Postgraduate training needs to be more flexible, says GMC

Postgraduate medical training needs to be more flexible to allow doctors to move between specialties more easily, the General Medical Council has said.

In its report State of Medical Education and Practice in the UK the regulator recommends that postgraduate training should undergo a “fundamental” review next year to ensure that trainees can transfer between specialties in response to changing patterns of healthcare demand.

“Specialties will grow or decline depending on what patient demand is. We’ve got to have an approach that reflects the needs of the healthcare system,” said Niall Dickson, chief executive of the GMC. “There’s not much point in producing types of doctor that aren’t actually required in the numbers required previously.”

The current training structure makes it difficult for trainees to transfer between specialties if they find that they are better suited to another discipline or if workforce requirements change, says the report. The system should be amended so that it can adapt to changing demand and accommodate changing career choices of individual trainees, it suggests.

The GMC also recommends that trainees be aware of a possible mismatch between their preferences, the opportunities available, and the workforce needs of the health service and that they should “balance their ambitions with realistic expectations of those specialties which continue to be over-subscribed.”

“We have shortages in some specialties at the moment, which is a problem,” said Mr Dickson. “Those coming through medical school and the foundation programme at the moment have to be aware that in some specialties there will be very high competition for places, and that may affect their career choices.”

The GMC’s report also highlights the negative effect that the European Working Time Directive and other pressures on service delivery are having on the time available for training.

“The worry that we have is that as resources become more constrained, there may be more pressure on trainers and their ability to supervise trainees and to give time for training,” said Mr Dickson. “We absolutely understand the difficulties that people running frontline services have, but we have a duty to ensure that trainees are protected and that we do train the next generation of doctors appropriately.”

• State of Medical Education and Practice in the UK is at www.gmc-uk.org/publications/10471.asp.