The Medical Training Review: Phase 1 report

The Review was established to look at all resident doctors, both locally employed and those in formal training programmes, as well as specialty and specialist doctors and those in clinical academic training; balancing both the personal and professional aspirations of doctors and the needs of clinical services and patients. The aim of Phase 1 of the Review (Phase One) was to explore the technical changes, enablers, and choices for reforming medical training for the future, how those changes could be made and how they will support the delivery of the 10 Year Health Plan (England) mission shifts.

The BOA, alongside BOTA and SAC submitted evidence to the Review and met with Professor Chris Whitty and Professor Steve Powis.

The Phase 1 report has now been published. It is recognised that although postgraduate medical training has continued to evolve, it is some time since the structures and processes that underpin it were last fundamentally reviewed. Changes have been incremental and tactical rather than following a strategic look at training as a whole. However, the intent was not to undertake a fundamental redesign of postgraduate medical education but rather to determine whether such a redesign is necessary and, if so, which specific components of training require most attention.

The Review suggests six principles should guide any approach to the reform of postgraduate medical training:

• Deliver through an evidence-based collaborative approach, engaging with patients and the public and the experience of professional groups
• Improve the work and training experience of doctors at all stages of their career
• Improve the fairness and equity of access to all stages of medical training and development for all groups
• Strive to develop a clinical and wider medical workforce with both medical and non-medical knowledge, skills and capabilities, to deliver high quality care to the population they serve
• Training must reflect the patient and public groups a doctor will serve over their clinical career. Therefore, we must ensure appropriate geographical distribution of the training workforce to balance health inequalities
• There are trade-offs and any reform needs to acknowledge these openly as we move forwards.

The Review makes a number of recommendations set out below (each recommendation is supported with a series recommendations detailed in the report in Chapter 3). The Review concludes that, "… it is now no longer a sensible option to rely on this unplanned evolutionary approach by Royal Colleges, NHS England, deans and the GMC."

Recommendation 1: We recommend that a reform of postgraduate medical education and training is undertaken as a matter of urgency.

Recommendation 2: Addressing bottlenecks at all points in training and development should be considered urgently. This will have to include consideration of the right ratio between new international graduate entrants to medicine in the UK and those who are already working and training in the NHS, taking into account the workforce need.

Recommendation 3: Training should become more flexible.

Recommendation 4: All doctors working in the NHS should be supported to progress and the differentiation between ‘training’ and ‘service’ roles should be made less rigid for doctors early in their careers. We recognise, however, that progression will not be at the same rate for all doctors.

Recommendation 5: The output from the review of rotational structures must be incorporated in the wider reforms.

Recommendation 6: Reform of medical training must consider the need to provide a medical workforce across the country for the whole population equitably. This means changes in medical school places and training places should take account of where medical need is growing and will grow in the future; this is seldom wealthy metropolitan areas. We recognise that there is a tension between this need and the geographical preferences stated by resident doctors.

Recommendation 7: A strategy to deliver educators who are supported and enabled to train the future medical workforce in a fit for purpose environment and with transparent funding should be a fundamental part of NHS reform. Training reform should aim to make the role of the educator less rather than more bureaucratic.

Recommendation 8: Resident doctors training in craft and procedure heavy specialties must have time to develop procedural skills, particularly early in their training. This includes requiring the independent sector to provide training if the NHS is commissioning and paying for the procedures it undertakes.

Recommendation 9: We should work with the other UK nations to support the GMC’s review of standards and outcomes and subsequent review by colleges of postgraduate training curricula, including considering changes from the 10 Year Health Plan. This will include maintaining generalist skills while specialising; and ensuring digital skills for all doctors, which are essential for future patient care.

Recommendation 10: The recruitment to medical training should be reviewed to ensure it supports future models of training delivery and training flexibility and is fair and equitable to all candidates, while aiming to recognise excellence in medical practice.

Recommendation 11: Clinical academic medicine is essential for the delivery of healthcare now and in the future, both in academic centres and across the NHS. This workforce should be developed to meet the current and future population health needs, particularly in primary care, community and public health settings.

The report concludes, "The point of medical education and training is to improve outcomes for current and future patients and the health of the wider population. If any changes do not achieve that, they have failed."

Link to full report including supporting appendices: www.england.nhs.uk/publication/the-medical-training-review-phase-1-diagnostic-report.