Intended for healthcare professionals


New arrangements for specialist training in Britain

BMJ 1995; 311 doi: (Published 11 November 1995) Cite this as: BMJ 1995;311:1242
  1. John Biggs
  1. Postgraduate dean University of Cambridge Clinical School, Addenbrooke's Hospital, Cambridge CB2 2SP

    Guidance notes for implementing the specialist registrar grade

    In 1993 the Calman report set out to revise specialist medical training.1 It recommended a curriculum for each specialty, structured training programmes, progression through training based on formal annual assessments of competence, and much shorter training in most specialties. Medical royal colleges and postgraduate medical deans would share in the planning and delivery of a new system to start by the end of 1995. On time, and after extended effort by the colleges, deans, and members of the NHS Executive, the new specialist training is to start for general surgery and clinical radiology in December and for all other specialties between April 1996 and April 1997.

    Guidance notes for implementing higher training in the new system were released last week. The notes focus on arrangements for transferring present trainees to the new specialist registrar grade during a transition period, which should last less than a year for most specialties. Career registrars and senior registrars will be eligible for transfer, as will many in research training. Overseas doctors, defined as those who are not nationals of countries in the European Economic Area, will be able to transfer, depending on their rights of residency or available permitted time for postgraduate training in Britain. After the transition period overseas doctors without rights of residency will be able to enter the specialist registrar grade, the only limits being the availability of approved training programmes and funding. There will be an early need for colleges to define what they will accept in terms of overseas experience and qualifications for entry to the grade.

    The notes describe a major innovation--fixed term training appointments--that will appeal to many overseas doctors. Appointments of six to 24 months' duration will be available for those without permanent resident rights in Britain and are aimed at providing planned programmes of specific training at a level equivalent to that of the specialist registrar grade. Fixed term training appointments will fill gaps in specialist registrar programmes and are aimed at replacing the often unplanned and unstructured “locum” appointments. University departments, subspecialty units, and others keen to offer training are expected to seek participants through international competition. Fixed term training appointments of shorter duration will be open to trainees with rights of residency in Britain and may be credited to subsequent specialist registrar training.

    The notes describe procedures for entry to the specialist registrar grade when the transition period for a specialty is complete. There are new requirements for providing information to applicants; a new application process; and new standards for shortlisting applicants, obtaining references, and convening appointment panels. These will improve objectivity and fairness in appointments and will also test the resources and staff of postgraduate deans, who will be responsible for recruiting people to the new grade.

    A feature of the new training is the emphasis on rigorous assessment of progress against defined criteria. Colleges will provide detailed descriptions of methods and standards, and these will be made available to both assessors and trainees. The outcome of reviews of progress will be monitored by colleges, and a summary report will be held by the postgraduate dean. Evidence that effective training has taken place will lead to recognition of a trainee's competence and skill and a recommendation to the appropriate authority that a certificate of completion of specialist training should be awarded.

    An aspect that will be new to many is the introduction of training agreements between the trainee, postgraduate dean, and the hospital trust or trusts where training is to take place. The notes give principles rather than final detail but speak of key elements, including the structure and aims of the training programme and the standards of achievement expected of the trainee; an explanation of the methods and frequency of assessment; a commitment by consultants to regular in service tuition; and protected time for trainees to study and be trained. There will also be a commitment from the trainee to take an active part in the training.

    A new system of national training numbers, to be maintained by the postgraduate deans, will keep track of where trainees are in their programmes and will allow the national needs for new consultants to be balanced against the numbers of trainees in each specialty. In the transition period deans will allocate to each eligible trainee a national training number from a quota determined nationally for each specialty. They will then allocate numbers to each newly appointed specialist registrar.

    As the Calman report makes clear, specialist training begins at full registration. The guidance notes spell out the process of implementation for the higher, second part of specialist training. An important recommendation of the report, on which advice is still awaited, concerns general professional training--that taken in the senior house officer grade. As progress is made in the higher level programmes, advance is urgently needed on the earlier, foundation part of specialist training.