Features: A year in the life of PMETB
27 November 2009
Looking at the current state of postgraduate medical education and training in the UK.
PMETB Chair, Professor Stuart G Macpherson, introduces this key resource and looks at some of the issues featured.
The last few years have seen some dramatic changes to the provision of postgraduate medical education and training (PMET) in the UK. From recruitment to content, from structure to delivery; few aspects have remained unaffected.
The Postgraduate Medical Education and Training Board (PMETB), to be merged with the GMC next year, is responsible for developing, promoting and maintaining high standards of medical education and training for postgraduate doctors.
In the light of so much change, the Board has published the second edition of its flagship resource The State of Postgraduate Medical Education and Training, which provides a snapshot of the sector, reflecting current thinking about where PMET is today. The publication provides a platform from which those involved at all levels of postgraduate training can voice their views and contribute to key debates.
Published this October, the publication also gives recognition to those who work behind the scenes at deaneries, colleges and in the NHS.
Standing up for training
Like the 2008 edition, The State of PMET 2009 looks at the issues and debates that have dominated the PMET landscape over the last year, including recruitment, the role of patients, credentialing and assessments. However, one of the dominating themes of this year’s edition focuses on the European Working Time Regulation (EWTR, formerly referred to as the European Working Time Directive or EWTD) and its impact on medical training.
The views shared on EWTR have been varied although contributors have been emphatic that training must not be sidelined by a shorter working week. Reflecting the views of many of the contributors, Department of Health EWTR adviser, Wendy Reid, says: ‘We must ensure that training is not the victim of short-term solutions for the EWTR and that trusts reflect the importance of training doctors as a core NHS activity...The move towards a service that is delivered by consultants and is not completely reliant on trainees out of hours is an expanding option for obstetrics and gynaecology and paediatrics…not only beneficial for training but also protects and enhances training.’
BMA Junior Doctors’ Vice-Chair, Tom Dolphin, agrees: ‘Employers have often not prioritised training for the future, instead focusing on service provision now…time available for training activities has been squeezed almost completely out on some rotas. More has to be done to redistribute service tasks away from junior doctors to other staff.’
The publication provides useful illustrations of good practice. Medical director, Dr John Coakley, believes a solution to the EWTR can lie in the smarter delivery of service and training for elective and emergency care: ‘At the Homerton, we have gone as far as possible to remove trainees from out-of-hours periods and encourage team working and sensible cross-cover…With the collaboration and good will of colleagues, junior and senior, medical, nursing and managerial, it is possible to achieve EWTD and, moreover, maintain or improve elective training to deliver improved patient outcomes.’ http://www.gmc-uk.org/
Meeting the teams
In order to truly reflect life in the sector in 2009, The State of PMET includes views not just of senior figures, but also of those at the coalface of training delivery, with personal accounts of day-to-day practice.
In chapter 5, which focuses on certification, Ruth Gibson from the Royal College of Radiologists describes how meticulously she and the equivalence committees need to work to ensure only the right candidates are approved for certification: ‘Once correctly completed, each equivalence application is sent to us electronically. These can be anywhere from 200 to 1,200 pages. I summarise the reportsfor evidence which relates to the criteria within Good Medical Practice that the committee is checking against.’
A platform for sharing reassuring common experiences is also presented. In chapter 3, Dr James Murphy recounts this experience of applying to specialty training in 2009: ‘I secured interviews with my two chosen deanery applications for paediatrics. Meanwhile colleagues awaiting responses from other specialties heard nothing. Their anxiety was palpable and the drawn-out process seemed inhumane…Thankfully their strong nerve and steely determination saw the majority secure posts in subsequent rounds’.
Developing policy, quality and certification
The State of PMET also plays an important role in documenting developments in policy, quality assurance and certification delivery. Chapter 1 looks at the big policy issues facing medical training over the year. Dr Mary Armitage at Modernising Medical Careers and Dr Patricia Hamilton at Medical Education England share their respective Department of Health (England) views, while PMETB’s Future Doctors’ policy statement group Chair, Dr Trevor Pickersgill, explores the key considerations for future training.
Contributors from a breadth of organisations, including the Conference of Postgraduate Medical Deans of the United Kingdom, the UK Foundation Programme Office, NHS Employers and the BMA Junior Doctors Committee, also share their training-related milestones.
Among them, Chair of NHS Employers’ Medical Workforce Forum, Andrew Horne, describes the renewed focus on employers’ involvement in standards and curricula design: ‘Developing these standards may be difficult, but [we] believe it is sensible and desirable…supporting greater mobility and transferability of relevant competencies and skills between specialties as doctors’ training and careers develop.’
Reflecting on developments in quality assurance and certification delivery in 2009, the publication also hears from PMETB’s directors. Quality Director, Patricia Le Rolland, reviews feedback gathered from deanery and college colleagues looking at how this, and evidence from PMETB’s Quality Framework, will impact on quality assurance activities in the future. Director of Certification, Lesley Hawksworth, follows the journey of PMET certification past, present and future and looks at the work that goes into processing applications for thousands of specialty and GP trainees each year.