The Lancet Student’s main focus is on global health but today, I want to stray from that a bit to discuss medical training in the UK as it is causing such a furore here. I would also be interested to hear about what is happening with medical training wherever you are and if your country has got it as badly wrong as the UK has in the last 5 years.

Five years ago, Modernising Medical Careers was introduced to overhaul the medical education training in the UK. It has always been controversial as there was always the accusation that it was concerned with service requirements rather than professional ones, as it drastically shortens the training time to become a specialist. But last Spring, all hell broke loose when the new online application system was implemented without being properly trialed leading to all kinds of errors and basically wrecking many medical students and doctors’ careers. The online application system was stopped- thankfully- and this latest disaster led to the Tooke Inquiry regarding the whole of Modernising Medical Careers. The final report Aspiring to Excellence: The Final Report of the Independent Inquiry into Modernising Medical Careers, is published today and is the result of a wide consultation exercise with many medical colleges, organisations, institutions, and individuals. (You can read more about the process here)

The report is highly critical of Modernising Medical Careers and has multiple (47!) recommendations about what should happen next. Right at the beginning of the report, it also clearly identifies the key issues and then sets corrective action in these areas which I think this is really helpful so I have copied them for you below. (Even if you don’t know the set up in the UK, I am think that you will be able to follow the points and I have spelled out all of the abbreviations for you.) So hopefully-at last- something will now be done to help turn around this UK medical training disaster.   Rhona

From Aspiring to Excellence: The Final Report of the Independent Inquiry into Modernising Medical Careers

Issues

1) The policy objective of postgraduate training is unclear. There is currently no consensus on the educational principles guiding medical training. Moreover, there are no strong mechanisms for creating such consensus

2) There is currently no consensus on the role of doctors at various career stages

3) Weak Department of Health policy development, implementation and governance, together with poor inter and intra departmental links adversely affected the planned reform of postgraduate training

4) Medical workforce planning is hampered by a lack of clarity regarding doctors’ roles and does not align with other aspects of health policy. There is a policy vacuum regarding the potential massive increase in trainee numbers. Planning capability is limited and training commissioning budgets are vulnerable in England now that they are held at the Strategic Health Authority level

5) The medical profession’s effective involvement in training policy-making has been weak

6) The management of postgraduate training is currently hampered by unclear principles, a weak contractual base, a lack of cohesion, a fragmented structure, and in England, deficient relationships with academia and service

7) The regulation of the continuum of medical education involves two bodies: The General Medical Council and the Postgraduate Medical Education and Training Board, creating diseconomies in terms of both finance and expertise

The structure of postgraduate training proposed by Modernising Medical Careers is unlikely to encourage o reward striving for excellence, offer appropriate flexibility to trainees, facilitate future workforce design, or meet the needs of particular groups (eg. those with academic aspirations or those pursuing non-consultant career grade experience.)

Corrective Action

1) There must be clear shared principles for post graduate training that emphasise flexibility and aspiration to excellence

2) Consensus on the role of doctors needs to be reached by the end of 2008 and the service contribution of trainees better acknowledges

3) Department of Health policy development, implementation and governance should be strengthened. The Department of Health should appoint a lead for medical education, and strengthen collaboration, particularly the health: education sector partnership

4) Workforce policy objectives must be integrated with training and service objectives. Medical workforce advisory machinery should be revised and enhanced. Strategic Health Authority workforce planning and commissioning should be subject to external scrutiny. Policies with respect to the current bulge in trainees and international medical graduates should be urgently resolved.

5) The profession should develop a mechanism for providing coherent advice on matters affecting the entire profession

6) The accountability structure for postgraduate training and funding flows should be reviewed. Revised management structures should conform to agreed principles but reflect local circumstances. In England, graduate schools should be trialled where supported locally

7) The Postgraduate medical Education and Training Board should be merged with the General Medical Council to facilitate economies of scale, a common approach, linkage of accreditation with registration and the sharing of quality enhanced expertise.

The structure of postgraduate training should be modified to provide a broad based platform for subsequent higher specialist training, increased flexibility, the valuing of experience and the promotion of excellence

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