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

8. 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 O&G 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

11. 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

12. 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

14. 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

15. 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

16. 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

18. Mini-CEX Assessment

19. 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

20. 3600 assessment form

21. 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

22. MTAS

23. 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

24. MTAS MMC

26. 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

29. Findings and Corrective Action - 3 • Weak DHPolicy 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

30. 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

31. 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

33. 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

34. 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

35. 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

36. 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

37. Postgraduate training - inquiry recommendations

38. 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.