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The Northern Deanery: Modernising Medical Careers

Introduction

Modernising Medical Careers (MMC) is a new UK policy likely to be at least as profound in its effects as the Calman reforms were for higher specialist training when introduced in 1996. Whilst these much needed reforms started life as proposed changes to the Senior House Officer grade, they will actually influence the whole training system, impinging both on undergraduate as well as on specialty training.

The whole purpose of this approach is to enhance the education of doctors and dentists in order to provide for the needs of a modernised National Health Service (NHS) that puts patients at the centre of its focus. The NHS has a fundamental responsibility to not only provide service today but also ensure the provision of a quality service for tomorrow.

Key concepts

At the heart of these changes is the idea of a structured two-year Foundation Programme (FP) for newly-qualified doctors and dentists. During these two years, doctors will hone their skills to be able to care for a range of patients from the young to the very old, including the acutely ill, and in a variety of settings - primary and community, as well as in hospital. In addition trainees will get the opportunity to sample a wider range of possible career opportunities. Pilot programmes will be introduced in 2004 and all newly qualifying doctors will be expected to embark on a Foundation Programme by August 2005.

The Department of Health describes seven pillars for Foundation Programmes: quality assured, flexible, trainee centered, competency assessed, service based, coached, structured and streamlined.

What we are doing

The Northern Deanery is approaching MMC by prioritising quality whilst understanding the need to meet longer term NHS aims. Each Foundation Programme will enable the trainee to access the full curriculum. Each placement in the programme has to fit with others to support increasing experience and development.

Various models will allow trainees to access training that meets their needs and career aspirations, elective opportunities, timely choice of their FP 2nd year programme and innovative use of study leave. With our FP Learning Portfolio we hope to encourage trainees to understand their own learning needs, and manage them according to programme requirements and their own aspirations.

Moving from experience-based to an outcome-based training puts competency assessment at the core of MMC. We will introduce a coaching model whereby the coach will support the trainee in their learning for the duration of the programme and will not be a member of the assessment committee.

The development of our faculty of trainers will be a key issue. We need to support the development of our coaches in providing careers information, guidance and counselling; improve the skills of our assessors (who will be from a range of professions); and skill up everybody (trainees and trainers) to support training and on the job learning.

Embedding the principles of assessment and the need for trainees to prepare for revalidation at this stage of training will enhance their effectiveness in the speciality training that follows.

From August 2007 all FP graduates should enter speciality training. The aim is for one competitive entry point from which to progress to a Certificate of Completion of Training. This will allow independent practice in their chosen speciality, whether it be general practice or urology, as long as the competencies are met. The duration of training will differ from specialty to speciality. Bottlenecks should be reduced; opportunities to move between specialities should be increased. Flexibility may be as important for speciality training as it is for FPs.

Conclusion

We need sufficient numbers of the right kind of doctor in the right place to meet the needs of the modern NHS. MMC aims to ensure that all doctors and dentists in their early postgraduate years have the necessary core skills and wider experience of clinical practice. This should improve career choice for the trainee, and enhance uptake of training, even for those specialities that have difficulty recruiting.

Useful addresses:

key elements:

Acute care, Communication skills, Clinical governance, Audit, Evidence based practice and academic work, opportunities to access shortage or difficult to recruit-to specialities. The wider NHS, Team working,

For more information: peter.hill@ncl.ac.uk

 
 
MEDEV, School of Medical Sciences Education Development,
Faculty of Medical Sciences, Newcastle University, NE2 4HH

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