Switching specialties must be made easier, says GMC

Authors: Abi Rimmer 

Publication date:  31 Mar 2017

Postgraduate medical training must become more flexible to end the “snakes and ladders” experience of trainees wishing to switch between specialties, the General Medical Council has said.

In its plan to improve the flexibility of training, submitted to the four UK health departments, the GMC said that the current training structure was too rigid and too slow to adapt to workforce and patient needs.[1] Trainees switching specialties currently experience a type of “snakes and ladders” where instead of having their previous training recognised, they have to start again from scratch, it said.

The GMC published the plan after it was asked by Jeremy Hunt, the secretary of state for health in England, to lead a review to “support appropriate recognition of competence where junior doctors change training paths.”

In its plan, the GMC said that there were currently five key barriers to improving flexibility in postgraduate medical education: transferring between specialties is difficult; training in other ways (such as working overseas) is not recognised as part of a doctor’s training; switching specialty is too difficult and better support for this is needed; postgraduate training is slow to adapt to keep pace with medical care; and rigid training structures can make rota gaps worse.

Medical royal colleges will be required to share components of their training that are similar to other specialties. “Many training programmes already encourage flexibility in practise, with opportunities for trainees to explore other interests without changing specialty,” the GMC said. “We want to build on and improve these cross specialty approaches.”

Speaking to BMJ Careers, Sarah Hallett, deputy chair of the BMA Junior Doctors Committee, said that many trainees did not understand why, currently, the skills that they gain in other specialties, in non-training grade posts, or abroad, cannot count towards their training.

“Any move towards recognition for these transferable skills would be welcomed by trainees,” she said.

Hallett said that the desire for training to be more flexible was one of the reasons an increasing number of trainees are choosing not to enter specialty training immediately after their foundation training.

“A lot of those who are not going straight into a specialty training programme are often either working abroad or taking non-training grade posts in hospitals,” Hallett said. “And yet, at the moment, the skills that they develop doing that work can’t count towards their training when they do enter a training post. I think trainees would like to see that changed.”

Most specialties will be expected to revise their curriculums in line with the new standards by 2020. The GMC said that it would launch a revised generic professional capabilities framework and new standards for postgraduate curriculums in May.

These new frameworks are designed to shift postgraduate training away from a time based focus towards helping doctors achieve high level learning outcomes, the GMC said. “Curriculums, in the future, will explain what doctors should know and be capable of doing at key points in their training and by the time they complete it,” it said.

The GMC also said that it would make it easier for new curriculums to be approved by streamlining its regulatory approach, and it would promote existing programmes that let trainees switch specialty.

Abi Rimmer BMJ Careers


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