Plan for improvement

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

Problems that create barriers to flexibility

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

  1. 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.
  2. Training in other ways is not recognised – work overseas and experience gained in non-training grade posts are not counted.
  3. More career support is needed to help doctors who want to refocus their training without starting from square one.
  4. Postgraduate training is slow to adapt to changes in patient demand.
  5. Rigid training structures can make rota gaps worse.

Seven-point plan proposal

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

  1. Training will be organised by outcomes rather than time spent in training.
  2. Related specialties curricula, such as surgical specialties, will share common outcomes and elements.
  3. We will reduce the burden of our approval system so that medical colleges and faculties can make changes to postgraduate curricula more quickly.
  4. 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.
  5. We will ask the UK government to make the law less restrictive so that we can be more agile in approving training.
  6. We will support doctors with specific capabilities or needs.
  7. 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.