1. health and fitness

Where on earth are we with
medical training in
Genitourinary Medicine?
Dr Janet Wilson
Consultant in GU Medicine
The General Infirmary at Leeds
Training Programme Director, Yorkshire
Why do trainees go through a
specific training programme?
• To get on the Specialist Register
• In order to be appointed as a consultant the
person must be on the General Medical
Council Specialist Register
– By obtaining a Certificate of Completion of
Training (CCT) a doctor gets put onto the
Specialist Register, or
– By going on the Specialist Register through
Article 14
Calman Years
Direct entry
Equivalent training
Consultant
Specialist Registrar – 4 years – CCST
(Previously Registrar and Senior Registrar)
MRCP
MRCOG + 1 year acute medicine
Medical SHO posts
2 – 4 years
O&G SHO posts
2 – 4 years
Pre-Registration House Officer Post – 1 year
Medical School – 5years
Hierarchy of Specialist Training
Calman Years
Specialist Training Authority
Royal College of Physicians
Joint Committee for Higher Medical Training
Specialist Advisory Committee in Genitourinary Medicine
Postgraduate Dean
Regional Specialty Advisor
Regional Programme Director
Educational Supervisor
Specialist Registrar
Hierarchy of Specialist Training
with PMETB
PMETB
Royal College of Physicians
Joint Committee for Higher Medical Training
Specialist Advisory Committee in Genitourinary Medicine
Postgraduate Dean
Regional Specialty Advisor
Regional Programme Director
Educational Supervisor
Specialist Registrar
PMETB
Direct entry
Article 14
Consultant
Specialist Registrar – 4 years - CCT
MRCP
MRCOG + 1 year acute medicine
Medical SHO posts
2 – 4 years
O&G SHO posts
2 – 4 years
Foundation Training – 2 years
Medical School – 5 years
PMETB and MMC
Certificate of Eligibility
of Specialist Training
Consultant
Specialist Registrar – 4 years - CCT
MRCP
MRCOG + 1 year acute medicine
Core Medical Training
2 years
O&G SHO rotation
2 – 4 years
Foundation Training – 2 years
Medical School – 5years
PMETB and MMC
Certificate of Eligibility
of Specialist Training
Consultant
Specialist Registrar – 4 years - CCT
Career posts eg Staff Grade
Fixed term specialist
training posts
MRCP
Core Medical Training
2 years
Foundation Training – 2 years
Medical School – 5years
Hierarchy of Specialist Training
MMC
Postgraduate Medical Education Training Board
Royal College of Physicians
Joint Royal Colleges of Physicians’ Training Board
Specialist Advisory Committee in Genitourinary Medicine
Postgraduate Dean
Regional School of Medicine
Regional Programme Director
Educational Supervisor
Specialty Registrar
Yorkshire Deanery
• Postgraduate Deans responsible for local delivery
of training programme
• Yorkshire Deanery has delegated medical training
to Regional School of Postgraduate Medicine
• Delegated GU Medicine training to Programme
Director and Specialty Training Committee
• Programme Director relies on Educational
Supervisors to provide day to day training and
make assessments
GUM Specialty Registrars
After appointment to Specialty Registrar (StR)
the Postgraduate Dean allocates a National
Training Number (NTN) and gives training
programme details
Each trainee should be allocated a local
Educational Supervisor (if rotation may have
several different Educational Supervisors)
They should enrol (on line) with the JRCPTB for
Higher Medical Training in GU Medicine, and
will be given access to the e-portfolio
RITA replaced by Annual Review of
Competence Progression (ARCP)
Satisfactory progress
Unsatisfactory or insufficient evidence
Development of specific competences required (additional
training time not required
Inadequate progress by trainee (additional training time
required
Released from training programme (with or without specific
competences)
Incomplete evidence presented (additional training time may
be required
Recommended for completion of training
Role of Assessment
There has been little guidelines about
how this should be done in the past
Often was just a case of “doing time”
Open to great variation in standards, so
therefore potentially unfair
and potentially dangerous
if poorly performing doctors
not identified
Assessments
Knowledge
• PMETB has approved Dip GUM as
knowledge-based assessment by the end of
year 2
• Liverpool Dip GUM, DFFP and Dip HIV
were not accepted by PMETB
Assessments
Skills
• Mini-CEX Assessment (Clinical Evaluation
Exercise). This is a short structured
observation exercise taking about 20
minutes, involving direct observation of the
trainee in a consultation
Mini-CEX Assessment
Assessments
Attitudes and generic skills
• Multi-source feedback (MSF) – these will
be given to 20 individuals to complete.
