Shape of Training – initial thoughts, considerations and concerns

The following is the College's response to this consultation.

1. The RCoA welcomes Professor Greenaway’s comprehensive report and recommendations contained within on the Shape of Medical Training: securing the future of excellent patient care.  The RCoA supports the report and many of its findings in concepts but would like to offer some thoughts and considerations as well as raising a few concerns at this stage.

2. Consideration must be given to the feasibility of the proposed changes, many of which are significant and will require considerable integrated planning from a vast array of stakeholders.

Considerations and Concerns
3. Absence of a realistic delivery timeline.  The delivery plan is ambitious and potentially flawed, further consideration is needed in deciding stakeholders and proposed collaborations.  Much of this work cannot be delivered as is suggested by the relevant national training boards (HEE, NES, Wales Deanery and NIMDTA as it will require specialty input from the outset.  Involvement of Colleges and Faculties should be explicit.

4. Clarity will be required at the early stage of the delivery plan to ascertain if and which specialties a might amalgamate.  This decision will be contentious and fraught with challenge.

5. It will be important for the GMC to recognise at this stage the need for increased flexibility and more emphasis on light touch regulation. This will facilitate the recommendations on transferable competences in particular. There may be a requirement for changes to the order to enable this and they should be addressed early to facilitate delivery from other stakeholders.

6. The CCT in Anaesthetics is already a generalist based training programme as was stated in the RCoA Call for Written Evidence response and going forward, there is benefit for all stakeholders in College involvement in the delivery plan to ascertain what is envisaged in the suggested recommendations that affect an established generalist training programme.  

7. Patient care themes do not identify acute care as an area of practice to be grouped together. This would enable development of a broad based training programme focused on ACCS for the acute, craft specialties (it will require cross College/specialty collaboration, which will be challenging but should be considered). Implementation of recommendation 7 will need considerable interagency collaboration for it to meet the aspirations of the author.  The amount of potential work on curricula specifically is substantial.  If the intent to reduce the number of specialties although not specifically identified in the Report is implemented this will require cross college collaboration, particularly when considering development of broad based training, for example in acute care, which would required cooperation between JRCPTB, RCPL, RCPE, RCoA, CEM and FICM.

8. Allowing trainees to progress at their own rate (Recommendation 7) will require careful consideration.  If this is focused on advance rather than delay then the proposal is sensible.  Such a policy may exacerbate dealing with doctors in difficulty.  Within the current Anaesthetics CCT benchmarking at stages of training (the Basic and Intermediate Level Training Certificates) are important gateways for progression.  This could potentially create a situation where trainees meander within the training programme not progressing within the time frame required.  Bottlenecks will occur in the training pathway, create delays and impact on other trainees and service delivery.

9. Credentialing is very general and more explicit detail on pre/post CST would be helpful.  The involvement of employers in developing credentials to meet local needs will be difficult and incredibly variable.  Consideration of transferrable credentials is important and Colleges should lead broadly applicable credentials for implementation by LETBs and LEPs.  Regulation of credentialing should be sufficiently light touch to allow flexibility and delivery.

10. RCoA welcomes the emphasis on recognising the importance of job planning and appraisal for training purposes (Recommendation 15).  The delivery plan must be explicit in ascertaining the importance of job planning and appraisal.  Colleges have the experience and professional knowledge to support CPD robustly enough to meet GMC standards.

11. The Report does not specifically address out of programme training as is currently in place and it is not clear if the additional training year explained in the model replaces OOP. 

12. The Report is very positive in the context of peri-operative medicine and consideration should be given to peri-operative medicine to be one of the CST work streams.  As previously raised, this will require cross specialty collaboration.

Going Forward
13. The College welcomes the opportunity to work closely with the Shape of Training Sponsoring Board and in particular the national training boards and the AoMRC in assessing the feasibility of delivery and if deemed appropriate implementing the recommendations.

08 November 2013