Broad based training is actively discouraged in UK postgraduate medical education
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1398 (Published 12 February 2014) Cite this as: BMJ 2014;348:g1398
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I read the item by Kumar with interest. It is ridiculous that we used to have a system that allowed trainees and non-trainees to both gain a broad range of experience and to explore their interests (with the decisions based on their choices not imposed by a lottery) prior to committing to a speciality yet this system was effectively destroyed by the introduction of MMC.
As someone who trained in the "old" system, I was able to choose my SHO posts in order to gain those skills and the experience that I needed and felt useful prior to settling into specialist training. I also experienced a broad range of different specialities and was able to ensure I made the right choice of career for me. There was no "rush" through training and no chance of making oneself "unselectable" as a broad training was appreciated and encouraged cf MMC and its pigeonholed approach.
A perfect example occurred the other day of the benefit of a broad training when I was able to perform a major vascular repair with a colleague who had also trained in the "old" system. There was no panic or drama as we both had the skills and technical abilities to deal with this unexpected complication. I doubt the outcome would have been so successful given the lack of experience and training in the new generation doctors. In fact, I decided to ask around and out of approximately 15 "new style" orthopaedic/neurosurgical ST3+ trainees, not one of them had any experience in vascular surgery or repair.
Doctors are bright, hard-working and motivated individuals who have worked hard to progress and it is ridiculous that the role of a reference and Consultant encouragement has been devalued in favour of "ticking boxes and stuffing bits of paper into portfolios".
Many excellent doctors who are not "paper-based" are lost to training sadly due to the intense focus on bits of paper and ludicrous competencies. We have lost sight of the fact that training is about learning skills and knowledge and being able to apply and use them whilst continuing to develop and learn new material - it is not about ticking a box, getting the certificate and moving on.
I think it is time that we revisited the system and that it was finally realised that MMC and its ridiculous "selection procedures" are not fit for purpose and are destroying training as well as not actually giving doctors the experience they want or selecting the best candidates.
At the end of the day, the division into trainee/non-trainee is artificial as all doctors have a duty to continue to learn, train and develop.
I hope that when I require medical care, the doctor treating me is not a new-style "portfolio collector" but a doctor with a broad exposure and lots of experience regardless of whether they are a "trainee" or not!
Competing interests: No competing interests
Dr. Kumar hits the nail on the head.
It is therefore perhaps unsurprising that the country's newest training scheme - broad-based training (BBT) - was the second-most oversubscribed training programme in the country in its pilot year, 2013.
BBT allows trainees to complete four 6-month posts in general practice, general medicine, psychiatry and paediatrics. Trainees may then enter non-competitively into the second year of one of these specialties' usual training programmes (GP specialty training, core medical training, core psychiatric training, and paediatric specialty training). Trainees then go on to follow the usual career paths for their chosen specialty.
BBT had a competition ratio of around 8 applicants per post. In terms of applicants-per-place, only cardiothoracic surgery was more popular in 2013. Ironically - and, outrageously - only 83% of BBT's posts were filled in its pilot year.
UK junior doctors clearly want flexible training that doesn't rush us into making premature decisions about our career paths.
Competing interests: Having completed foundation training, I am in the process of specialty training applications.
Re: Broad based training is actively discouraged in UK postgraduate medical education
This letter is all too accurate. Over the last 20 years postgraduate training in this country has become increasingly rigid, bureaucratic and tick-box based. Meanwhile, thanks in part to the EWTD which is slavishly followed here but not in most other European countries, experience has declined especially in surgical specialties. No doubt there were big drawbacks in the old approach, where junior doctors could try a number of specialties before coming to a career decision, but at least you did feel you were a member of a profession not a petty bureaucrat spending as much time with your eportfolio as with your patients.
Competing interests: No competing interests