservient to service needs. Training arrangements that ensure proper professional development of doctors in non-consultant career grades will be a welcome demonstration of a commitment to full and continuing professional development for all.

There is a commitment among everyone with a part to play in improving medical education and training to equip doctors with the capability to change and adapt to meet unforeseen longer-term developments in medical science, service and practice.

In modernising medical careers there are many things we must do well. But as The Next Steps makes clear, there is still much to do.

Carol Black is president of the Royal College of Physicians.