The independent review of postgraduate training (the shape of training review) for doctors in the UK was completed in the past 2 months and suggested a host of recommendations. This includes a greater emphasis on creating ‘generalists’ through a broad based training program, with few of these progressing on to be specialists. On paper, the proposals look at the reverse of modernising medical careers, which came in less than a decade earlier. The proposed change to award a CST (certificate of specialty training) as opposed to CCT (certificate of completion of specialist training), has led to fears that this may result in a sub-consultant grade that those with CST have to progress through before they can reach consultant appointments.
An item buried in the report is the move of full GMC registration to the end of medical school. Currently this sits after the foundation 1 (FY1) year. On paper, this change may seem innocuous; however, it potentially may lead to several issues. Firstly, it will put greater pressure on medical schools to ensure their graduates are fit to practice independently. Second, it will increase competition for FY1 posts from other countries, as now doctors who were previously ineligible from applying for FY1 posts (currently reserved for doctors with provisional registrations) will be eligible to apply; a move which may cause UK graduates (who already face over-subscription for foundation posts) to be unemployed. Thirdly, it also makes it easier for UK doctors to leave the UK immediately after medical school. Finally, it may cause legal ramifications for graduate entry medical schools who current provide 4 year courses (but under EU law are required to provide a five year course, with the FY1 being used as proxy for the final year, leading to full GMC registration). A move to earlier registration may mean that these medical schools may need to consider adding an extra year to the training (thus negating benefit of the graduate entry course) or even consider closure.
As with anything, the devil will be in the detail. In the meantime, the British Medical Association (BMA) are monitoring the situation carefully through their representative committees.
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