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UK should train more generalists and give all trainees full GMC registration, says review

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6557 (Published 29 October 2013) Cite this as: BMJ 2013;347:f6557
  1. Abi Rimmer
  1. 1BMJ Careers

The UK should train more generalist doctors and extend full registration with the General Medical Council to all trainee doctors, a major review of postgraduate medical education and training has concluded.

The UK-wide “Shape of Training” review, led by David Greenaway, vice chancellor of Nottingham University, has made a wide range of recommendations on how UK medical training should develop.1 It said that some changes should be implemented immediately, such as forming a UK-wide group to deliver the changes, while others should be completed within two to five years.

The review was jointly sponsored by the Academy of Medical Royal Colleges, the GMC, Health Education England, and the Medical Schools Council, among others. It looked at five areas: the balance of the medical workforce; flexibility of training; breadth and scope of training; balance between service and training; and needs of the patient.

The review concluded that postgraduate training needed to adapt to prepare medical graduates for delivering “safe and effective” general care and that general care should continue to be given within specialty areas. “A key element of postgraduate training will be to produce doctors capable of caring for patients more holistically, even if they end up working in a focused practice area,” the review said.

The review also recommended that full GMC registration should move to the point of graduation from medical school, “provided there are measures in place to demonstrate graduates are fit to practise at the end of medical school.”

It suggested that on completion of their postgraduate training doctors should be awarded a certificate of specialty training, rather than the certificate of completion of training (CCT). For example, a GP would get a certificate of specialty training (general practice), and a general surgeon would get a certificate of specialty training (general surgery).

The review also proposed that specialties be grouped together under “patient care themes” with common clinical objectives, such as women’s health or child health. The delivery group should consider how these themes would “bridge the boundary between hospital and community care,” it said.

In addition, it recommended that doctors also be given the opportunity to spend up to a year working in “a related specialty or undertaking education, leadership or management work” at any time during their training. This would “allow them to gain wider experiences that will help them become more rounded professionals,” the review said.

To reduce the “stress and intensity of the workload” in acute and emergency care, it recommended that all doctors should be able to manage acutely ill patients with multiple comorbidities within their broad specialty areas. Training more doctors to manage acute and emergency cases could also “break the vicious cycle” that is created by too few trainees entering acute and emergency care because it was “perceived as too stressful.”

Commenting on the review, Greenaway said, “Patients’ needs are changing fast, and we need to ensure that medical training keeps pace. Today’s report sets out a framework for delivering this. It will ensure that the training doctors receive continues to be of the highest standard and meets the increasingly complex demands of future medical care.”

Peter Rubin, the GMC’s chairman, welcomed the recommendations for more flexible training of doctors. But he said that some recommendations, such as awarding doctors full GMC registration on graduation from medical school, would need further discussion. “The key is to ensure that we are able to make steady progress towards these reforms while maintaining some stability in a system that has already been subject to a great deal of change and pressure in recent years,” he said.

Kitty Mohan, co-chair of the BMA’s Junior Doctors Committee, said that the BMA supported the idea of broad based training but that there were “less disruptive” ways of achieving it than the recommendations made in the review. The BMA also had concerns about the proposal to move full GMC registration to the end of medical school and a recommendation to move highly specialised skills outside postgraduate training, Mohan said.

Dean Royles, chief executive of NHS Employers, said that the review would be an important factor in the current negotiation of doctors’ contracts. He said that employers generally favoured the move towards broad based training proposed by the review and its plans to better involve patients and employers in doctors’ training.

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