Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
News could be better- more consultant numbers are needed
- Asrar Rashid (28 March 2000)
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Experience of SpRs undergoing Calman Training
- G M Addison (29 March 2000)
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Re: Experience of SpRs undergoing Calman Training
- E Paice (30 March 2000)
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Is training better?
- P B Goodfellow (3 April 2000)
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Discrepancies in shortlisting for Orthopaedic Specialist Registrars in the United Kingdom
- Ben J Davis, Birender Kapoor, Anjani K Singh, and Nicola Maffulli (16 October 2002)
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Asrar Rashid, Specialist Registrar Birmingham Heartlands Hospital
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Dear Editor I agree that there have been improvements in postgraduate teaching because of calman reforms1. I also agree that all consultants should take an active role in this process. However in some specialities the envisaged expansion of consultant numbers has not occurred. As a result consultants are being hard pressed to balance their clinical time with hospital management, teaching, audit and clinical governance. In the speciality of paediatrics consultants are expected to play an active role in oncall duties. Therefore making time outside clinical duties is mandatory but difficult. More consultant numbers may be a part of the solution? 1. Catto G. Specialist registrar training. BMJ 2000;320:817-818. |
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G M Addison, Consultant Chemical Pathologist Royal Manchester Children's Hospita;
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In the editorial by Catto and the accompanying article it was claimed that SpRs do not think that they were getting inadequate experience. On what grounds could they make this observation? Surely they can only judge the adequacy of the experience they have had during training by either direct comparison with undergoing the old registrar/senior registrar training or alteratively evaluating it after practicing as a consultant for the first few years. Clearly the former is not possible. There was a lot wrong with pre-Calman days but as a potential patient I have considerable concerns that doctors are becoming consultants with a minimum of experience. Training may be better organised, trainees are clearly happier but what needs to be added is some mechanism for quantifying what individual SpRs have been exposed to and perhaps prolonging training in those with less than adequate practical exposure. |
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E Paice, Dean Director TPMDE
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Dr Addison is right to say that the SpRs in the survey were not in a position to compare the experience they were getting in their training with that contained in old-style training or that needed for a consultant post. They were not asked those questions, only 'How would you rate the hands-on experience acquired in this post?' on a scale of 1=very poor to 5=excellent. The ratings were slightly higher in the second survey (mean 3.88 vs 4.00, p<0.001). It would be wrong to deduce from this that the total experience gained in the training programme as a whole was more satisfactory. The study did not address the programme as a whole, only the current post. |
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P B Goodfellow, SpR Surgery Chesterfield and North Derbyshire Royal Infirmary
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Dear Sir In response to the editorial by Graeme Catto I have two points to make. Firstly I would agree that there has undoubtedly been a revolution in medical training, but whether this produces better doctors remains to be seen. Undergraduates do have a reduced “burden” of factual knowledge and spend more time on many aspects of information acquisition, communication, curiosity and public health. However the undergraduates now spend much reduced times with each clinical firm, and often express no particular involvement with a “firm” they are attached to for a short period (often only a week). This has repercussions on the acquisition of clinical skills. A recent (yet to be published) study of new graduates before starting house jobs revealed that more than 50% had performed two or less of a group of basic clinical skills (arterial blood gas, per rectum examination, male catheterisation, ECG and nasogastric tube insertion). In addition less than 50% of house officers finishing their house year had received any further training in these skills, yet performed them on a weekly basis. This highlights the concern that we should be training undergraduates not only as doctors capable of finding appropriate knowledge sources, but also equipping undergraduates with the appropriate basic skills to be house officers. Secondly, regarding training specialist registrars, some specialities have long recognised the value of a sufficient “apprenticeship”, and if training were now universally adequate, would there still be debate on “junior consultants”. Yours sincerely P B Goodfellow |
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Ben J Davis, Orthopaedic Research Fellow North Staffordshire NHS Trust, Hartshill Road, Stoke-on-Trent, ST4 6QG., Birender Kapoor, Anjani K Singh, and Nicola Maffulli
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Editor, Catto’s editorial regarding Specialist Registrar training was subtitiled “Some good news at last” 1. However, despite guidelines issued by the Joint Committee of Higher Surgical Training (JCHST)2 regarding the selection of candidates for addition to the Orthopaedic Specialist Register, it is apparent that wide variation in requirements exists on a regional basis. We contacted the 14 Orthopaedic deaneries in the UK and obtained details of eight person specifications and five shortlisting scoring systems. Three deaneries declined to assist us, four had no scoring system, and the remainder, despite assurances, failed to pass their details to us. The common requirements amongst the deaneries were GMC registration, a medical degree, basic training and a postgraduate qualification. Essential experience in Orthopaedics varied from 6 to 18 months, with one deanery classing 6 months post-membership experience as essential. While 3 deaneries required A & E experience, the remainder did not. Three deaneries required ATLS as essential, three as desirable and two made no mention. Interestingly, two deaneries included ATLS instructor status either as desirable, or in their scoring system. To be eligible for ATLS instructor status, you must be an SpR or equivalent. Completion of a fracture fixation course was listed as essential by one deanery, desirable by one, and not mentioned by the remainder. Arthroscopy and plastering courses were also desirable at one deanery. All deaneries included audit, teaching and research experience to varying degrees, from involvement in, to completion of research projects. For teaching, anywhere from informal teaching of juniors, to specific evidence of teaching medical students was requested. Higher degrees were listed as desirable by all but one deanery, but the points awarded depend on the type of degree (MD / PhD scores higher than BSc), and the class (1st / 2nd). Requirement for publications varies markedly, from evidence of publication, to peer-review journal publication as essential. Striking findings on the scoring systems included completion of a teaching qualification (8% of available marks) and a position on a national committee (5%). Massive variation exists between the deaneries and therefore, the chance of successful entry to the Specialist Register will vary on a regional basis. Ironically, junior doctors are victims of their own desire to succeed. As we strive to better ourselves to stand out from the crowd, we raise the expectations placed upon us. However, room exists to improve the present situation and make the selection process fairer to all. References 1. Catto G. Specialist registrar training. BMJ 2000; 320: 817-818. 2. A manual of Higher Surgical Training in the United Kingdom and Ireland. Joint Committee on Higher Surgical Training. Seventh Report, July 1999. |
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