Dr Andrew Hilson FRCP - Royal College of Physicians

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Shape of Trainingresponse6d. How would a more flexible approach to postgraduate training look in relationto the current postgraduate medical education and training structure itself(including clinical academic structures)?Recommendations Medical school curricula and the Foundation Programme should be reviewed. Preparation forFoundation year 1, the value of Foundation year 2, and the degree of emphasis on management oflong term conditions should all be reviewed. A two or three year broad-based training programme for some trainees could contribute to (General)Internal Medicine training requirements, as well as leading on to training programmes for GPs,psychiatrists and other specialties. Such a programme must comprise at least six months in (General)Internal Medicine. Capabilities should be based on knowledge and skills required by the majority of the post-CCTpractitioners. They should be transferable between specialties. There should be a more flexible, phased consultant career. Post-CCT training should be nationally managed. The regulator and the Royal Colleges should ensure that standards are maintained. Taught MSc or MD degrees in clinical subjects or health services research should be available to all. Individual trainees should have flexibility to take time out of training for research or other out-ofprogrammeexperiences. This includes geographical flexibility.Background The Foundation Programme should be reviewed. This includes the need for specialist rotations and theneed for greater focus on management of long term conditions. The purpose of Foundation year 2 should be evaluated. The broad-based programme could include (General) Internal Medicine, community care, psychiatry,and general practice. Consideration should be given to when community care rotations, supervised byspecialists, are most useful for trainees and patients. This may be later in training. Narrow subspecialist capabilities should be removed from the training curriculum and perhaps addedas post-CCT credentials for a subgroup of CCT holders in that specialty. An implication of the above is that training up to CCT is likely to contain more (General) InternalMedicine. There could then be part-time training, probably in competition, to develop furthersubspecialty experience and credentialed experience. However, this post-CCT training needs to continue to be managed, and assessed to the highestpossible standard. It also needs to be planned on a national basis, with deaneries and colleges workingtogether. As far as possible, capabilities should be transferable between specialties not only for physicians, butalso for those wishing to move into other disciplines. LETBs will allow service providers to map training requirements to local service posts. Here it is crucialthat the regulator and the Royal Colleges ensure that training standards are maintained. Academic trainees are required to complete academic training alongside gaining clinical competencies,for example by taking time out to complete a PhD. The needs of individual trainees must be taken intoaccount and training programmes must enable them to take time out of the clinical training pathway,11 St Andrews Place, Regent’s Park, London NW1 4LETel: +44 (0)20 3075 1649, Fax: +44 (0)20 7487 5218 www.rcplondon.ac.ukRegistered charity no. 210508
Shape of Trainingresponseand to move back into it at an appropriate point. Such flexibility would be aided by moving to acapability-based curriculum.This not only applies to research, but to those who wish to take time out of training for voluntarywork, medical education, and medical management or leadership.Trainees may also have unique requirements in terms of geographical flexibility, which is difficult toachieve in the current arrangements. For example, it may be difficult for some trainees to transfertheir academic work to a new location, because they are working with a particular patient populationor they require specific laboratory facilities. Equally, other trainees may need to move to a certainlocation to pursue their research or other out-of-programme experience.Training programmes should plan for this with additional capacity so that the service implications donot become a surprise.11 St Andrews Place, Regent’s Park, London NW1 4LETel: +44 (0)20 3075 1649, Fax: +44 (0)20 7487 5218 www.rcplondon.ac.ukRegistered charity no. 210508
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Dr Andrew Hilson FRCP - Royal College of Physicians

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