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NEWS ROUNDUP: Roger Dobson Continental doctors take up top posts in UK heart medicine and surgery BMJ 2004; 329: 702-d [Full text]

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Academic physicians are affected by specific failures of postgraduate training

Hamish S Fraser   (29 September 2004)

Academic physicians are affected by specific failures of postgraduate training 29 September 2004
Hamish S Fraser, Academic physician/Medical informatics Specialist Brigham and Womens Hospital, 75 Francis Street, Boston, MA, 02115, USA Send response to journal: Re: Academic physicians are affected by specific failures of postgraduate training	The article by Roger Dobson "Continental doctors take up top posts in UK heart medicine and surgery" describes an important but not surprising situation. The refusal of the postgraduate training system to train more than a few cardiologists in the 90s has had serious repercussions for the provision of cardiac care in the UK. Nine years ago when I moved to the US there were more consultant cardiologists in one of 7 or 8 major teaching hospital in Boston than in the whole of Scotland! It could be argued that the greatest need just now is to get clinical cardiologists and surgeons into post as soon as possible. This will obviously reduce the flow into the academia, compounded by the incentive of gold. In addition the UK specialist training system remains rigid and perverse. New specialties such as my own, medical informatics, struggle to take hold in hospitals as it is very hard to take the risk of stepping off the career ladder to complete novel research training (which ideally needs to be done when young). In the US and some European countries, medical training is modular - a 3 or 4 year residency leads to a registerable qualification to practice. Academic physicians can "bolt on" fellowships in research or clinical work relatively interchangeably. Often research training is also done as an undergraduate in the US. In the UK 7 or 8 years of clinical work and the MRCP or FRCS counts for virtually nothing. Exciting research requires risk taking and a new vision, but the 9-10 year monolithic training system sets up such individuals to fail. It is no coincidence that with short modular training in general practice the UK leads the world in primary care informatics, but its hospitals require massive and risky investment to catch up. Competing interests: None declared