Dr Andrew Hilson FRCP - Royal College of Physicians

Shape of Trainingresponse14. What needs to be done to improve the transitions as doctors move betweenthe different stages of their training and then into independent practice?Recommendations There needs to be more graduated transitions between grades, including a phased consultant grade.There should be training specific to each grade, especially for new consultants. Transfer of information on trainees between different employers should be encouraged as long asthey comply with doctors’ employment rights.Background A more structured consultant workforce could ensure that the transitions are far more carefullymanaged, particularly into independent practice, than they are now. For a transition to independent practice as a consultant, there should be training in understanding NHSsystems (such as commissioning and Trust functions), business plans, clinical governance (such asnational audits, standards, and outcomes) and litigation. Transfer of information on trainees between different employers will help protect patients andsupport doctors. Learning needs can then be identified after a transition. This should comply withdoctors’ employment rights. For academic trainees, there must be sufficient opportunities to move into senior academic posts. It is essential that individuals in academic training have the flexibility to balance clinical and academicduties at the postdoctoral level, both before and after the point of CCT, so that they build anindependent research career. This is a vital step in developing the next generation of academicleaders. There should be more opportunity for consultants at all stages of their career, by agreement with theiremploying organisation, to change their workload mix.15. Have we currently got the right balance between trainees delivering serviceand having opportunities to learn through experience?No. Currently many young doctors are spending too much time on ‘out-of-hours’ cover of a largenumber of patients, rather than participating in other important educational activities, such asoutpatient clinics or community care.This is a fundamental concern, particularly for medical registrars. There needs to be a substantial shiftin the balance towards learning and structured training. 8This will be helped by more trainees regularly taking part in (General) Internal Medicine.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