Drawing a line under MMC

1. Drawing a line under MMC

3. Why MMC? • To deal with the SHO bulge, the lost tribe • To mop up the 7,000 a year output of British graduates to meet the NHS plan

4. What was wrong? • BST took five and a half years • SHOs were no longer surgical trainees, but rota fodder • Medical Schools do not teach basic sciences particularly anatomy

5. What was right? • The end product is of a high standard • The mix of generalist/emergency and sub-specialist training is “fit for purpose” • The Intercollegiate Exam is fair and relevant

6. PMTEB Principles • Training to be “seamless” after F2 • Progress to be based on “competence” not experience • These principles defined MMC

7. PLANNED PROGRESSIVE SURGICAL TRAINING A cost-effective alternative Advantages No change to MRCS or FRCS Use of valid, robust, reproducible examinations No development costs Six years without examination Measured development of curriculum with assessments and competencies Minimal disruption of training A full year of SHO surgical training Early career decisions Resource Requirement PGY 3 STEP Course with intensive supervised training and career advice Training support for PGY 4-9 with STEP Course development Development of sophisticated interview techniques to guide trainee to correct appointment Development of sophisticated quality assurance Post CCT Mentored training Career doctors with surgical responsibilities Yearly appraisal Duties designated by competency attainments Post CCT Mentored training Optional training selection Consultant appointment CCT FRCS and Consultant interview Year according to competency PGY 9 500 trainees MRCS distinction PGY 8 500 trainees Selection by competency PGY 7 500 trainees Overseas Existing SHOs PGY 6 500 trainees PGY 5 500 trainees PGY 4 500 trainees Career change MRCS and Specialist interview PGY 3 F3 SURGERY PGY 2 F2 GENERIC Current non-training grade surgeons PGY 1 F1 GENERIC Graduation Medical School RCG Russell 10.09.04

10. Postgraduate training – Inquiry recommendations Postgraduate trainee Medical student ‘Stand Alone’ Practitioner Pre-registration doctor Registered Doctor Specialist Registrar Specialty assessments at selection centres Competitive selection process with limits Optional higher credentialling/sub- specialty exams Computer adaptive tests Medical Degree Full GMC registration CCT Core Speciality Training Medical School Specialist Consultant F1 • 1 year • Attends ‘Graduate’ school • Guaranteed place for UKMG • Linked to medical • school ‘Higher specialist Training’ PMETB CESR • Several Core Specialty stems • 3 years (fixed term) • 6 x 6 month positions • May interrupt training for up to 12 months • Integrated ‘Masters’ programmes available • - Research • - Education • - Management • - Global health Trust Registrar • Trust Registrar position • Routes for higher specialist Training * stems include for example Medicine, Surgery, Diagnostic, ‘Hybrid’ and GP training. NB the term ‘specialty’ has no formal legal significance in these examples GP • GP Registrar

11. 1 year House Jobs 3 years Basic Surgical Training 6 years HST 1 year Foundation 3 years Core Specialty Training 6 years Specialist Training A Re-Badging Exercise

12. A College View We endorse with enthusiasm the return to Core and Specialty Training with two selection points

13. Reasons for Uncoupling • Better informed career selection • Selection on performance in the chosen specialty • The historic 10% per annum drop out in BST

14. The End of Permit Free Training One of the Biggest Changes ever to hit UK Medicine

15. 7,000 Medical Graduates • Careers for all • But not necessarily in what you want to do

16. What does the College Want? • A service staffed by fully trained specialists called consultants and by those training to be consultants • This means more consultants but probably the same number of trainees

17. Why MMC? • To deal with the SHO bulge, the lost tribe • To mop up the 7,000 a year output of British graduates to meet the NHS plan

18. What would we have done in 2002, if asked? • Too many applicants for too few jobs • Too long a wait to get into specialty training

19. Solutions • Reduce the number entering core training, which will limit competition for Specialty Training places • Set a block for aspirants, based either on number of applications or time in core training

20. College Questionnaire August 2010 Appropriate Structure • Run through training after Foundation - 5.4% • A period of core training in the generality of surgery followed by competitive entry to specialty training at ST3 - 93.5% • No opinion - 1.1%

21. College Questionnaire August 2010 Length of Core Training • 2 years - 29.4% • 3 years – 69.2% • No opinion – 1.4%

22. College Questionnaire August 2010 Should there be a limit on how long/how many times a doctor will be allowed to continue to apply for specialty training after completing core? • Yes - 54.3% • No - 40.9% • Don’t know - 4.8%

23. College Questionnaire August 2010 Appropriate Competition Ratio • 3.4% Less than 1.25 to 1 • 9.6% 1.25 - 1.5 to 1 • 33.6% 1.5 - 2 to 1 • 42.2% Above 2 to 1 • 11.2% No opinion

24. College Questionnaire August 2010 • Everybody wants a Core/Specialty Split • More than two thirds want three years of Core • A majority favours a limit on applications • The most favoured competition ratio is 2 to 1

25. How to draw the line • Three years of Core for all • Core entry numbers set for for a competition ratio of up to 2 to 1 • This needs about the current number of Core posts, with a one off increase to help those in limbo

26. How to draw the line • National Selection, or at the very least to National Standards • No absolute limit on the number of applications, but properly worded Job Specifications • More recognition of training and flexibility for those who do not succeed