Romanian authorities – 16 November 2011: The GMC and Medical Education Ben Griffith – Education Policy Manager

How doctors are trained

Medical School

(4-6 years)

F1 year

(1 year)

F2 year

(1 year)

Specialty/GP training

(3-8 years)

Specialist/GP register

(to retirement)

Provisional registration Full registration Certificate of completion of training (CCT)

The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a College

Course, a Medical Course but a Life Course, for which the work of a few years under teachers is but a preparation

William Osler, The Student Life, Address to Students at McGill University, April 1905

Medical School

(4-6 years)

• 32 medical schools in the UK

• Around 35,000 medical students

• Have own approaches to curricula, teaching, assessment etc

• Courses include clinical exposure

• But must all meet standards and outcomes in Tomorrow’s Doctors

• Subject to fitness to practise, graduates receive provisional registration with GMC

• GMC quality assures

Map of UK medical schools

Tomorrow’s Doctors Outcomes for graduates: The doctor as …

1. Scholar and scientist2. Practitioner3. Professional

Standards for delivery:1. Patient safety2. Quality assurance, review and evaluation3. Equality, diversity and opportunity4. Student selection5. Design and delivery of the curriculum, inc. assessment6. Support and development of students, teachers, faculty7. Management of teaching, learning and assessment8. Educational resources and capacity9. Outcomes

Practical procedures for graduates

Foundation programme

(2 years)

Foundation programme (FP) is a two year programme of general training with placements within various specialties and healthcare settingsApproximately 12,000 doctors in FP First year has outcomes set by the GMC which must be achieved to receive full registration GMC quality assures

Specialty/GP training

(3-8 years)

• Medical royal colleges draw up criteria for specialist and GP training and assessments, which are now approved by GMC

• National competition for selection, training overseen by postgraduate deans

• GMC certifies completion of training, leads to entry on GMC GP or specialist register and eligibility to work as a consultant

• GMC quality assures

• Around 35,000 doctors in training

The Trainee Doctor

Standards for postgraduate training: 9 domains Standards for trainers

Standards for deaneriesOutcomes for provisionally registered doctors (first year after graduation from medical school)Core skills for provisionally registered doctors.

Routes to Specialty training

• Run through or coupled: progression to the next level of training is automatic provided you meet all the competency requirements

• Uncoupled: split into ‘core’ and ‘higher’ training: two or three years of core training, followed by competition into higher training

Source: Quick Guide to Recruitment in 2010 - DH

Map of UK Deaneries

• 20 Deaneries are responsible for postgraduate medical and dental training

• In England, they are aligned to the Strategic Health Authorities

• In Scotland, the deaneries are aligned to NES (NHS Education for Scotland)

• COPMeD (Conference of Postgraduate Medical Deans) provides a forum for medical deans to meet and discuss issues

• Also COGPeD (for deans responsible for general practice)

Medical Royal Colleges

General responsibility for training and assessing doctors within specialties

14 Medical Royal College, and 4 medical faculties

Colleges in Scotland and Ireland

Largest in England include: Royal College of Surgeons of England Royal College of Physicians Royal College of General Practitioners Royal College of Paediatrics and Child Health Royal College of Anaesthetists Royal College of Radiologists Royal College of Psychiatrists

Specialist/GP register

(to retirement)

• Revalidation

• Role of CPD (see current consultation)

• Framework based on Good Medical Practice

• Colleague and patient questionnaires

But it’s not quite that simple …

Not everyone can (or wants to) become a consultant Staff, Associate Specialist and Specialty (SAS) doctors (around

14,000) Challenge is to develop this grade

Not everyone stays in clinical practice: Public health Academic research Medical law Management Pharmaceutical industry Journalism

But it’s not quite that simple …

There are other routes to the specialist and GP register: CESR (Certificate confirming eligibility for specialist

registration) CEGPR (Certificate confirming eligibility for GP registration)

Designed to assess applications from doctors who have not followed a traditional training programme but who may have gained the same skills and knowledge

Assessment is now undertaken by GMC

Some trends in medical workforce - England

Doctors in training current represent 36% of NHS medical workforce (135,916)

DH workforce projections suggest by 2029 doctors in training will represent 28% of NHS medical workforce (168,000)

Training numbers broadly the same

Aim is for 54,000 GPs (now 34,000), 52,000 specialists (now 35,000)

Future need for more GPs (many retiring), and particularly in UK urban centres

Source: MMC (England) Workforce Review team, NHS Information Centre

Workforce statistics - UK

1998 2008 Increase

NHS Doctors 112,400 162,400 +44%

Medical graduates pa 4500 7250 +61%

Drs/1000 population 1.9 2.8 +47%

Sources: UK Departments of Health

Drs/1000 population

European average 3.2 US 2.4

Scotland 3.3 Canada 2.2

Wales 2.7 Australia 2.8

Northern Ireland 2.7 France 3.5

England 2.7

Further information

GMC’s Education Strategy

Education strategy projects

Co-ordination of quality assurance Reviews of CPD and equivalence routes to Specialist

and GP registers Transition issues Approval of trainers Generic learning outcomes in postgraduate education Assessment Evaluating the case for student registration

Other useful web links

Medical Schools Council – www.medschools.ac.uk

Foundation Programme Office – www.foundationprogramme.nhs.uk

Academy of Medical Royal Colleges – www.aomrc.org.uk

BMA – www.bma.org.uk

Any questions?