Dr Andrew Hilson FRCP - Royal College of Physicians

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Shape of Trainingresponse There must be clear differentiation between interprofessional learning and a multi professionalapproach to education and training. There are opportunities for interprofessional learning for areas of the curriculum such as leadership andmanagement, and clear opportunities in the service field for the multidisciplinary training (such as instroke services) of consultants, physiotherapists, nurses and pharmacy staff for the purposes of CPD. However, there is no evidence to support the emphasis on a much greater multi professional approachto education. Trainee medical specialists, for example, have particular education needs, which wouldnot be met in multi disciplinary training sessions. Any changes to the system should recognise thesedifferences.10. Are the doctors coming out of training now able to step into consultant leveljobs as we currently understand them?Recommendations Broader, necessary capabilities should form a greater part of training curricula and replace somecurrent narrower capabilities. There should be a much more formal structure of bringing people into an independent practitionerrole, which should include mandatory mentoring of new consultants for the first few years. Phased consultant grades should be considered.Background For physicians, most doctors coming out of training are competent in their field. The CCT shouldcontinue to signal the capability for independent practice in that particular field. However, we are aware that they have less experiental training. They need greater team support andmentoring in the first years of a consultant appointment. We also note that some new consultantsstruggle not from lack of knowledge or skill, but because of the more difficult professionalexpectations. This is reinforced by the notion of all consultants being equal. Conversely, there are areas of subspecialised medicine in which it is not reasonable to expect traineesto achieve proficiency before CCT. These would be suited to post-CCT credentials and should bereplaced by broader, necessary capabilities. To resolve this, there should be a much more formal structure of bringing people into an independentpractitioner role, which should include mandatory mentoring of new consultants for the first fewyears. This could be achieved by having different, phased grades of consultant such as principal consultantsrather than by having a pre-consultant grade. There should be a method to allow more experienced trainees to ‘act up’ as a consultant undersupervision, to ease the transition between grades. A more specific induction and support mechanism should be considered. This has often failedpreviously and needs to be ably planned and implemented.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 Trainingresponse11. Is the current length and end point of training right?Recommendation A minimum length of time, with capability-based progression and assessment should determine theend point of training. Broader, necessary capabilities should form a greater part of training curricula and replace somecurrent narrower subspecialist capabilities. (General) Internal Medicine should form a greater proportion of the pre-CCT curriculum. There aredifferent options for this. There should be national standards set by the Royal Colleges for post-CCT training. All consultants should continue high quality CPD. Academic trainees should have time to complete both clinical and academic training.Background There should be no compulsory or rigid length of training to obtain a CCT. Instead, a minimum lengthof time, with capability-based progression and assessment should determine the end point of training. There are too many requirements in the pre-CCT curriculum for physicians currently. For each medical specialty, there may be scope to move highly subspecialist knowledge and skills intopost-CCT credentialing curricula. Instead, the pre-CCT curriculum would focus on more knowledge and skills related to (General)Internal Medicine. These are discussed more fully in question 6c.o One option is for dual accreditation pathways in (General) Internal Medicine and aspecialty, but only at an ‘intermediate level’ for the specialty prior to CCT in (General)Internal Medicine.o Another option is initial single accreditation in (General) Internal Medicine for some ormost trainees, before further specialisation in (General) Internal Medicine or anotherspecialty.o Yet another option is for pre-CCT credentialing, in which a set of credentials can confirmcapability in a certain area and lead to a CCT. Post-CCT training should be more formally acknowledged, encouraged and nationally managed to highstandards. It is essential that academic trainees have the time to complete both clinical and academic training.They should be able to progress at a pace that reflects their clinical and academic abilities. Moving to acompetency, rather than time-based, system would help. Trainees should be actively involved inplanning their competency acquisition and in conversations about their progression.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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