We recently hosted a meeting where junior doctors and a range of organisations from across the UK came together to explore how we can make postgraduate training more flexible. In this blog Professor Terence Stephenson, our Chair, reflects on the experiences of trainees, now and then, and how we’ll take forward this important work.
Many of today’s doctors in postgraduate training feel very disaffected and I find it very sad to see them so frustrated and disenchanted. Talk to trainees in any part of the UK and they are demoralised and alienated. I’ve recently come back from visits to Belfast, Edinburgh and Cardiff; doctors in the early stages of their career in all these countries feel the same way.
You can’t attribute these issues purely to an employer-employee dispute, as the only country of the UK in which there is a formal contractual dispute is England. Clearly there are a range of other things going on here – and one of the issues is the rigid way postgraduate training is organised and managed.
Although I acknowledge it is now a long time ago, and medicine then was less intense but certainly not perfect, I remember well what it was like to be a doctor in postgraduate training. There were the incredibly long hours, having to adapt fast to cope with stressful situations, all the while trying to cram in as much knowledge and learning as possible. It was pretty scary – but it was also stimulating and exciting and I felt motivated and a valued part of the health service.
I contrast that feeling of being valued with my recent visits round the UK where I heard from a trainee who, in his last rotation, got the news of where he would be training the day before he started. Another spoke of applying for leave for his brother’s wedding three times and being told he would not get an answer until six weeks before.
There has to be a better and fairer way to train our next generation of clinicians and medical leaders.
Working collectively to find solutions
The inflexible nature of training has been a legitimate concern for years and it was because of the urgent need to address the problem that I agreed the GMC would conduct a review of the situation.
The idea to conduct a review came about during the ACAS-hosted negotiations between the BMA and employers in England earlier this year. We were asked if the GMC would lead this project, with the aim of identifying ways in which doctors in training could move more flexibly between postgraduate training programmes.
I agreed to take it forward on the basis of two things. Firstly, that it was not part of the contractual dispute – the GMC has no role to play in the negotiations. And secondly, because we are a four-country regulator, any recommendations we make would have to be applied across all four nations – England, Northern Ireland, Scotland and Wales.
This is an opportunity to collectively examine the scope for greater flexibility so that doctors are supported better as they go through their postgraduate training.
As part of the review we wanted to hold a roundtable event where we could have an exploratory discussion, where everyone present – doctors in training and the organisations responsible for planning and delivering their training – was given the chance to speak their mind and make a contribution.
The aim was to consider key policies already being developed, identify issues still to be addressed, look for common ground, and reflect on how we can drive collective change which promotes and enhances flexibility through training in the UK. There was wide participation from organisations from across the UK. Some of the issues they raised included:
- Educational issues – challenges when transferring from one specialty to another
- Lifestyle issues – what organisations could do from a workforce perspective to recognise the wishes of doctors in training to have different work patterns
- Patient issues – how flexibility is needed to support diverse and well-rounded doctors which helps provide safe, effective care for patients
We will now go away and put together a stock-taking paper, which we will later share to ensure we have captured all the important issues raised at the roundtable. This will lead to a report to be delivered by the end of March 2017, which will identify the key areas for development to enhance flexibility in doctors’ career pathways. It will also reference the wider developments from the workforce and service perspective which may support flexibility.
Those of my generation wanted to improve postgraduate training to produce doctors with all the attributes needed for sound patient care by adding more structure into training – while avoiding the ridiculous hours we suffered. While this improved the quality of training and patient care in many ways it made some things worse, because it introduced a new problem – lack of flexibility. This was not deliberate but we need to take responsibility and take this chance to make things better.
One thing was clear from the roundtable discussions – all those present were committed to finding proactive, helpful solutions to the current problem. I am hopeful we will achieve this together.
Professor Terence Stephenson is Chair of the General Medical Council
The Shape of Training Review (external page)