Date Published: 9 August 2005

Major re-organization of UK Medical Training announced by the Department of Health

Health News from the United Kingdom (UK).

Today (9th August, 2005) the UK Departent of Health announced a major re-organiation of the British structure of training for doctors.

Their announcement concerns a groundbreaking change in postgraduate medical training beginning this week as thousands of medical school graduates begin their careers in the National Health Service (NHS) as part of a new foundation training programme.

For the first time ever, all junior doctors who are starting their first year after medical school (previously known as the pre-registration house officer or PRHO year) will have to demonstrate explicitly that they are competent in a number of areas including:

  • communication and consultation skills,
  • patient safety and
  • teamworking,
  • as well as the more traditional clinical skills.

Around 4850 trainees are starting the Foundation Programme this week.

The two-year Foundation Programme replaces the existing PRHO year and first year of senior house officer (SHO) training and will give trainees exposure to a range of career placements across a broad spectrum of specialties. All trainees will also have access to an educational supervisor, as well as a clinical supervisor for each placement. The programme has as its focus patient safety: progression through the programme is based on the achievement of competence, rather than time served.

Deputy Chief Medical Officer Bill Kirkup said,

"At the heart of this new training programme is quality of medical care. By making the continuous development of skills and knowledge central to training, and by making explicit the standards of competence that doctors reach before they progress, the Foundation Programme will improve patient safety as well as medical careers. Because these changes have been introduced systematically across the health service, patients can be assured that doctors at each stage of their career have demonstrated their ability to practise safely and effectively at that level."

Health Minister Lord Warner said:

I welcome the introduction of the Foundation Programme. This is just the beginning of a much wider ranging change in medical training, driven by the needs of patients and the NHS. As healthcare changes, the Foundation Programme will ensure that doctors going through the system have a good solid base from which to progress in the modern NHS which puts patients at the centre.”

In the first year of the programme, foundation doctors will still undertake placements in medicine and surgery, as required for General Medical Council (GMC) registration. Many trusts are now offering three four-month placements, which means that in the first year, many trainee doctors will be able to experience an additional placement in another specialty. The foundation doctors’ competence will be assessed against the standards set out in the Foundation Programme curriculum by senior healthcare professionals in their trusts.

Dr Cate O’Neill, F2 pilot trainee said:

I was part of a Foundation Programme pilot that was evaluating the new assessment methods. Initially, the thought of having consultants assess me was quite intimidating, but it became easier after the first one. The best part about the new assessment process is the opportunity for immediate feedback and the ability to bring up problems in a safe and supportive atmosphere.

Dr Laurence Gant, clinical lead at the Homerton Hospital said:

The Foundation Programme trainees will experience a co-ordinated training and teaching programme over the next two years which conforms to the national curriculum. This, together with ongoing teaching in the clinical environment, will mean that they reach a proven level of competency in a wide variety of skills and knowledge that will help to ensure optimum patient care and safety. The teaching programme recognises the multidisciplinary nature of the Trainees work environment and will also be delivered to, and with the help of, the nursing and allied health professionals.

The second year of the programme will provide new opportunities for trainee doctors to gain experience in primary care, shortage specialties (those specialties that are actively recruiting) and in academic medicine. Assessment of doctors’ competence will be required throughout their training in order for them to progress to further training in areas in which they wish to specialise.

Training will be organised and delivered by postgraduate deaneries through new foundation schools, which will bring together medical schools, the local deanery, trusts (mental health, acute and PCTs) and other organisations (e.g. hospices) to offer training in a range of different settings and clinical environments.

Each foundation doctor will have a dedicated educational supervisor who will be responsible for supporting them and ensuring they have appropriate learning opportunities. Each deanery will also ensure that foundation doctors have access to career advice. Modernising Medical Careers, the Department of Health initiative behind the training reforms, has just published a career management paper for medical schools, trusts and deaneries for their career advisors.

Source: UK Department of Health

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