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Aspiring to excellence

Aspiring to excellence

“To deal with many of the deficiencies identified and to ensure the necessary concerted action, the creation of a new body, NHS:Medical Education England (NHS:MEE) is proposed. NHS: MEE will relate to the revised medical workforce advisory machinery and act as the professional interface between policy development and implementation on matters relating to PGMET. It will promote national cohesion in England as well as working with equivalent bodies in the Devolved Administrations to facilitate UK wide collaboration. The Inquiry has charted a way forward and received a strong professional mandate. The Recommendations and the aspiration to excellence they represent must not be lost in translation. NHS:MEE will help assure their implementation”

Aspiring to excellence

The NHS Next Stage Review describes a vision

for the NHS that delivers high quality for all and

gives staff the freedom to focus on quality.

Achieving this vision requires us to provide the

best possible education and training for future

generations and to ensure that our existing

staff get the support they need to continuously

improve their skills.

Aspiring to excellence

Chapter 3 ‘A high quality workforce’

“We will improve key aspects of workforce planning at national level by establishing an independent advisory non-departmental body, Medical Education England (MEE)”

Sir john tooke s response to a high quality workforce
Sir John Tooke’s response to ‘A high quality workforce’

  • “I am particularly pleased to see the creation of Medical Education England which will give the profession the strong voice and the scrutiny function that it needs”

Structure of mee
Structure of MEE workforce’


29 members 6 meetings per annum

Structure of mee1
Structure of MEE workforce’






Nhs nsr a high quality workforce mee agenda 1
NHS NSR:A high quality workforce workforce’MEE agenda 1

  • Suggest more valid and reliable selection methods

  • Commission a formal evaluation of the 2 year Foundation programme and consider an alternative model linked to wider reform of postgraduate medical education

  • Look at the balance between generalist/core training and specialty training

  • Reach a consensus on PGME and training structure by August 2010

  • Continue discussions with Royal Colleges, deaneries, junior doctors, patients, employers, trade unions, SHAs and other stakeholders on how to take PGME and Training forward.

Nhs nsr a high quality workforce mee agenda 2
NHS NSR: A high quality workforce workforce’MEE Agenda 2

  • Work with the Royal College of General Practitioners to develop cost- effective proposals for training at least half of doctors going into specialty training as GPs.

  • Strengthen the public health workforce and produce a system of dual accreditation

  • Be responsible for the development of modular credentialing

  • Advise on how the training of dentists should reflect the changing pattern of dental needs

  • Develop modular training for healthcare scientists leading to the post of accredited specialist

  • Promote the incorporation of leadership and management training into undergraduate curricula

Nhs nsr a high quality workforce mee agenda 3
NHS NSR: A high quality workforce workforce’MEE Agenda 3

  • Ensure that educational supervisors in secondary care undergo mandatory training and review of their performance

  • Promote the incorporation of academic pathways as per the Walport report.

  • Develop the modernising scientific careers programme (Life Sciences, Physiological Sciences, Physical Sciences and Engineering each with a rotating training programme)

  • Take responsibility for the development of the training programme for pharmacists with the new emphasis on promoting health and well-being and giving life-style advice

  • Take on the responsibility for low volume specialties that require national planning

  • Take on the job of working with the newly established HIECs to develop a model interface between universities and the NHS for innovation in education, training, certification, local workforce development and translational research.

Additional items suggested by board members
Additional items suggested by Board members workforce’

  • Quality of training agenda; developing trainers; metrics and incentives; effect of EWTD

  • Disseminating information on workforce planning; working with CoE

  • Development of a national simulation strategy including collaboration with MoD

  • Ensuring that all final year medical students have an opportunity to shadow in the hospital in which they will be working

The 2007 08 pmetb survey showed the following implementation rates for f1 shadowing
The 2007 / 08 PMETB survey showed the following implementation rates for F1 shadowing.



  • Warwick            48%

  • Cambridge         45%

  • Oxford               42%

  • Keele                42%

  • Birmingham      37%

  • Belfast              96%

  • Glasgow            86%

  • Aberdeen         81%

  • Barts                 78%

  • Dundee            78%

Kieran seyan et al bmj 2004
Kieran Seyan et al BMJ 2004 implementation rates for F1 shadowing.

Definition of the standardised admission ratio for applicants to medical school

No of admissions from a particular population subgroup as a proportion of

all admissions


Proportion of the general population that belongs to that subgroup

Kieran seyan et al bmj 20041
Kieran Seyan et al BMJ 2004 implementation rates for F1 shadowing.

  • Asians Social Class 1 6.07

  • Whites 0.73

  • Blacks Social Class IV 0.07

  • No black people from Social Class V were admitted to Medical School

  • Females 1.15

  • Data from 1996-2000

Gender balance in medical schools
Gender balance in Medical Schools implementation rates for F1 shadowing.

“I could not find any information on male to female ratio of current medical students at Newcastle medical school . Grateful for any information”

“In our year the ratio is about 2:1, females:males. In my seminar group of 20, for example, 14 are female and 6 are male. This is the same with the majority of seminar groups.”

