Career Focus

Flexible training as a specialist registrar

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7055.2 (Published 24 August 1996) Cite this as: BMJ 1996;313:S2-7055

Part time training is becoming a mainstream option in the specialties. Patricia Scriven, an associate dean with responsibility for flexible training, outlines the rules.

Flexible (part time) training has been available to a few doctors for many years, but only recently has it has become a recognised option. Initially organised ad hoc, part time posts for doctors could be arranged, but in practice very few regions bothered, Oxford being a notable exception. In 1979 a new national scheme allowed senior registrars to train part time. It was bureaucratic and slow but the scheme enabled more doctors throughout the country to complete their higher specialist training.

Following the report of the “Working Party on Flexible Training” in 1994, two schemes were introduced. One replaced the previous scheme for senior registrars, the second extended flexible (part time) training to career registrars. This was accompanied by central funding and was very successful. The main drawback was that it was so popular in some specialties (anaesthetics, obstetrics and gynaecology, paediatrics, and psychiatry in particular) that waiting lists were created because there were limited places in each specialty. In 1995 the waiting list for staffing approvals was removed. Unfortunately this coincided with a shortage of funding, as limited central resources had been transferred to each region. Some regions were unable to fund all their flexible trainees and some waiting lists still exist.

For senior house officers, no central scheme exists. The numbers of flexible senior house officer posts vary from region to region, but most are actively trying to increase them, especially via job sharing schemes for vocational trainees in general practice.

Two recent surveys demonstrate the dramatic increase in flexible trainees nationally. If more funding had been available even more doctors would be training part time. There are wide regional variations, with proportionately more flexible (part time) trainees in regions where that have had more part-time trainees previously. One reason for this may be that greater awareness of the possibility of training part-time in these regions means more doctors have applied.

Almost all regions in England have appointed associate deans to take responsibility for flexible training. Many more doctors are aware of the flexible training schemes and demand continues to increase. Most flexible trainees are women, and the commonest reason for wanting to work part time is responsibility for small children. Relatively few men have opted for flexible training, but as with women, caring for children is the commonest reason. Disabled children can cause tremendous problems for parents attempting to combine a job with childcare. Reducing workload to part time may allow parents to cope. Ill health or disability may be another reason for working part time.

In December 1995 career and senior registrars in radiology and surgery were the first doctors to become specialist registrars. The changeover to Calman training will be completed within the next six months for all disciplines. The Guide to Specialist Registrar Training confirms that flexible training remains an alternative to full time, and contains a whole section on flexible training.

Eligibility

Trainees with a “well founded” individual reason will be considered eligible for flexible training. The commonest reasons are responsibilities for small children, ill health, and disability. The postgraduate deans, or their associate deans with responsibility for flexible training, can use their discretion to decide what is “well founded.” This can allow doctors who would have been excluded from previous schemes (because of rigid entry criteria) to be included now. Trainees apply to the region in which they wish to work, and all regions should have an information sheet on the procedure for flexible appointments.

Current flexible senior registrars and career registrars should be able to transfer automatically to a flexible specialist registrar post. The exception is psychiatry, where entry is restricted to senior registrars and those who have obtained the MRCPsych.

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All specialist training posts are equally open to those who wish to train full time or flexibly, and this should be stated in the advertisement. Doctors can start as flexible trainees at the beginning or transfer from full time to flexible (or vice versa) during training. All training programmes should include programmes for both full time and flexible trainees.

The same appointments procedure applies to both full time and flexible trainees.

Selection process

Most regions arrange for the full advisory appointment committee to attend a short listing meeting. The best candidates will be selected using the submitted curriculum vitae only. This procedure must be fair and reasons for why a candidate is, or is not, short listed are recorded.

Once the short listed applicants have been chosen, areas of questioning at the subsequent interview are decided. Each candidate should be questioned in the same broad areas to allow fair comparison.

At interview, candidates do not have to reveal that they wish to train flexibly although many may wish to do so. Only after the successful candidate has been appointed to the grade is it permissible to ask whether the appointee wishes to train flexibly or full time.

Once the interviews are completed, the interview committee will select the best candidates according to the numbers of training opportunities available and issue national training numbers as appropriate. Again the reason why individual candidates were not successful must be recorded.

If eligibility, funding, and placement arrangements for flexible training can be confirmed at the time of appointment it may be possible to appoint an extra doctor. The next best candidate can be appointed, and an extra national training number awarded.

The Guide to Specialist Registrar Training says that flexible trainees should start soon after appointment. If a suitable flexible training placement is unavailable the candidate can be asked to wait until one becomes vacant. If this is necessary the trainee will be given the choice of working full time as a specialist registrar until a vacancy occurs, staying in the present grade with the national training number reserved, or waiting.

If either of the latter two are chosen another candidate can be appointed to the programme and issued with a national training number. If this person chose part time working there would be the opportunity to job share in the initial post in the programme.

During training

Try to give postgraduate deans (or associate deans) as much notice as possible of any planned change between flexible and full time status. This allows time for a training post to be created or to arrange for the trainee to fill the next available slot. The trainee retains their national training number.

Flexible trainees will need to continue training for longer than full timers to be eligible for a certificate of completion of specialist training. For example, those working 20 standard hours (i.e. 50% of full time) will need to work twice as long. Those working more than 20 standard hours could qualify for a CCST in a shorter time pro rata.

Overseas doctors

Overseas doctors without the right of indefinite residence can apply to train flexibly, provided they satisfy the criteria for eligibility. However they cannot expect to have an extension of their “permit free” training on the grounds that they are training flexibly.

The present immigration rules allow doctors four years of “permit free” training, with a possible extension of a further year. This is usually too short a time for an overseas doctor to complete a full training programme. This may cause overseas doctors to be ineligible for entry as they will be unable to complete the training programme for a type 1 appointment, so in practice, the immigration rules restrict overseas doctors to a fixed term type 2 training appointment.

A Guide to Specialist Registrar Training NHS Executive, Department of Health 1996.

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