Working with doctors Working for patients

Promoting flexibility in postgraduate training

We have worked with stakeholders to identify how we can collectively make postgraduate medical training more flexible.

In 2016 we began a review of flexibility in postgraduate training. We reported to the health ministers of the four UK countries in March 2017, identifying key actions we will take with others to deliver increased flexibility for doctors in training.

We are now working with partners to carry out the commitments outlined in our plan for improving the flexibility of training (pdf).

Help us make your training more flexible

What are the barriers and opportunities to more flexible training? Have you had experience of changing, or trying to change training programmes?

We want to hear what you think, to help us take forward our seven point action plan for improving flexibility in training across the UK.

Take our short, anonymous survey to help make training more flexible.

   

Reviewing flexibility

Following talks in May 2016 between the government in England and the BMA over the new contract for doctors in training, we agreed to lead a review with the aim of identifying ways in which doctors in training across the four countries of the UK could move more flexibly between postgraduate training programmes.

While the contract was rejected by doctors in training, we committed to the review in order to look at some of the deeper-seated issues which the contract dispute highlighted, including the inflexibility of current training pathways noted in the independent Shape of Training Review.

The review offered an opportunity to examine collectively the scope for greater flexibility to better support doctors in training through the education journey.

Working with partners

Roundtable meeting

In October 2016 we held a roundtable meeting to explore collectively how we could promote flexibility in postgraduate medical education and training. The roundtable was chaired by Professor Terence Stephenson, who opened the meeting with his reflections on the issues facing doctors in training.

We invited a range of stakeholders, including doctors in training, education leaders, and representatives from all four countries of the UK. We held a discussion with the aim of working together to identify issues to be addressed, look for common ground, and explore how we can drive collective change to promote and enhance flexibility.

Following the roundtable we produced a stocktaking paper (pdf) identifying areas for exploration, and referencing wider developments from the workforce and service perspective which may support flexibility.

Gathering evidence across the UK

In late 2016 and early 2017 we met with key organisations and individuals from across the UK, for further engagement and exploration of options, barriers, gaps and potential solutions.

We heard throughout this review that the current approach to training is out of date and urgently in need of reform. The structure and processes in training have created barriers for doctors in training who seek to change specialty. The same structures limit the ability of training to adapt to changing population and service needs.

Our engagement report (pdf) gives details of the views and experiences shared with us by stakeholders throughout the UK.

Plan for improvement

Adapting for the future: a plan for improving the flexibility of UK postgraduate medical training (pdf) was delivered to the health ministers of the four UK governments on 30 March 2017.

Barriers to flexibility

In this report, we identify five problems that create barriers to more flexible training arrangements.

  • Transferring between specialties is difficult without doctors going back to the start – often referred to as the ‘snakes and ladders’ effect. This is caused by the complex legal framework controlling UK postgraduate training.
  • Training in other ways is not recognised – work overseas and experience gained in non-training grade posts are not counted.
  • More career support is needed to help doctors who want to refocus their training without starting from square one.
  • Postgraduate training is slow to adapt to changes in patient demand.
  • Rigid training structures can make rota gaps worse.

A seven-point plan

In the report, we propose a seven-point plan geared to deliver more flexible training.

  • Training will be organised by outcomes rather than time spent in training.
  • Related specialties curricula, such as surgical specialties, will share common outcomes and elements.
  • We will reduce the burden of our approval system so that medical colleges and faculties can make changes to postgraduate curricula more quickly.
  • We will work with others to promote mechanisms which already exist to help trainees change training programmes – such as the Academy of Medical Royal Colleges’ Accreditation of transferable competences framework.
  • We will ask the UK government to make the law less restrictive so that we can be more agile in approving training.
  • We will support doctors with specific capabilities or needs.
  • We will encourage national education bodies to continue to improve the work-life balance of trainees.

Our vision

Our vision for flexibility is for trainees to have clarity and confidence in what it will mean for them if they switch specialties. Equivalent training between related specialties will be recognised. This will improve efficiency by allowing doctors to transfer their skills more easily and to avoid repeating training. Patients and the health services will benefit from having doctors who can care for patients with conditions that cross specialty and subspecialty boundaries.

From 2020, the benefits from our reform agenda for postgraduate training will be realised. Patients, trainees and employers will better understand what to expect from doctors in different specialties – and how these expectations will have to be met.