__________________Third year Medical Student at Newcastle University, Tyne Clinical Base Unit

Graduate entry into medicine
Graduate entry into Medicine implementation rates for F1 shadowing.

  • Normal mode of entry in USA for many years

  • 1997 Four Australian Medical Schools changed exclusively to graduate entry

  • Ireland has now changed to graduate entry

Aspiring to excellence
GP Analysis: implementation rates for F1 shadowing.There is a clear risk of an undersupply of GPsAnalysis with impact of supply side variation

The magnitude of the likely GP undersupply depends on supply assumptions, e.g.:

Future participation;

Future attrition;

Future retirements.

The GP age profile suggests an imminent retirement bulge.

Early indications from modelling development suggest the higher end scenarios may be more likely as supply assumptions are updated

Not intended for publication

Aspiring to excellence
Specialist Analysis: implementation rates for F1 shadowing.There is a clear risk of an oversupply of CCT holders Analysiswith impact of supply side variation

The magnitude of the likely CCT oversupply depends on supply assumptions, e.g.:

Future participation;

Future attrition;

Future retirements.

The demand profile is dependent on skill mix: moving towards a trained doctor delivered service may result in increased CCT holder demand in the short term.

Not intended for publication

HIECs implementation rates for F1 shadowing.

  • Health Innovation and Education Clusters (HIECs) are aimed at more rapidly translating research and innovation into clinical practice, and linking workforce planning to a quality framework of education.

  • HIECs could be one of the key ways in which MEE is ‘plugged in’ at a local level

HIECs implementation rates for F1 shadowing.

  • A partnership between

    • NHS organisations (primary, secondary and tertiary)

    • HE sector (universities and colleges)

    • Industry (healthcare and non-healthcare)

Principles of hiecs
Principles of HIECs implementation rates for F1 shadowing.

  • Span settings (Trusts, FTs, private sector; primary, secondary and tertiary care)

  • Span sectors (NHS, HE, Industry)

  • Span professions (i.e. Multi-professional)

  • Deliver measurable impact in innovation

  • Focus on quality

  • Support the purchaser-provider split in education and training

Hiec 2009 timetable
HIEC 2009 timetable implementation rates for F1 shadowing.

  • May distribution of national prospectus to outline HIEC’s concept, application process

  • May- July regional stakeholder events run by SHA

  • Early September completion of pre-qualification questionnaire

  • October submission of formal applications

  • November presentations to National selection panel

  • December first wave of HIECs announced

Ewtd john black s february newsletter carpe diem
EWTD: implementation rates for F1 shadowing.John Black’s February Newsletter ‘Carpe Diem’

“I explained that a general reduction to a 48-hour week would in our view have profound consequences for the provision of local services and training. Many medium-sized and small hospitals would not have sufficient staffing levels to maintain rotas. Surgical services would become unsustainable and of course without surgical cover accident and emergency departments would have to close. The increasing demands on consultants to keep emergency services going would inevitably have a serious impact on elective surgery, with little hope of meeting government targets on waiting times.”

Ewtd asit survey jan 2009
EWTD: ASiT survey Jan 2009 implementation rates for F1 shadowing.

  • ASiT suggest that to ensure optimal training, with adequate time for exposure and high quality patient care with increased continuity, it is necessary to return to a working week of approximately 65 hours. For higher specialty trainees (ST3 and above), on-call rotas rather than shift working would best protect training opportunities, and would be the optimal arrangement where workload permits.

Evaluation of the introduction of the intercollegiate surgical curriculum programme

Evaluation of the Introduction of the Intercollegiate Surgical Curriculum Programme

Professor Michael Eraut

University of Sussex

Jcst discussion document of the eraut report
JCST discussion document of the Eraut report Surgical Curriculum Programme

  • “..disturbing insight into the current condition of surgical training in the UK. Many factors are identified as being responsible for this unwelcome state, not all of them obviously remediable.”

  • “Allowing for the environmental factors identified in the Eraut report is the ISCP ‘fit for purpose’ as a curriculum for surgical training?” (these factors included the EWTD and the MTAS disaster)

Annual specialty report overview jcst
Annual Specialty Report Overview JCST Surgical Curriculum Programme

  • ISCP:

    • “despite its many strong points, the ISCP continues to generate a degree of discontent amongst some trainees and trainers, and engagement with both groups, in some areas, is less than the JCST would wish to see”

  • Opportunities for training in operative surgery:

    • 29% ST1 trainees have access to less than two operating sessions per week; “JCST would like to see a commitment to innovative training methods such as simulation to help offset this reduction in clinical experience”

  • Support for trainers:

    • “..widespread evidence that surgical trainers are poorly supported by their employing Trusts. Urgent action is needed to correct this before consultant surgeons become completely disengaged from the training process”.

Summary Surgical Curriculum Programme

  • The creation of MEE is an opportunity to produce a more coherent approach to manpower planning and the promotion of excellence in the education and training of doctors, dentists, pharmacists and healthcare scientists

  • If we are to tackle the very challenging agenda then the MEE Board and Subcommittees will need to work closely together to produce a consensus which best represents the interests of the professions, trainees and, above all, patients