Specialist registrar training
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7238.817 (Published 25 March 2000) Cite this as: BMJ 2000;320:817
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Dear Sir
In response to the editorial by Graeme Catto I have two points to
make.
Firstly I would agree that there has undoubtedly been a revolution in
medical training, but whether this produces better doctors remains to be
seen. Undergraduates do have a reduced “burden” of factual knowledge and
spend more time on many aspects of information acquisition, communication,
curiosity and public health. However the undergraduates now spend much
reduced times with each clinical firm, and often express no particular
involvement with a “firm” they are attached to for a short period (often
only a week). This has repercussions on the acquisition of clinical
skills. A recent (yet to be published) study of new graduates before
starting house jobs revealed that more than 50% had performed two or less
of a group of basic clinical skills (arterial blood gas, per rectum
examination, male catheterisation, ECG and nasogastric tube insertion). In
addition less than 50% of house officers finishing their house year had
received any further training in these skills, yet performed them on a
weekly basis. This highlights the concern that we should be training
undergraduates not only as doctors capable of finding appropriate
knowledge sources, but also equipping undergraduates with the appropriate
basic skills to be house officers.
Secondly, regarding training specialist registrars, some specialities
have long recognised the value of a sufficient “apprenticeship”, and if
training were now universally adequate, would there still be debate on
“junior consultants”.
Yours sincerely
P B Goodfellow
Competing interests: No competing interests
Dr Addison is right to say that the SpRs in the survey were not in a
position to compare the experience they were getting in their training
with that contained in old-style training or that needed for a consultant
post. They were not asked those questions, only 'How would you rate the
hands-on experience acquired in this post?' on a scale of 1=very poor to
5=excellent. The ratings were slightly higher in the second survey (mean
3.88 vs 4.00, p<0.001). It would be wrong to deduce from this that the
total experience gained in the training programme as a whole was more
satisfactory. The study did not address the programme as a whole, only the
current post.
Competing interests: No competing interests
In the editorial by Catto and the accompanying article it was claimed
that SpRs do not think that they were getting inadequate experience. On
what grounds could they make this observation? Surely they can only judge
the adequacy of the experience they have had during training by either
direct comparison with undergoing the old registrar/senior registrar
training or alteratively evaluating it after practicing as a consultant
for the first few years. Clearly the former is not possible. There was a
lot wrong with pre-Calman days but as a potential patient I have
considerable concerns that doctors are becoming consultants with a minimum
of experience. Training may be better organised, trainees are clearly
happier but what needs to be added is some mechanism for quantifying what
individual SpRs have been exposed to and perhaps prolonging training in
those with less than adequate practical exposure.
Competing interests: No competing interests
Dear Editor
I agree that there have been improvements in postgraduate teaching
because of calman reforms1. I also agree that all consultants should take
an active role in this process.
However in some specialities the envisaged expansion of consultant
numbers has not occurred. As a result consultants are being hard pressed
to balance their clinical time with hospital management, teaching, audit
and clinical governance.
In the speciality of paediatrics consultants are expected to play an
active role in oncall duties. Therefore making time outside clinical
duties is mandatory but difficult.
More consultant numbers may be a part of the solution?
1. Catto G. Specialist registrar training. BMJ 2000;320:817-818.
Competing interests: No competing interests
Discrepancies in shortlisting for Orthopaedic Specialist Registrars in the United Kingdom
Editor,
Catto’s editorial regarding Specialist Registrar training was
subtitiled “Some good news at last” 1. However, despite guidelines issued
by the Joint Committee of Higher Surgical Training (JCHST)2 regarding the
selection of candidates for addition to the Orthopaedic Specialist
Register, it is apparent that wide variation in requirements exists on a
regional basis.
We contacted the 14 Orthopaedic deaneries in the UK and obtained
details of eight person specifications and five shortlisting scoring
systems. Three deaneries declined to assist us, four had no scoring
system, and the remainder, despite assurances, failed to pass their
details to us.
The common requirements amongst the deaneries were GMC registration,
a medical degree, basic training and a postgraduate qualification.
Essential experience in Orthopaedics varied from 6 to 18 months, with one
deanery classing 6 months post-membership experience as essential. While 3
deaneries required A & E experience, the remainder did not. Three
deaneries required ATLS as essential, three as desirable and two made no
mention. Interestingly, two deaneries included ATLS instructor status
either as desirable, or in their scoring system. To be eligible for ATLS
instructor status, you must be an SpR or equivalent. Completion of a
fracture fixation course was listed as essential by one deanery, desirable
by one, and not mentioned by the remainder. Arthroscopy and plastering
courses were also desirable at one deanery.
All deaneries included audit, teaching and research experience to varying
degrees, from involvement in, to completion of research projects. For
teaching, anywhere from informal teaching of juniors, to specific evidence
of teaching medical students was requested. Higher degrees were listed as
desirable by all but one deanery, but the points awarded depend on the
type of degree (MD / PhD scores higher than BSc), and the class (1st /
2nd). Requirement for publications varies markedly, from evidence of
publication, to peer-review journal publication as essential.
Striking findings on the scoring systems included completion of a
teaching qualification (8% of available marks) and a position on a
national committee (5%).
Massive variation exists between the deaneries and therefore, the
chance of successful entry to the Specialist Register will vary on a
regional basis.
Ironically, junior doctors are victims of their own desire to succeed. As
we strive to better ourselves to stand out from the crowd, we raise the
expectations placed upon us. However, room exists to improve the present
situation and make the selection process fairer to all.
References
1. Catto G. Specialist registrar training. BMJ 2000; 320: 817-818.
2. A manual of Higher Surgical Training in the United Kingdom and Ireland.
Joint Committee on Higher Surgical Training. Seventh Report, July 1999.
Competing interests: No competing interests