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The Tooke Report on postgraduate training in Britain: What can we learn from it?
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The well-documented failure of the British Medical Training Application Service led to a period of uncertainty and confusion for many junior doctors in 2007. It also resulted in a rash of resignations from among the senior medical figures involved in the implementation of the new Modernizing Medical Careers scheme for postgraduate training.
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Unfortunately, the politicians responsible for the debacle offered little more than apologies, although subsequent government “reshuffles” have corrected this anomaly. A more positive outcome was the appointment of Prof. John Tooke to chair a review group to investigate the failures of the Modernizing Medical Careers program and to make recommendations for the future.
After extensive consultations with all the parties involved, Tooke published an interim report in October, on its 45 recommendations. This was well received and attracted nearly 40,000 responses, leading to only two slight changes in his final report, which was just published in February.
New recommendations
Tooke’s proposals — which have been largely welcomed by doctors, trainees, the British Medical Association and the Royal Colleges — would effectively turn the clock back. They would end the proposed “run-through training” and introduce clearer procedures for the assessment and selection between the foundation, core and specialist training.
The first of the two foundation training years following graduation would revert to the control of the medical schools, while the second would form part of an integrated 3-year core training prior to entering specialist or general practitioner training schemes.
Tooke was critical of the shared regulation of postgraduate education between the General Medical Council (GMC) and the new Postgraduate Medical Education and Training Board and proposed that the two bodies be merged to ensure linkage between accreditation and registration.
What is now concerning the medical profession in the United Kingdom is the deafening silence from the federal government in response to the report, while their own Parliamentary Select Committee is busily accepting evidence from many of the same sources.
Not enough training posts
The NHS employers have estimated that there will be 23,000 applicants, many from the European Union and overseas, for the 9,000 training posts available this year. In response, the British government attempted to introduce new immigration rules to prevent “highly skilled migrants” from taking a post as a doctor in training.
An organization representing Indian doctors took their objection to the Court of Appeal, who upheld their protest. Currently the government has referred their proposals back to the final Court of Appeal, the House of Lords, and we anxiously await their decision.
Whatever the outcome, it seems that the upcoming year will be a difficult one for all parties involved in these complex negotiations. For both British and international medical graduates, the uncertainty and lack of clear guidance is driving many to look for medical posts elsewhere. Meanwhile, the GMC, Royal Colleges, Postgraduate Deaneries, and Health Departments compete for the control of medical education and training and the finance to deliver them. If the standards of British postgraduate training are to be maintained and improved, a solution must be found, but at the moment the omens do not seem very favorable.
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- David L. Hamblen, PhD, FRCS, is professor emeritus at the University of Glasgow and is the consulting editor for Orthopedics Today International. He can be reached at oti@slackinc.com.