Dr Andrew Hilson FRCP - Royal College of Physicians

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Shape of Trainingresponse7. How should the way doctors train and work change in order to meet theirpatients’ needs over the next 30 years?Recommendations Doctors should be trained to provide holistic care, to be professional, to understand concepts, such asrisk management, and to be able to assess research evidence. Consultants should have dedicated time to train doctors. Continuity of care is essential in all medical settings for effective training. There should be an aspirationtowards a single named physician being responsible for the care pathway of each patient. Most training should occur in the setting in which a doctor will primarily be working.Background Holistic care includes taking responsibility for aspects such as compassion, dignity, pain relief, hydrationand nutrition. More (General) Internal Medicine experience in different settings may help to deliver this. Doctors should also be trained in professionalism, that is a set of values, behaviours, and relationshipsthat underpins the trust the public has in doctors. In any clinical encounter, there must be a partnershipbetween patient and doctor, one based on mutual respect, individual responsibility, and appropriateaccountability. 10 For example, this includes shared decision making and supporting patients in tacklingobesity or smoking. Doctors must be committed to the values of integrity, altruism, compassion, continuous improvement,excellence and working in multi professional environments. 10 There needs to be training in patient safety and risk management, with more openness about medicalerrors. One of our options allows for a grade of doctor that is both providing service in independent practiceand studying part-time in a supervised fashion to obtain credentials. This would be a new way ofworking for the NHS. However these doctors must be able to continue to progress, and must not besubconsultants. Consultants need to have dedicated time to train, and this must be recognised in their job plans. Our2010 census showed that 52% of consultants had less time to spend with their trainee than three yearsago, with only 14% saying they had more time. 5 Continuity of care is essential. In acute or (General) Internal Medicine, this would mean a continuous‘block’ of shifts for all grades of doctors on the rota, rather than more frequent, fragmented shifts. Inthe community, this may mean greater availability and access to doctors. Most training for any doctor should occur in the setting in which they will be primarily working. This maymean partly community and secondary care environments for physicians, rather than tertiary carecentres. Patients want integrated care with named responsible physicians, particularly in hospitals. As far aspossible, a single physician should provide continuity of care during an admission. This is also highlightedin the recent report by Robert Francis QC. Physicians are likely to play a greater role in the management of other patient groups, such as surgicaland obstetric perioperative care.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 Trainingresponse8. Are there ways that we can clarify for patients the different roles andresponsibilities of doctors at different points in their training and career anddoes this matter?Recommendations Retain the term ‘consultant’ for trained practitioners Engage with trainees and patient groups to identify the best terms for other groups of doctors. ‘Generalist’ is not a useful term for patients or doctors in training. Greater continuity of care by trainees will also help reduce confusion of doctors’ roles amongst patients.Background We accept that there is an ongoing problem with the number of terms for trainees – ‘trainees’, ‘juniordoctors’, ‘house officers’, ‘specialty registrars’, ‘specialist registrars’, and so forth. Some of these olderterms are still being used. We suggest working particularly with trainees and patient groups to identify how to improve this. To avoid confusion amongst the public, it would be best to retain the term ‘consultant’ for any trainedpractitioners at CCT-level. One idea is to display the grade of doctor more prominently, such as with coloured badges.9. How should the rise of multi professional teams to provide care affect the waydoctors are trained?Recommendations Medical leadership and management need to become more important in training. There areopportunities for interprofessional learning in these areas. There is no evidence to support the emphasis on greater multi professional approach to education, butthere may be limited opportunities in some areas. Trainees should not be disadvantaged by working in environments in which other healthcareprofessionals do work that overlaps with trainees’ duties. However, there needs to be effective teamwork during many clinical activities, such as ward rounds,multi disciplinary team meetings and surgical procedures. The role of other healthcare professionalsshould be appreciated by trainees.Background Doctors are trained in the environment in which clinical practice is delivered. As clinical practice isbecoming more multi professional, it is inevitable that trainees will learn in these multi professionalenvironments. Doctors should be encouraged to lead and be responsible for patients, their outcomes and their safety.This should be a natural extension of existing medical training into problem solving, risk assessment, andcommunication with patients. To foster this, the training environment itself could be accredited for specific multi professionalteamwork criteria. This may be suited towards post-CCT credentials.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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