Moving the point of doctors’ registration
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2863 (Published 25 April 2014) Cite this as: BMJ 2014;348:g2863
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What a sensible analysis of an issue which has suffered from some very muddled thinking. A medical school degree is valueless if the holder is unable to proceed to postgraduate training, irrespective of whether registration is provisional or full. It is fantasy to imagine that there will be career opportunities for fully registered doctors who have no further training, no matter what changes are made to the medical school curriculum. Medical students want the education that will allow them to pursue a career: registration is an early step on the educational pathway, not an end in itself. Though there may be valid reasons for moving the point of registration, Niall Dickson is right that solving the challenges of medical workforce planning is not one of them.
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"The two year foundation programme was introduced in 2005 (as part of the Modernising Medical Careers programme) and has had broad support, reflected in Aspiring to Excellence (the report of John Tooke’s independent inquiry into Modernising Medical Careers) in 2008..."
I read this particular part of Niall Dickson's piece with great interest and am far from convinced that the Foundation programme has had broad support. The Tooke review found many problems within Foundation training including the fact that a “sub analysis of the e-consultation response from 398 FY2 doctors revealed that 60% did not feel that the year had added value over and above further patient exposure”(1) and consequently recommended that “Foundation Year 2 should be abolished as it stands but incorporated as the first year of Core Specialty Training”. Professor John Collins’ subsequent review of Foundation training in 2010 detailed numerous significant concerns including the “assessment of Foundation doctors is considered to be excessive, onerous and not valued’, and concluded that “the lack of an agreed purpose and of prospectively collected evaluative data made it difficult to accurately quantify how successfully the Foundation Programme is delivering against these objectives” (2). A survey that I organised also demonstrated clear failings in the Foundation Programme including a lack of acute emergency exposure for FY1 trainees (3). It appears strange that Niall Dickson equates the above with ‘broad support’.
I must add that the true motives of the Shape of Training Review are not yet known. I have requested documentation from the GMC relating to the motives behind Professor Greenaway’s review under the Freedom of Information Act:
“Has the Chair of the review (Prof Greenaway) discussed the review with any ministers/civil servants? If so may I see the documentation of these meetings and who was involved?”
Strangely the GMC are blocking this request, using a public interest argument for withholding this vital information. This is particularly strange for an organisation that claims as one of its five core organisational values “We are honest and strive to be open and transparent”. The emerging consensus opinion of the medical profession appears to be that the Shape of Training Review is highly flawed and the public deserves to see all the information that may shed light on the true motivations behind such a review.
1. Tooke J. Aspiring to excellence: findings and final recommendations of the independent inquiry into Modernising Medical Careers. Jan 2008. www.medschools.ac.uk/AboutUs/Projects/Documents/Final%20MMC%20Inquiry%20...
2. Collins J. Foundation for Excellence. October 2010.http://www.mee.nhs.uk/pdf/401339_MEE_FoundationExcellence_acc.pdf
3. Dean BJ, Duggleby PM. Foundation doctors' experience of their training: a questionnaire study.JRSM Short Rep. 2013 Jan;4(1):5. doi: 10.1258/shorts.2012.012095. Epub 2013 Jan 14.
Competing interests: No competing interests
Re: Moving the point of doctors’ registration
Niall Dickson clearly identifies several major problems with the proposal to move the point of full registration to the end of the undergraduate course.
Undergraduate schools will also encounter major difficulties. Currently their final examination measures what students can do as students. What they will actually do as doctors remains somewhat conjectural. If graduation leads to full registration then schools will need both to ensure that final year students play a much more active role in the care of patients than heretofore and to measure and judge that activity. Indeed much has been attempted over many years to do just that, nevertheless the transition to F1 remains fraught.
Perhaps there is an opportunity here to rethink the relationships between the schools and the employing authorities, between training and education, between preparation for the next job and preparation for a life of change. Perhaps something important was lost when postgraduate deans and the F1 year ceased, in practice, to have much connection with medical schools.
Could we make the final undergraduate year, F1 and perhaps F2 a true continuum in both education and training to which both the schools and the employers would contribute? A good start would be to ensure that the next versions of the GMC’s Tomorrow’s Doctors and The New Doctor were better articulated than at present.
Perhaps final year students should have an employment contract and receive a small salary thus clarifying their role in the workplace (F1 salaries could be reduced to keep the change cost neutral). This would stop students being sent home after hours with the phrase, ‘you’re a student; you don’t need to be here’. Perhaps any assessment at the end of F2 could be a Master’s degree? EU employment law might have much to say about some of this but current political imperatives are for change, perhaps much change.
Overall there needs to be a better understanding between medical schools and NHS employers about their relative strengths and weaknesses, roles and responsibilities. The GMC is perhaps best placed to facilitate this.
Competing interests: No competing interests