They will be sent back to the educational
supervisor who will “pool” the results and
discuss the findings with the trainee
0
360
assessment form
Future assessments
Knowledge and skills
• Case based Discussion – indicates
competence in clinical reasoning, decision
making and application of medical
knowledge in relation to patient care
MTAS
The numbers that broke MTAS in 2007
Applicants
Eligible total
UK graduates
IMG doctors
27,800
13,600
12,100
Training posts
Total
15,604
Run through training 11,800
FTSTA
3,627
Academic fellowships 177
Acceptances
UK graduates
IMGs
EAA
9,800
3,950
750
England, data from MMC Programme Board October 2007
69%
28%
3%
MTAS
MMC
Aspiring to Excellence
• Interim Report published on 8th October 2007
• 8 key issues identified with suggested
corrective actions
• On-line consultation now taking place on the
recommendations at www.mmcinquiry.org.uk
until 20 November 2007
Findings and Corrective Action - 1
•
•
•
MMC Policy objectives unclear, compounded by
workforce imperatives
Guiding principles lacking flexibility and ‘broad
based beginnings’ lost
Clear, shared principles for Postgraduate
Training that emphasise
- flexibility
- aspiration to excellence
Findings and Corrective Action - 2
Doctor Role Clarity
• Trainees increasingly supernumerary
• Post CCT role unresolved
 against a background of deficient acknowledgement of what a
doctor brings to the healthcare team
• Consensus on the role of the doctor needs to be
reached by end 2008 and service contribution of
trainees better acknowledged
Findings and Corrective Action - 3
•
•
Weak DH Policy development, implementation and
governance
Poor intra- and interdepartmental links, particularly
health:education sector partnership
•
DH Policy development, implementation and
governance strengthened with Medical Education
lead
•
Health:education sector partnership strengthened
Findings and Corrective Action - 4
• Medical Workforce Planning hampered by lack of
clarity of doctor’ role
• Policy vacuum regarding increased numbers of
prospective trainees; FTSTAs – the new lost tribe?
• Training budgets vulnerable now held at SHA level
• Revised medical workforce advisory machinery with
oversight and scrutiny of SHA roles
• Policy regarding international medical graduates and
the future career path of FTSTAs needs urgent
resolution
Findings and Corrective Action - 5
Medical Professional Engagement
• Despite involvement influence weak
•
The profession should develop a mechanism for
providing coherent advice on matters affecting
the entire profession
Findings and Corrective Action - 6
Management of Postgraduate Training
in England
•
Lack of cohesion
•
Suboptimal relationships with service and
academia
•
Postgraduate Deaneries should be reviewed to
ensure they deliver against guiding principles
(flexibility, aspiration to excellence) and NHS
priority of equity of access
•
In England trial ‘Graduate Schools’ where
supported locally
Findings and Corrective Action - 7
Regulation
• The split between two bodies, GMC and PMETB
creates diseconomies (finance and expertise)
PMETB merged within GMC offering:
• Economy of scale
• A common approach
• Linkage of accreditation with registration
• Sharing of quality enhancement expertise
• Reporting direct to Parliament, rather than
through monopoly employer
Findings and Corrective Action - 8
Structure of Postgraduate Training with MMC
• Lacks broad based beginnings
• Lacks flexibility
• Doesn’t encourage excellence
• Non resolution of NCCG contract and FTSTA plight
•
The structure of Postgraduate Training should be
modified to provide a broad based platform for
subsequent higher specialist training, increased
flexibility, the valuing of experience and the
promotion of excellence
Key training recommendations (1)
• FY1 doctors renamed Pre Registration Doctors
- linked to local medical schools
• FY2 year cease in 2009, jobs move into Core training –
medicine, surgery, O&G, family medicine etc
• Selection into one of a small number of broad based
core specialty systems after FY1
• Core training increased to 3 years - called Registered
Doctors
• Hybrid training of 2 years for “uncommitted”
• Modular curricula to aid flexibility / transferability
Key training recommendations (2)
• Standardised short listing and selection
processes across Deaneries within 2 years
• “Trust registrar” is the new Staff grade and
must be destigmatised - eligible for some
HST positions and Article 14 (CESR) route
• Entry into HST three times a year by
National Assessment Centres
Postgraduate training - inquiry recommendations
Conclusions of Tooke Report
From this damaging episode for British
Medicine must come a recommitment to
optimal standards of postgraduate medical
education and training.
This will require a new partnership
between DH and the profession, and health
and education.
An aspiration to excellence must prevail in
the interests of patients.