Career Focus

The core curriculum for senior house officers

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7054.2 (Published 17 August 1996) Cite this as: BMJ 1996;313:S2-7054

Professor John Wass, director of the training office at the Royal College of Physicians in London unveils a new medical grimoire*

I sometimes wonder how many junior doctors, newly registered after that “in-at-the-deep-end” year as a house officer, wander around the wards feeling like the sorceror's apprentice—wanting to learn so much, yet not knowing which elements to concentrate on and hoping for an illicit peek at the book of magic spells which will make everything clear. It has certainly become increasingly clear to the Sorceror, charged with the responsibility of educating this comparatively raw recruit, that the time-honoured apprenticeship system of medical training should be improved by a more structured approach and better supervision. This is particularly true in the post-Calman era, where the emphasis is firmly placed on the preparation for entering specialist training, coupled in some cases with a reduced period of general training.

With this in mind, the Royal College of Physicians of London has just produced its first core curriculum for senior house officers in medicine—not a book of magic spells exactly, but an outline of the knowledge, skills and attitudes that should be developed and acquired during the period of general professional training. This is part of an ongoing programme to improve the accessibility of the college to junior doctors, to give them a clearer picture of what their training is expected to cover, and, importantly, who is responsible for their supervision and guidance.

It will also help them to distinguish between educational supervisors, college tutors and associate tutors, regional advisers and others responsible for postgraduate training—names, titles and roles which are all too easy to confuse when you are working up to 72 hours a week and getting to grips with new clinical situations, let alone trying to find out who can help you with a particular training difficulty.

Example: Renal Medicine

Clinical situations

Acute renal failure, chronic renal failure, management of hypokalaemia and hyperkalaemia, investigation of abnormal dipstick urine analysis

Topics

Fluid balance and electrolytes: recognition of under and over hydration, causes, consequence and treatment, constitution of and indications for common intravenous fluid solutions.

Acid-base: recognition and emergency diagnosis and treatment of metabolic acidosis, respiratory acidosis, metabolicacidosis

Acute renal failure: definition, differentiation between ‘pre-renal, renal and post-renal’ common causes, assessment of severity, non-dialytic therapy, indications for dialytic therapy

Chronic renal failure: Knowledge and understanding of the natural history, causes and mechanism underlying

Dialysis: modalities available, indications for acute and chronic renal replacement therapy, recognising problems with dialysis in patients with renal disease: understanding incidence, common aetiological factors

Diagnosis of renal function: screening, urine testing—dipsticks/microscopy, serological testing, appropriate use of renal imaging techniques Diabetic nephropathy: incidence, stages, microalbuminuria, management, early and late

Hypertensive and renovascular disease: incidence, natural history, diagnosis, antihypertensive management (to include drugs)

Urinary tract infections: microbiology, diagnosis, investigation, management

Glomerulonephritis: primary, secondary

Nephrotic syndrome: aetiology, complications

Inherited renal diseases

Effect of drugs on renal function

Effect of deranged renal function on drugs Renal biopsy: indications, requirements for, and complications

Practical skills for all senior house officers

Assessing patients' hydration status

Basic urinemicroscopy

Developing the curriculum

The college had been wary of producing a curriculum for senior house officers in medicine, on the grounds that this would have to incorporate the whole of medicine. However, it became increasingly obvious that there was a need for guidance, and the college training office, working very closely with the specialty committees, specialist societies and the Faculty of A&E Medicine, have completed the core curriculum over a six month period. Many individual physicians involved in postgraduate education had produced their own curricula which were studied carefully by the college and proved invaluable in the development of our own.

Not a magic wand

The core curriculum should not be seen as a curriculum for the MRCP (UK) examination. Although the experience contained within the curriculum will help doctors gain part of the knowledge required, the MRCP (UK) may test a wider body of knowledge and experience. As a set of guidelines, it is intended to be neither exhaustive nor prescriptive, but provides a clear indication of the range of subject areas which would reasonably make up a training and educational programme for all SHOs in medicine and for those passing through the various sub-specialties of medicine.

The working environment

Before getting to grips with clinical aspects of the curriculum, the document gives useful general information on the process of evaluation of training posts and the sort of working environment that senior house officers can expect. The kind of teaching and educational supervision are specified, as are the standards of accommodation, catering, and security to which SHOs are entitled.

Generic skills, general goals

Whether in medicine or another specialty, there are some skills which are needed by all senior house officers: the clinical, managerial, and analytical skills which will all enable the senior house officer to play a full part as a professional team member. To these generic skills need to be added basic scientific knowledge of epidemiology, recognition of social and ethical issues in healthcare, understanding the nature of professional etiquette, and, importantly, awareness of the psychosocial as well as biological factors in the assessment and management of patients. As senior house officers are often hard pressed, they need to be able to recognise both stress and personal limitations and know when to seek advice. The skills and goals reached at this level will provide a solid grounding for a career in any specialty.

Specific clinical skills

The clinical aspects of the curriculum are divided up into two distinct sections—the first, for all senior house officers in general internal medicine covers the ground required in each specialty. This is divided up into clinical situations, topics and practical skills for all senior house officers.

The core of each unit was initially produced by the relevant college specialty committee with subsequent help from colleagues such as college tutors and individual physicians.

The second section is for senior house officers in posts within a specific specialty, and is again divided into topics and practical skills. This means that there are two entries for most specialties, one in the core unit, with the second entry providing an additional list of material for senior house officers who are actually doing a post in that specialty. The second section also includes accident and emergency medicine, intensive care, and rehabilitation medicine.

Lastly, the document includes a further reading list, together with a list of useful addresses, and a reprint of the General Medical Council's “Attributes of the Independent Practitioner” first published in Tomorrow's Doctors. The core curriculum was produced in time for the new intake of senior house officers this August, and copies are being sent to college tutors, associate tutors' and postgraduate deans. Since the document became available some trusts and doctors involved in education have bulk ordered copies of it, a sign that there is demand for this information.

We hope to receive a lot of feedback on the core curriculum, which will be revised over the next twelve months. We need to know how useful it is both to senior house officers and those responsible for their education, and how it could be improved. I hope we have got it right, for although it may not provide a magical overnight solution to the need for a structured approach to senior house officer training, it should help both sorcerors and apprentices in their thirst for knowledge.

The core curriculum for senior house officers is available from the Education Office, Royal College of Physicians, price £3.50 including postage and packing.

*a grimoire is a magician's book of spells

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