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

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

Calman Years Consultant Specialist Registrar – 4 years – CCST (Previously Registrar and Senior Registrar) Medical SHO posts 2 – 4 years O&G SHO posts 2 – 4 years MRCP MRCOG + 1 year acute medicine Medical School – 5years Pre-Registration House Officer Post – 1 year Direct entry Equivalent training

Hierarchy of Specialist Training Calman 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

Hierarchy of Specialist Training with 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 PMETB

Consultant Specialist Registrar – 4 years - CCT Medical SHO posts 2 – 4 years O&G SHO posts 2 – 4 years MRCP MRCOG + 1 year acute medicine Medical School – 5 years Foundation Training – 2 years Direct entry Article 14

PMETB and MMC Consultant Specialist Registrar – 4 years - CCT Core Medical Training 2 years O&G SHO rotation 2 – 4 years MRCP MRCOG + 1 year acute medicine Medical School – 5years Foundation Training – 2 years Certificate of Eligibility of Specialist Training

PMETB and MMC Consultant Specialist Registrar – 4 years - CCT Core Medical Training 2 years Fixed term specialist training posts MRCP Career posts eg Staff Grade Medical School – 5years Foundation Training – 2 years Certificate of Eligibility of Specialist Training

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

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

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

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

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

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

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

Mini-CEX Assessment

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

360 0 assessment form

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

MTAS

The numbers that broke MTAS in 2007 Applicants Eligible total 27,800 UK graduates13,600 IMG doctors12,100 Training posts Total15,604 Run through training 11,800 FTSTA 3,627 Academic fellowships 177 Acceptances UK graduates 9,80069% IMGs 3,95028% EAA 750 3% England, data from MMC Programme Board October 2007

MTAS MMC

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

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

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

Findings and Corrective Action - 3 Weak DH Policy development, implementation and governance Poor intra- and interdepartmental links, particularly health:education sector partnership DH Policy development, implementation and governance strengthened with Medical Education lead Health:education sector partnership strengthened

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

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

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

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

Findings and Corrective Action - 8 Structure of Postgraduate Training with MMC Lacks broad based beginnings Lacks flexibility Doesn’t 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

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, O&G, 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

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

Postgraduate training - inquiry recommendations

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.