‘How can we deliver training that meets the needs of an increasingly older and multimorbid population?’ asks Dr Ruth Law, RCP censor and consultant physician, in our latest blog taken from the RCP’s submission to the NHS England national medical training review.
Three years ago, I became an RCP censor. This is an ancient role, dating back to the Royal Charter signed by Henry VIII, and at any time there are at least four censors (as well as the education and training vice president, who is also known as the senior censor). Today, there are eight of us who oversee a focus on physician education and wellbeing at the college.
As a consultant physician in integrated geriatric medicine and general internal medicine (GIM) in London, I am passionate about educating, supporting and training the next generation, especially in the context of a rapidly growing older population living with frailty and multiple conditions. In my role as censor, I have been privileged to participate in the RCP next generation oversight group and hear from our resident doctors about their current concerns and hopes for the future of training.
What does the future look like? How can we deliver training that meets the needs of an increasingly older and multimorbid population? I’m an advocate of integrated multidisciplinary working and interdisciplinary learning, and I recently presented at an RCP next generation oversight group meeting on why frailty is everyone’s business and why we need to train more physicians to deliver high quality generalist medicine across care settings.
That’s why it’s so tough to read that 31% of respondents to our next generation survey of resident doctors said there was too much focus on GIM in their medical training.
The acute medical take has expanded rapidly in recent years and now dominates the workload of many resident doctors working in the medical specialties. At its best, it offers a crucial foundation in general and acute medicine. But too often, poor rota design, unfilled gaps, and a heavy reliance on locum cover – particularly at weekends and overnight – create working environments that leave doctors feeling overwhelmed, undervalued, and unsafe. The result? High levels of burnout, and a workforce that’s stretched too thin to thrive.
When the acute take becomes all – consuming, it crowds out vital training opportunities. Specialty experience, outpatient clinics, and procedural skills – essential components of becoming an expert physician – are frequently sacrificed to meet relentless service demands. This is particularly true in hospitals without supernumerary protections for training, where education is the first casualty of workforce shortages.
Our recent next generation survey of resident doctors found that only 44% of respondents were satisfied with their clinical training. They wanted more opportunities for hands – on learning, better clinical supervision, improved workload and rota design and a sense of being valued. In fact, positive team culture came out top when we asked them about the best bits of medical training. We need to find our way back to a training system where residents feel a sense of purpose and belonging. After all, only 26% of respondents to our survey felt prepared for the next stage in their career: this is about good quality care as well as the wellbeing of our staff.
Across the UK, there’s no minimum national standard for what a good learning environment should look like. As a result, residents face a postcode lottery in their access to clinics, educational supervision, rest facilities, and even functioning IT systems. Differences in departmental culture, educator capacity and the physical resources available contribute to stark inequalities in the quality of training.
To put this right, the NHS needs to reset its approach. We must:
- standardise supervisor training and ensure that consultant job plans include protected time for supervision
- embed mentorship schemes that support career planning and wellbeing
- guarantee protected time for outpatient clinics, especially through supernumerary periods during high-pressure placements
- invest in the basics: functioning IT, safe and comfortable rest spaces, affordable childcare, and access to hot food and drink out of hours.
Above all, we must build a training culture that values education and training as a priority.
That means developing and enforcing minimum standards for learning environments, recognising and rewarding excellent educators, and providing resident–led quality review to shine a light on lived experience and drive continuous improvement.
If we’re serious about retaining the next generation of physicians, the learning environment can’t be an afterthought. It must be a priority.
Dr Ruth Law
RCP censor
