Whilst I agree with most of Professor Sir John Tooke's
recommendations, II have concern about his proposal to decouple F1 from
F2. I have listed my concerns as questions.
1. I share Prof Tooke’s concern about guaranteeing UK Medical School
graduates core training in generic medical skills, before specialty
selection. Why did he not consider moving full registration back to the
end of F2 as this would guarantee all UK medical graduates 2 years of
employment? If this requires primary legislation then surely that could be
undertaken?
2. Can he reassure us that the motive behind splitting F1 and F2 is not so
that universities gain control of the income stream?
3. The Foundation Programme has taken 5 years of piloting and
implementation plus a huge amount of work from Foundation Programme
Directors and Deaneries (1). There have been some problems with poor
quality F2 placements in some Deaneries, partly because some were
converted trust grade posts with inadequate educational supervision, but
moving them into Core Specialty Training will not improve their quality.
Why change the part of training that was working quite well and does he
really think that Foundation Schools and Programme Directors have the
stomach for more change at this time?
4. Many universities do not place undergraduate teaching or clinical
skills training high on their list of priorities. Is he confident that
medical schools can be entrusted with F1 if it is decoupled from F2? Many
medical schools did not have a good track record in terms of generic
skills training and assessment in the PRHO year prior to the introduction
of Foundation.
5. The experience of the Foundation programme is that, with the reduction
in hours of work, one year is insufficient to ensure the competence of
doctors in core generic skills. How will he ensure that such generic skill
training is protected in Core Specialty Training? Alternatively the final
year of medical school training may have to become even more clinically
orientated. The lack of competence in core generic skills is something
that will concern the Medical Directors of all Trusts.
6. One deficiency of the Foundation Programme was the lack of a nationally
ranked ‘exit’ exam at about 18 months, which could have been used to
inform specialty selection. If F1 is decoupled from F2, selection into
Core Specialty Training will have to occur at about 6-8 months after
graduation. Won’t this be too close to Finals and risk ‘exam’ overload?
Wouldn’t it be more sensible to ensure that Medical School Exams are
standardised and ranked so that they can contribute to specialty
selection? One of the problems of selection into the existing Foundation
Programme is this lack of equivalence.
7. What will be the criteria for selection into Core Specialty Training?
Presumably the computer adaptive tests that he refers to will map to the
F1 syllabus and the potential for specialty training?
8. One of the key aims of the 2 year Foundation Programme was to give more
opportunity for young doctors to gain work experience in more specialties,
before having to make a career decision. This has proved very successful
for some ‘less popular’ specialties, as well as primary care. Won’t there
be less rather than more time for career decisions if doctors have to
choose a Core Specialty after only one year?
9. What happens to those doctors who make the wrong choice of Core
Specialty? What are his plans for inter-specialty transfer and the
recognition of cross-competencies? His suggestion of hybrid rotations will
be regarded as ‘second-class training’ by many specialties. A limited
number of broad-based Core Specialties will help to address this problem.
1. Developing an education and assessment framework for the
Foundation Programme. Beard JD, Strachan A Davies H, Patterson F, Stark P,
Ball S, Taylor P, Thomas S.
Medical Education 2005; 39: 841-851
Competing interests:
Foundation Programme Director
Rapid Response:
Questions for Professor Sir John Tooke
Whilst I agree with most of Professor Sir John Tooke's
recommendations, II have concern about his proposal to decouple F1 from
F2. I have listed my concerns as questions.
1. I share Prof Tooke’s concern about guaranteeing UK Medical School
graduates core training in generic medical skills, before specialty
selection. Why did he not consider moving full registration back to the
end of F2 as this would guarantee all UK medical graduates 2 years of
employment? If this requires primary legislation then surely that could be
undertaken?
2. Can he reassure us that the motive behind splitting F1 and F2 is not so
that universities gain control of the income stream?
3. The Foundation Programme has taken 5 years of piloting and
implementation plus a huge amount of work from Foundation Programme
Directors and Deaneries (1). There have been some problems with poor
quality F2 placements in some Deaneries, partly because some were
converted trust grade posts with inadequate educational supervision, but
moving them into Core Specialty Training will not improve their quality.
Why change the part of training that was working quite well and does he
really think that Foundation Schools and Programme Directors have the
stomach for more change at this time?
4. Many universities do not place undergraduate teaching or clinical
skills training high on their list of priorities. Is he confident that
medical schools can be entrusted with F1 if it is decoupled from F2? Many
medical schools did not have a good track record in terms of generic
skills training and assessment in the PRHO year prior to the introduction
of Foundation.
5. The experience of the Foundation programme is that, with the reduction
in hours of work, one year is insufficient to ensure the competence of
doctors in core generic skills. How will he ensure that such generic skill
training is protected in Core Specialty Training? Alternatively the final
year of medical school training may have to become even more clinically
orientated. The lack of competence in core generic skills is something
that will concern the Medical Directors of all Trusts.
6. One deficiency of the Foundation Programme was the lack of a nationally
ranked ‘exit’ exam at about 18 months, which could have been used to
inform specialty selection. If F1 is decoupled from F2, selection into
Core Specialty Training will have to occur at about 6-8 months after
graduation. Won’t this be too close to Finals and risk ‘exam’ overload?
Wouldn’t it be more sensible to ensure that Medical School Exams are
standardised and ranked so that they can contribute to specialty
selection? One of the problems of selection into the existing Foundation
Programme is this lack of equivalence.
7. What will be the criteria for selection into Core Specialty Training?
Presumably the computer adaptive tests that he refers to will map to the
F1 syllabus and the potential for specialty training?
8. One of the key aims of the 2 year Foundation Programme was to give more
opportunity for young doctors to gain work experience in more specialties,
before having to make a career decision. This has proved very successful
for some ‘less popular’ specialties, as well as primary care. Won’t there
be less rather than more time for career decisions if doctors have to
choose a Core Specialty after only one year?
9. What happens to those doctors who make the wrong choice of Core
Specialty? What are his plans for inter-specialty transfer and the
recognition of cross-competencies? His suggestion of hybrid rotations will
be regarded as ‘second-class training’ by many specialties. A limited
number of broad-based Core Specialties will help to address this problem.
1. Developing an education and assessment framework for the
Foundation Programme. Beard JD, Strachan A Davies H, Patterson F, Stark P,
Ball S, Taylor P, Thomas S.
Medical Education 2005; 39: 841-851
Competing interests:
Foundation Programme Director
Competing interests: No competing interests