This article is more than 5 years old. Information may no longer be current.
United Kingdoms failing plan leads to protests, apologies and review
Click Here to Manage Email Alerts
This editorial was originally planned to address the emerging problems in orthopaedic surgical practice following the recent changes to specialty training throughout much of Europe. But the dramatic medico-political events in the United Kingdom over the past few weeks surrounding the selection process, and described in detail in this issue, now justify broader coverage (See related article).
Although the major restructuring of specialist training envisaged in the scheme for Modernizing Medical Careers (MMC) only applies to Great Britain, it will inevitably have major repercussions elsewhere. It will certainly disadvantage those from overseas working in temporary nontraining posts in the British National Health Service (NHS), who may find themselves excluded from the system. It will inhibit recruitment from other European Union countries, except to staff the increasing number of specialist treatment centers developing outside the NHS.
|
Fewer hours, less training
The government developed the MMC scheme, allegedly with the tacit approval of the British Surgical Colleges and Specialist Associations, and was to phase it in from 2005. Following graduation, new surgeons would take part in a 2-year Foundation course, which would replace the old Preregistration House Officer and Senior House Officer posts. This would then be followed by a selection process for specialty posts, allowing a progressive 6-year “run through” training to produce a certified specialist, capable of holding a consultant appointment in the NHS.
The advantages of shortening the overly long British surgical training, which often takes 8 to 9 years, were largely neutralized by the European Working Time Directive (EWTD) legislation that, since 2004, has limited the working week of European junior doctors to 56 hours, including 10 hours of education. In turn, this has led to the introduction of “shift” rotas to replace the old “on-call” systems that were no longer compatible with these restricted hours. The results of this transition have included:
- a weakening of the traditional team system;
- trainees spending less time with their consultant trainer;
- less opportunity for supervised daytime operating under supervision; and
- a loss of continuity in patient care.
|
Another outcome of the shorter training: New surgeons enter posts with far more limited clinical experience, particularly outside the range of their subspecialty. This creates difficulties in providing broad-based cover in general orthopaedics, particularly for trauma and pediatrics, in the district hospitals outside the main specialist centers.
Probably the greatest concern and controversy surrounds the new centralized selection process for trainees under the Medical Training Application Service (MTAS) scheme. The original proposal had been to base this on a combination of assessment questionnaire, the trainee’s clinical logbook, observed practical skills, a Multiple Choice Question (MCQ) test and a structured interview.
The reality, as a result of the technical problems in processing 30,000 applications for 20,000 posts, was to reduce this to a short listing for at best one interview. The selection was based on a nonvalidated computerized application form, designed by nonclinicians and with no section to record previous clinical experience.
Damage control
The predictable outcome has been a storm of protest from juniors, a 10,000-participant protest march in London, refusal of many consultants to undertake interviews, and the resignation of the Director of the MMC scheme. The Health Minister has also apologized in Parliament and agreed to review the whole selection process with a guarantee of one interview for every trainee. Whether this will be sufficient to rescue the scheme, now regarded as flawed, remains to be seen.
What are the lessons for the future? They must be that politicians should not seek to control medical training, but should concentrate their efforts in improving workforce planning for the NHS. This demands better coordination between the needs of the clinical service and the number of places available in medical schools.
For more information:
- David L. Hamblen, PhD, FRCS, is professor emeritus at the University of Glasgow and is the consulting editor for Orthopaedics Today International. He can be reached at 3 Russell Drive, Bearsden, Glasgow G61 3BB, Scotland; +44-141-943-1797; e-mail: dlhortho@doctors.org.uk.