Intended for healthcare professionals

Rapid response to:

Observations Medical Training

Moving the point of doctors’ registration

BMJ 2014; 348 doi: (Published 25 April 2014) Cite this as: BMJ 2014;348:g2863

Rapid Response:

Re: Moving the point of doctors’ registration

"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.
2. Collins J. Foundation for Excellence. October 2010.
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

25 April 2014
Benjamin Dean
orthopaedic registrar
Nuffield Orthopaedic Centre