Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Foundation Programme and "run through" period for doctors in training
- Rafey A Faruqui, Alia Faruqui (14 June 2004)
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SHO Training: Difficulties on the ground.
- Mohammad A Hussain (17 June 2004)
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A firm foundation for senior house officers
- Alan M Leaman (19 June 2004)
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Re: A firm foundation for senior house officers
- Chris M Laing (19 June 2004)
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A firm foundation for general practice?
- Robin Christie (22 June 2004)
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Lost Time
- Ashar Wadoodi (4 September 2005)
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Rafey A Faruqui, Specialist Registrar and Hon. Research Fellow West London Mental Health NHS Trust &Imperial College London,Charing Cross Campus,W6 8RF, Alia Faruqui
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We agree with Gallen & Peile (2004) that the foundation programme for Senior House Officer (SHO) training offers an opportunity to reshape the delivery of health care. Development of a future medical workforce, possessing a wider range of general medical competencies in recognizing and managing acutely sick patients is a highly desireable target. However, proposal to create a shorter specialist training period raises the fear of inappropriate development of specialist competencies at the end of the "run through" period. The authors'statement about incomplete work on the development of tasks, such as curriculum development, competency framework and assessment methods highlights another worrying sign. Learning oppurtunities for work based learning are crucially dependent on the way in which work is organized and allocated; and that in turn is dependant on prevaling assumptions about the competence of the people involved (Eraut,1994). In order to establish a competency based training system, core competencies of educational and clinical supervisors also need to be established and supported through training and mentoring. Quality assurance procedures of postgraduate training may benefit from ethos and lessons from quality assurance work in the higher education sector with an emphasis on consumer entitlement, accountability and externality. Foundation programme may be based on the principles of good practice and current expert opinion but the end point of improved patient care would only be realized if this programme is appropriately supported by competent educational supervisors and a robust and transparent quality assurance system. References: 1 Gallen D, Peile Ed. A firm foundation for senior house officers. BMJ 2004;328:1390-1 2 Eraut, M.Concepts of competence and theirlimitations. In Developing Professional Knowledge and Competence,pp 163-181. London: Falmer, 1994 Competing interests: Alia Faruqui is aspiring to find a placement in Foundation Training Programme |
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Mohammad A Hussain, PRHO Medicine University Hospital Birmingham NHS Trust, B29 6JD
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Dear Editor, I would like to thank Gallen and Peile for their informative editorial about the future of medical training. (1) The authors hit the nail on the head when they said "doctors in training need to be convinced of the benefits of the new scheme". Myself a doctor in training, I definitely need to be convinced of these benefits, especially as I try to plan the career ahead of me. I am finding this difficult due to a number of reasons. Firstly, there seems to be a general confusion among current PRHO's and SHO's about the new scheme. The confusion is increased by of the number of pilot Foundation Year 2 (F2) posts beginning this August. There is, for example, a question mark over whether there will be run through courses available for doctors completing their F2 in August 2005 or whether they need to go back down the familiar traditional routes. It also seems likely that at some point the situation will occur where newer graduates will be completing their training at the same time or even sooner than those how graduated a few years ahead of them. Apart from seeming unfair, there are concerns about a possible bottleneck effect. There are also a lot of questions to be answered with regard to current specialty training and how it will integrate with the new scheme during the transitional period. The effects on each individual specialty could be more easily accessible. Change is never easy, especially so for those whom it affects directly. Let us hope that "those who will deliver this agenda" can communicate it effectively with those that need it most. Competing interests: None declared |
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Alan M Leaman, Consultant in emergency medicine Princess Royal Hospital, Telford TF1 6TF
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Dear Sir The article by Gallen and Peile (1) signals anything but a firm foundation for training senior house officers. To those of us involved in a pilot foundation programme two things have become apparent. Firstly, that the F1 year will essentially be an extension of undergraduate training, it's doctors allowed only to observe medical practice. Secondly that in respect of the F2 year these doctors will be 'career tourists', spending too little time in each speciality to be able to provide much in the way of useful service in return. Medical educationalists should understand that nurses and other para- medical groups are happily encroaching on traditional medical practice, and do not seem to need the sort of extended training we demand of our medical students. For example a 6 week course apparently enables paramedics to safely administer almost all drugs used in emergency medical practice. By contrast we seem intent on postponing the time at which our bright and enthusiastic young doctors can start treating patients. Five years is quite long enough to learn the theory of medicine. After that the sooner young doctors are allowed to start treating patients, albeit in supervised circumstances, the better. Of course the best way to learn medicine is by apprenticeship, with junior doctors treating patients alongside senior colleagues (who have time to teach). Naturally such an approach does not figure prominently in the new system Alan M Leaman Consultant in Emergency Medicine (1) Gallen D, Peile E. A firm foundation for senior house officers. BMJ 2004; 328: 1390-1 Competing interests: None declared |
