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Changes to British junior doctor program lead to protest among trainee applicants
A large discrepancy exists between number of specialty applicants and available posts, trainers.
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The junior doctors training program in the United Kingdom is in disarray, caused by multiple policy changes at a time when the number of trainee applicants is sharply increasing, according to British trauma and orthopaedic training experts.
In the past 5 years, the government has introduced the Postgraduate Medical Education Training Board (PMETB), the Modernizing Medical Careers (MMC) system, and the Medical Training Application Service (MTAS) — all with the goal of transitioning the existing system to a competency-based system, according to Craig White, president of the British Orthopaedic Trainees Association (BOTA).
However, the number of specialty applicants in the United Kingdom is overwhelmingly larger than the number of available positions. Likewise, some junior doctors who were involved in the old training system are falling by the wayside because of the new reforms, according to Clare Marx, FRCS, chair of the Specialist Advisory Committee (SAC) in trauma and orthopaedics [training] and vice president-elect of the British Orthopaedic Association (BOA).
The plight of junior doctors
“We already had quite a lot of people who had done 3 to 7 years of training for a specialty at a very, very junior level, and in that time they would often picked up a PhD or research,” she told Orthopaedics Today International. “[However] they still were not getting into the specialty training because there weren’t enough posts.”
Not surprisingly, junior doctors became discouraged. In January, a study in the Postgraduate Medical Journal revealed that four out of every 10 specialist trainee doctors in England viewed their job prospects as “poor” or “very worrying.”
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On March 17, 10,000 junior doctors held a demonstration and marched through the streets of London and Glasgow to protest the medical training reforms. Some are planning to leave the country to find work, according to BBC News.
The trauma and orthopaedics specialty, specifically, has encountered problems increasing the number of trainees. According to Marx, nearly 1,000 trainees are already enrolled in the specialty, but there are only 1,000 to 1,200 consultant trainers.
What is more, 40 doctors fully trained in trauma and orthopaedics do not have hospital posts, due to a slowdown in hospitals hiring these physicians. “This is the first time in the United Kingdom that we have really seen this situation occurring,” she said.
Flaws of MTAS, MMC
In addition to the increasing trainee numbers, the introduction of the MMC system shortened the number of training years required and changed the requirement from a curriculum vitae (CV)-based system to a competency-based application system – setting back those trainees already involved in the old system, Marx said.
Health officials applied this approach to MTAS as well. Under the new approach, reviewers look at applications without also checking the corresponding CV, so they have no way to know the relevance of an applicant’s answer, Marx said.
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“MTAS, in its form that went out, was massively flawed,” White told Orthopaedics Today International. “There were problems with the computer system itself, and there were problems with the long listing and the short listing.”
White added to those problems an underestimation of the time necessary to grade the applications, interobserver error on the grading, and inconsistencies among specialties and regions.
Marx and White both stressed the need for a transition period.
“[Those junior doctors] who spent the last 3 or 4 years of their lives doing research and [public service jobs] to try and increase their CV work … need to be given a time period where they can have a chance of getting into the specialty. … One of the big emotional issues is that people have just been given no chance,” White said.
What needs to be done?
White and Marx also suggested requiring a second round of applications, if needed, based on the old system.
“People should be interviewed in the [old] way until we actually get to the backlog of people who have been around in the system for a long time with a whole host of different competencies,” Marx said.
The BOA continues to offer advice on the current selection process.
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“We have been trying hard to ensure that the government understands the problems at the end of training, because unless we can get more people into consultant posts, we can’t train more surgeons,” Marx said.
The SAC has given advice to PMETB and MMC on numbers modeling, specifications for selection, conducting interviews, selection panels and pilot studies.
“We do want to support the general mantra of MMC, which is to try and ensure that young doctors can get into their chosen area of training, whether it be general practice or specialty training,” she said.
BOTA’s split opinion
PMETB recently accepted a curriculum for trauma and orthopaedics, written by the SAC, Marx said. “We’re hoping that with this, we can actually channel the trainers’ efforts into a much more structured form of training from an earlier stage so that people will be properly trained, rather than left [on their own] to carry out service work.”
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BOTA is straddling both sides of the issue.
“We’re split between trying to get these people who are currently associated [with the training program] into jobs, and also being well aware of the fact that if you exponentially increase training numbers at the bottom level, you’re going to end up with an exponential increase at the top level in 6 years time,” White said.
“Our stance has been that we need to appoint in the old basis and have a transitional period. … Overall, we support the idea of MMC,” he added. “We’ve got an extremely good curriculum in place now and the tools to train orthopaedic surgeons. We are in liaison with our SAC and deaneries, and we feel that the people who are the best candidates should be appointed to the job.”
For more information:
- Clare Marx, FRCS, chair of the Specialty Advisory Committee in Trauma and Orthopaedics [training], vice president-elect of the British Orthopaedic Association, Ipswich Hospital, Heath Road, Ipswich, Suffolk IP4 5PD, England; +44-1473-702030; e-mail: clare.marx@ipswichhospital.nhs.uk.
- Craig White, president of the British Orthopaedic Trainees Association, 275 Old Birmingham Road, Marlbrook, Bromsgrove, Worcestershire B60 1HQ, England; +44-797-755-3158; e-mail: craigwhite@doctors.org.uk.