Broad based training: the story so far

Why BBT?

It is well recognised that the UK’s population is ageing and that patients now have more complex and long term conditions. As a result, healthcare provision is becoming less focused on single episode care, delivered in acute hospitals, and is moving towards management of long term conditions within community settings.

The ongoing Shape of Training review has suggested that the structure of medical training needs to be more flexible to allow doctors to transfer their learning and experience between specialties and care settings.2 Allowing doctors to receive broad training in a range of specialty areas and in both primary and secondary care settings could provide this flexibility and also help doctors to work effectively in multiprofessional teams, helping the NHS to meet the challenges posed by the aging patient population.

The BBT programme aims to deliver a more broadly trained clinician—that is, a more “generalist specialist” and a more “specialist generalist”—and a practitioner who is better equipped to manage patients with complex conditions that encompass both mental and physical health.3 BBT trainees will spend six months in each of core medical training, general practice, paediatrics, and psychiatry, delivering care across healthcare boundaries and following patients on their healthcare journeys. After successful completion of the two year programme, BBT trainees will be eligible to enter any one of the four specialties at core training/specialty training year 2 without further competition.4

Local programmes

Each local BBT programme has been designed to give trainees a broad understanding of patient care across healthcare sectors. During a six month rotation, trainees spend up to 90% of their working week in a “parent” specialty and at least 10% in an integrated “minor” specialty. For example, trainees in a paediatric post may spend half a day a week in a division of one of the other three specialties that is related to paediatrics, such as child and adolescent mental health services, or following patients with long term conditions as they transfer between services, such as from paediatric to adult medical services.

Each deanery has a dedicated training programme director for BBT, and trainees have a tailored teaching programme to deliver the aims of the programme. Careers advice is available throughout the programme.

Implementation of BBT

The North Western Deanery coordinates the national recruitment process for BBT. Seven deaneries offered a total of 52 posts in the pilot in 2013:

• East Midlands

• Kent, Surrey and Sussex

• Northern

• North Western

• Severn

• West Midlands

• Yorkshire and the Humber.

A total of 429 applicants applied to BBT in November 2012 through the national general practice application process (www.gprecruitment.org.uk). The process comprises an online shortlisting stage that tests applicants on professional dilemmas and clinical problems, as well as a selection centre day that assesses candidates’ communication skills, empathy and sensitivity, conceptual thinking and problem solving, and professional integrity. Following successful progression through the general practice recruitment process, as well as through BBT shortlisting, 210 applicants were invited to attend a BBT selection centre.

The face to face selection process aimed to identify trainees who had a clear understanding of the aims of the programme. The selection day for BBT comprised four stations that tested various competencies: paediatric prescribing, evidence of suitability, clinical thinking and communication, and ethics and professionalism. Each interview panel had representatives from medicine, psychiatry, and paediatrics. A total of 43 trainees were appointed to the programme and started training on 7 August 2013.

Feedback from the 2013 intake

An online survey was sent to all 429 applicants to BBT to explore their reasons for applying and their perspectives on the recruitment process. Trainees reported that they had applied to BBT to gain broader experience of specialties before moving into specialty training. Examples include trainees aspiring to a career in general medicine who hoped to gain experience in adolescent and holistic care and others who felt that BBT would make them more well rounded general practitioners.

The additional year in training was seen as being valuable in terms of giving trainees more generic experience before choosing a particular specialty. Trainees reported that BBT would allow them to make the right decision about which specialty to choose and that they would feel better informed about which career path to choose.

Most trainees who had been through the selection process for BBT reported that they were happy with the overall process. Trainees said that the selection centre stations allowed them to demonstrate their suitability for BBT, but they would have liked more space in the shortlisting exercise to demonstrate fully their skills, knowledge, and experience. These comments have been taken on board for 2014: the word count has been increased for the shortlisting questions.

Applicants also stated that they would have liked more time in between interview stations to read the vignettes given out on the day, so we have altered the scheduling for 2014 to allow more time between stations. In addition, more information on the assessment centre format will be available for applicants in advance of the selection day.

The future

The seven deaneries who recruited to BBT in 2013 will again recruit to posts starting in August 2014, although under their new structures as education boards. The North Western Deanery, now known as Health Education North West, will once again coordinate the national recruitment process. Shortlisting will take place in December and the selection centre date is set for 30 January 2014 at the Reebok Stadium in Bolton.

This new programme is ideally structured for those trainees wishing to gain experience in integrated care provision in both primary and secondary care settings, and it will allow trainees the time to explore the different integrated specialties before moving into a chosen career pathway.

• Further information is at www.nwpgmd.nhs.uk/bbt.