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Chris M Laing, Specialist Registrar Nephrology and General/Internal Medicine Hammersmith Hospital, Du Cane Road, London
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Editor Myself and many of my colleagues in the acute medical specialities have growing concerns about trends in junior doctor training. There is further concern that the proposed reforms will exacerbate rather than alleviate what is a deteriorating situation. The last decade has seen nothing less than a collapse in the competencies of junior-grade doctors. Previously junior house officers would rapidly aquire emergency medicine skills by being supervised participants in on-call ward cover and acute-takes. They would then consolidate these skills and aquire considerable responsibilities in the SHO grades. The current situation is that juniors are now often sheltered from clinical responsibility until the registrar grade. An early result of this has been that on-site medical competency has been extremely thin on the ground in out-of-hours and emergency settings. A worse scenario is now emerging - that registrar grade entrants themselves are ill equipped to deal with emergencies due to lack of SHO grade exposure. Intensive care outreach, increased tertiary or sub-speciality referrals and the appointment of acute medicine consultants may absorb some of this experience deficit but this nonetheless represents a worrrying threat to patient safety which, in the face of increasing worloads, is unlikely to be sustainable. Is it really desirable to devalue and underutilise such a large pool of motivated, capable junior doctors and undergraduate medical trainees? It is likely that the foundation year will become a two-year JHO year and extend this process further. One might contrast this with the US situation where final year medical students are inducted into clinical responsibility in their "clerkship" year. This poverty of expectation is not progressive but utterly regressive and is creating a cadre of under- utilised, frustrated, demoralised juniors and inexperienced middle graders. JHOs and SHOs should be becoming progressively more competent and enabled, not the reverse. Competing interests: None declared |
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Robin Christie, GP Portmill Surgery,Hitchin
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The Modernising Medical Careers initiative is an excellent concept and provides the potential to improve the recruitment and retention crisis in primary care by exposing young doctors to a general practice environment. However, I am concerned that the general practice component may flounder due to lack of support from Deaneries,Primary Care Trusts and Workforce Development Confederations. For the scheme to get off the ground, the development of the educational supervisor and Associate Trainers roles needs to be encouraged so that foundation year 2 doctors can have an appropriate and well supported experience in primary care that can enable attainment and proper assessment of the foundation competencies. Although there is enthusiasm in both training and non-training practices, there is a lack of commitment from the WDC and Deaneries to properly resource training programmes for educational supervisors and associate trainers. In addition, for many practices, there is an issue around space and accomodation for F2 doctors that needs to be urgently addressed. I suspect PCTs do not yet fully understand the importance of engaging with and enthusing F2 doctors in order to promote future recruitment to general practice. Unless these resourcing issues are properly addressed, then the general practice component of modernising medical careers is unlikely to become established. Competing interests: None declared |
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Ashar Wadoodi, Vascular Research Fellow St Thomas' Hospital
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Dear Sir, Having been involved in several of the discussions and deanery teachings surrounding the foundation training scheme, I congratulate you on its intention. My fear is that better assessment of junior staff does not in self compensate for a reduction in training time within the limits of the new EU(european union) regulations. At the same time as we are reforming training so that it can be completed in a shorter space of time, we are also reducing training intensity. This overhall will surely lead to doctors who will find it difficult to cope in situations that in anyway move out of their realm of training. I myself have gone through the old SHO(senior house officer) training system and although some of the training I recieved may eventually become obsolete in my chosen career path, I have no doubt that it has made me into a better doctor. Medicine is much more than a science which can be learned merely by formal instruction, it has to be experienced. By removing experience from training I feel we may be headed for doctors who can talk the talk but may not be able to walk the walk. Competing interests: None declared |
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