Subspecialisation is threatened by Shape of Training review, BMA warns
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1881 (Published 08 April 2015) Cite this as: BMJ 2015;350:h1881Subspecialisation is under threat if the recommendations of a major review of postgraduate medical education and training are implemented, the BMA has warned.
The UK-wide Shape of Training review, carried out by David Greenaway, vice chancellor of Nottingham University, recommends that most clinicians should have a generalist qualification and says that employers should be responsible for subspecialty training.1
However, Paul Flynn, chair of the BMA’s Consultants Committee, noted fears that “employers might not see the big picture in terms of subspecialty training . . . it might take a long time for consultants to prove to the employer that they need a subspecialist in a particular area.”
He said that the BMA was concerned that “the hard won benefits of subspecialisation could risk being lost again because we are just churning out generalists who can’t keep up with all specialties.”
Andrew Collier, co-chair of the BMA’s Junior Doctors Committee, said that he was concerned by the review’s suggestion that specialist areas of medicine could be delivered as “add-on” credentials rather than through structured training programmes.
“One of the reasons structured training programmes were developed was to match patients’ needs and professional needs. To atomise those training programmes would be to lose something that’s great about postgraduate medical training,” he said.
As well as introducing uncertainty within the profession, Collier said that the reforms could mean that people would view the new training structure as inferior to the existing one. “A generalist approach to training could potentially ‘dumb down’ medicine,” he warned. “While we need doctors who have a broad knowledge, this should not be at the expense of losing specialist knowledge.”
Collier added that all clinicians should be aware of the review’s recommendations but also that no agreement had yet been reached on what changes would be implemented.