Where on earth are we with medical training in Genitourinary Medicine?

1
Where on earth are we with medical training in
Genitourinary Medicine?

• Dr Janet Wilson
• Consultant in GU Medicine
• The General Infirmary at Leeds
• Training Programme Director, Yorkshire

2
Why do trainees go through a specific training
programme?

• To get on the Specialist Register
• In order to be appointed as a consultant the
  person must be on the General Medical Council
  Specialist Register
• By obtaining a Certificate of Completion of
  Training (CCT) a doctor gets put onto the
  Specialist Register, or
• By going on the Specialist Register through
  Article 14

3
Calman Years
Direct entry Equivalent training
Consultant
Specialist Registrar 4 years CCST (Previously
Registrar and Senior Registrar)
MRCP
MRCOG 1 year acute medicine
Medical SHO posts 2 4 years
OG SHO posts 2 4 years
Pre-Registration House Officer Post 1 year
Medical School 5years
4
Hierarchy of Specialist TrainingCalman Years
Specialist Training Authority
Royal College of Physicians Joint Committee for
Higher Medical Training
Specialist Advisory Committee in Genitourinary
Medicine
Postgraduate Dean Regional Specialty
Advisor Regional Programme Director
Educational Supervisor
Specialist Registrar
5
Hierarchy of Specialist Training with PMETB
PMETB
Royal College of Physicians Joint Committee for
Higher Medical Training
Specialist Advisory Committee in Genitourinary
Medicine
Postgraduate Dean Regional Specialty
Advisor Regional Programme Director
Educational Supervisor
Specialist Registrar
6
PMETB
Consultant
Direct entry Article 14
Specialist Registrar 4 years - CCT
MRCP
MRCOG 1 year acute medicine
Medical SHO posts 2 4 years
OG SHO posts 2 4 years
Foundation Training 2 years
Medical School 5 years
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(No Transcript)
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PMETB and MMC
Certificate of Eligibility of Specialist Training
Consultant
Specialist Registrar 4 years - CCT
MRCP
MRCOG 1 year acute medicine
Core Medical Training 2 years
OG SHO rotation 2 4 years
Foundation Training 2 years
Medical School 5years
9
PMETB and MMC
Certificate of Eligibility of Specialist Training
Consultant
Specialist Registrar 4 years - CCT
Career posts eg Staff Grade
MRCP
Fixed term specialist training posts
Core Medical Training 2 years
Foundation Training 2 years
Medical School 5years
10
Hierarchy of Specialist Training MMC
Postgraduate Medical Education Training Board
Royal College of Physicians Joint Royal Colleges
of Physicians Training Board
Specialist Advisory Committee in Genitourinary
Medicine
Postgraduate Dean Regional School of
Medicine Regional Programme Director
Educational Supervisor
Specialty Registrar
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Yorkshire Deanery

• Postgraduate Deans responsible for local delivery
  of training programme
• Yorkshire Deanery has delegated medical training
  to Regional School of Postgraduate Medicine
• Delegated GU Medicine training to Programme
  Director and Specialty Training Committee
• Programme Director relies on Educational
  Supervisors to provide day to day training and
  make assessments

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GUM Specialty Registrars

• After appointment to Specialty Registrar (StR)
  the Postgraduate Dean allocates a National
  Training Number (NTN) and gives training
  programme details
• Each trainee should be allocated a local
  Educational Supervisor (if rotation may have
  several different Educational Supervisors)
• They should enrol (on line) with the JRCPTB for
  Higher Medical Training in GU Medicine, and will
  be given access to the e-portfolio

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(No Transcript)
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RITA replaced by Annual Review of Competence
Progression (ARCP)

• Satisfactory progress
• Unsatisfactory or insufficient evidence
• Development of specific competences required
  (additional training time not required
• Inadequate progress by trainee (additional
  training time required
• Released from training programme (with or
  without specific competences)
• Incomplete evidence presented (additional
  training time may be required
• Recommended for completion of training

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Role of Assessment
There has been little guidelines about how this
should be done in the past Often was just a case
of doing time
Open to great variation in standards, so
therefore potentially unfair and potentially
dangerous if poorly performing doctors not
identified
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Assessments

• Knowledge
• PMETB has approved Dip GUM as knowledge-based
  assessment by the end of year 2
• Liverpool Dip GUM, DFFP and Dip HIV were not
  accepted by PMETB

17
Assessments

• Skills
• Mini-CEX Assessment (Clinical Evaluation
  Exercise). This is a short structured observation
  exercise taking about 20 minutes, involving
  direct observation of the trainee in a
  consultation

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Mini-CEX Assessment
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Assessments

