Rigid medical training needs radical overhaul to provide trainees with more flexibility and patients with doctors who can care for multiple health conditions, the GMC’s plan for training has revealed.
The plan follows a review of training which Jeremy Hunt, the secretary of state for health, asked the GMC to carry out during the contract dispute in 2016, an analysis which heard from trainees, trainers, patients and the medical colleges and faculties.
The GMC was told the current approach to training is out of date and in urgent need of reform. The inflexible approach to postgraduate training is caused partly by the complexity of training structures.
Many of the 66 specialties and 32 subspecialties develop their training requirements in isolation from each other. While there are inherent differences between specialties, this creates barriers for trainees who seek to change specialty. The same structures limit the ability of postgraduate training to adapt to a changing population and service needs.
The plan identifies five key barriers to improving training flexibility:
- Transferring between specialties is difficult without doctors going back to the start – often referred to as the ‘snakes and ladders’ effect. This is caused by the complex legal framework controlling UK postgraduate training
- Training in other ways is not recognised – work overseas and experience gained in non-training grade posts are not counted;
- More career support is needed to help doctors who want to refocus their training without starting from square one;
- Postgraduate training is slow to adapt to changes in patient demand
- Rigid training structures can make rota gaps worse.
Charlie Massey, Chief Executive of the GMC, said:
“The way that medical training has developed in the last 30 years has contributed to the low morale that doctors in training continue to experience. The actions that we set out in our report can make a meaningful difference to the professional lives of doctors and the choices they make about their careers. But ultimately it is patients who will benefit the most from these changes.”
“We are ideally placed to drive these changes forward but we cannot deliver more flexibility and choice for doctors on our own. We need all bodies involved in the delivery of UK medical education to work with us and be as determined as we are to deliver this ambitious vision. If postgraduate training in the UK looks the same in five years’ time, then we will have failed trainees and we will have failed patients.”
In Adapting for the future, the GMC proposes a seven-point plan geared to delivering more flexible training:
- Training will be organised by outcomes rather than time spent in training
- Related specialties curricula, will share common outcomes and elements
- The GMC will reduce the burden of its approval system so that medical colleges and faculties can make changes to postgraduate curricula more quickly
- The GMC will work with others to promote mechanisms which already exist to help trainees change training programmes – such as the Academy of Medical Royal Colleges’ Accreditation of Transferable Competences Framework
- The GMC will ask the UK government to make the law less restrictive so that we can be more agile in approving training
- The GMC will support doctors with specific capabilities or needs
- The GMC will encourage national education bodies to continue to improve the work-life balance of trainees.
The GMC, which has overseen postgraduate training in all four countries of the UK since 2010, will require training to focus more on the generic professional capabilities common to all doctors. Medical specialties will be asked to work together to identify aspects of their training that are common across related areas of practice, enabling doctors to switch specialties more easily.
The GMC will now work with the Academy, the medical colleges and faculties, the national education bodies, and professional organisations of the four UK countries to develop the plans further.