modernising medical career dr chris wong mr. chris low

Modernising Medical Careerwww.mmc.nhs.uk

Dr Chris Wong

Mr. Chris Low

Changes over the past decade

• 1996 Calman reforms– Introduction of structured training in UK

• 1996-2004– Establishing Calman Training, ‘grid’ trainees

• 2005 onward – ‘Modernising Medical Careers’– Establishing education programmes at all levels– Promotion of continuous professional development

Changing Training

• Combination of (1) Calman changes and (2) New Deal reduced time for training a consultant by ~ 50%

• Further reductions from EWTD (Aug 2004) reduce this further (~20%)

• Expectations that streamlining training through SHO-SpR grades will substancially reduce training time may be optimistic

• Move from time-based to competency-based training

Competency-based training

• A real and demonstrated ability to successfully carry out an identified activity

• Thus competence focuses on the outputs from activities, not inputs. It is not what is known or has been learnt, but what is implemented when the job is performed.

MMC

• All graduates now enter a Foundation programme focused on developing key competencies (started Aug 2005)

• F1=PRHO, F2=SHO• Move from experienced-based to outcome- based training• Stage specific learning objectives• In training work-based assessments• Demonstrated competence in (7 areas of Good medical

practice) will drive career progression

• GMC apporval• PMETB – quality assurance• Deaneries – implementation and management

Senior medical appointment

Specialist/GP register

ST1

ST2

ST3+

F2

F1

Medical school

FTSTA 2

FTSTA 1

Career post

CCT Article 14

MMC career map

Medical Training Application Service – Online, Score provided by medical school and application answers

The Big Bang

• ST1, ST2, ST3 will start simultaneously in 2007• Junior SHOs will be permitted to enter a ST2• Year 1 SpRs will move to ST3• As few as 9500 entry points for all three years of

specialist training• Deferred places announced• After 2008, entry to specialty training will mainly

be ST1.

Senior medical appointment

Specialist/GP register

ST1

ST2

ST3+

F2

F1

Medical school

FTSTA 2

FTSTA 1

Career post

CCT Article 14

MMC career map

Senior medical appointment

Specialist/GP register

ST1

ST2

ST3+

FTSTA 2

FTSTA 1

Career post

CCT Article 14/11

MMC career map

Senior medical appointment

Specialist/GP register

ST1

ST2

ST3+

F2

F1

Medical school

FTSTA 2

FTSTA 1

Career post

CCT Article 14

MMC career map

Senior medical appointment

Specialist/GP register

ST1

ST2

ST3+

F2

F1

Medical school

FTSTA 2

FTSTA 1

Career post

CCT Article 14/11

MMC career map

Senior medical appointment

Specialist/GP register

ST1

ST2

ST3+

FTSTA 2

FTSTA 1

Career post

CCT Article 14/11

MMC career map

Advantages of MMC

• More structured training

• More emphasis will be placed on training in the workplace as opposed to theory style instruction

• Follow set curriculum

• Produce consultants on average about 2 years earlier

Disadvantages

• Make decision regarding chosen specialty after 2 postgraduate years

• Unable to gain experience in some specialties and shortage in some specialties

• Shaortage in number of training positions – increased competition!

• Acceleration to consultant level (restriction in training time with EWTD) result in less experienced newly qualified consultants