• Attitudes and generic skills
• Multi-source feedback (MSF) these will be given
  to 20 individuals to complete. They will be sent
  back to the educational supervisor who will
  pool the results and discuss the findings with
  the trainee

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3600 assessment form
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Future assessments

• Knowledge and skills
• Case based Discussion indicates competence in
  clinical reasoning, decision making and
  application of medical knowledge in relation to
  patient care

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MTAS
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The numbers that broke MTAS in 2007

• Applicants Eligible total 27,800
• UK graduates 13,600
• IMG doctors 12,100
• Training posts Total 15,604
• Run through training 11,800
• FTSTA
  3,627
• Academic
  fellowships 177
• Acceptances UK graduates 9,800 69
• IMGs
  3,950 28
• EAA
  750 3
• England, data from MMC Programme Board October
  2007

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MTAS
MMC
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Aspiring to Excellence

• Interim Report published on 8th October 2007
• 8 key issues identified with suggested corrective
  actions
• On-line consultation now taking place on the
  recommendations at www.mmcinquiry.org.uk until 20
  November 2007

27
Findings and Corrective Action - 1

• MMC Policy objectives unclear, compounded by
  workforce imperatives
• Guiding principles lacking flexibility and broad
  based beginnings lost
• Clear, shared principles for Postgraduate
  Training that emphasise
• - flexibility
• - aspiration to excellence

28
Findings and Corrective Action - 2

• Doctor Role Clarity
• Trainees increasingly supernumerary
• Post CCT role unresolved
• against a background of deficient acknowledgement
  of what a doctor brings to the healthcare team
• Consensus on the role of the doctor needs to be
  reached by end 2008 and service contribution of
  trainees better acknowledged

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Findings and Corrective Action - 3

• Weak DH Policy development, implementation and
  governance
• Poor intra- and interdepartmental links,
  particularly healtheducation sector partnership
• DH Policy development, implementation and
  governance strengthened with Medical Education
  lead
• Healtheducation sector partnership strengthened

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Findings and Corrective Action - 4

• Medical Workforce Planning hampered by lack of
  clarity of doctor role
• Policy vacuum regarding increased numbers of
  prospective trainees FTSTAs the new lost
  tribe?
• Training budgets vulnerable now held at SHA level
• Revised medical workforce advisory machinery with
  oversight and scrutiny of SHA roles
• Policy regarding international medical graduates
  and the future career path of FTSTAs needs urgent
  resolution

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Findings and Corrective Action - 5

• Medical Professional Engagement
• Despite involvement influence weak
• The profession should develop a mechanism for
  providing coherent advice on matters affecting
  the entire profession

32
Findings and Corrective Action - 6

• Management of Postgraduate Training
• in England
• Lack of cohesion
• Suboptimal relationships with service and
  academia
• Postgraduate Deaneries should be reviewed to
  ensure they deliver against guiding principles
  (flexibility, aspiration to excellence) and NHS
  priority of equity of access
• In England trial Graduate Schools where
  supported locally

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Findings and Corrective Action - 7

• Regulation
• The split between two bodies, GMC and PMETB
  creates diseconomies (finance and expertise)
• PMETB merged within GMC offering
• Economy of scale
• A common approach
• Linkage of accreditation with registration
• Sharing of quality enhancement expertise
• Reporting direct to Parliament, rather than
  through monopoly employer

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Findings and Corrective Action - 8

• Structure of Postgraduate Training with MMC
• Lacks broad based beginnings
• Lacks flexibility
• Doesnt encourage excellence
• Non resolution of NCCG contract and FTSTA plight
• 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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Key training recommendations (1)

• FY1 doctors renamed Pre Registration Doctors
• - linked to local medical schools
• FY2 year cease in 2009, jobs move into Core
  training medicine, surgery, OG, family
  medicine etc
• Selection into one of a small number of broad
  based core specialty systems after FY1
• Core training increased to 3 years - called
  Registered Doctors
• Hybrid training of 2 years for uncommitted
• Modular curricula to aid flexibility /
  transferability

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Key training recommendations (2)

• Standardised short listing and selection
  processes across Deaneries within 2 years
• Trust registrar is the new Staff grade and must
  be destigmatised - eligible for some HST
  positions and Article 14 (CESR) route
• Entry into HST three times a year by National
  Assessment Centres

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Postgraduate training - inquiry recommendations
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Conclusions of Tooke Report

• From this damaging episode for British Medicine
  must come a recommitment to optimal standards of
  postgraduate medical education and training.
• This will require a new partnership between DH
  and the profession, and health and education.
• An aspiration to excellence must prevail in the
  interests of patients.