The Academy of Medical Royal Colleges recently published new guidance for doctors in training who move from one specialty to another. Mark Dexter, the GMC’s Head of Strategic Policy Development (Education), explains why making postgraduate medical education more flexible is so important.
A lot of water has passed under the bridge since the industrial action by doctors in training in England during 2015 and 2016. Contracts were the spark, but the dispute also highlighted other deep-seated issues affecting doctors that needed to be addressed.
One of those was the lack of flexibility in their training, the so-called ‘snakes and ladders’ effect of having to start again at the bottom if a doctor decided to move between training in one specialty to another.
Following the dispute, the then Secretary of State for Health, Jeremy Hunt, asked the GMC to review training. We did, and we listened to the views of trainees, trainers, patients and medical colleges and faculties.
While the industrial action only involved doctors in England, frustration at too-rigid training structures was something we heard consistently across all four UK nations.
And it went beyond just frustration. Too many doctors were being lost to the profession, storing up potential future workforce challenges, because they couldn’t develop their careers in ways that suited them.
Doing something about it was among the actions and commitments we set out in our Adapting for the future report in 2017. We asked the Academy of Medical Royal Colleges (AoMRC) to review its arrangements to support trainees who felt that they would be better suited to another specialty and so wished to transfer.
It’s been a complex piece of work. As is often the case in medical education and training, what can seem relatively straightforward on the surface becomes much more challenging once you get into the detail.
It’s been a partnership between us, the AoMRC and other organisations. The hard work of many people was rewarded in June when the AoMRC published new Guidance for flexibility in postgraduate training and changing specialties.
It means doctors in training can now move between specialties, without losing recognition for the work they’ve already completed. They’ll no longer have the disincentive of the unpalatable prospect of having to repeat aspects of training that are common to both.
The implementation of this guidance will address both general principles, and those which are specific to certain specialties.
There’s never a one-size-fits-all of course. For many doctors training progression in a single specialty works well, and for those doctors there is no need to change and they’re not disadvantaged at all.
But this new guidance will make things better. It will enhance the experience of training, make it easier for doctors to broaden their experience of different specialties, and to develop their careers in ways that are tailored to their own strengths, preferences and circumstances. All that while making sure patients continue to receive high quality and safe care.
On its own it’s no panacea. This is only a part of our wider educational reforms which have seen the introduction of outcomes-based training and the review of flexibility in postgraduate training. For example, we have restated our commitment to less than full time training, updated our policy for doctors wishing to step on to UK training and receive a CCT through the CESR combined programme, and issued comprehensive guidance on support for trainees with health and disability issues.
There is more to be done, by the GMC and others, to continue to improve the flexibility doctors have during their training. But this is another important step in the right direction.