A new survey of junior doctors in core medical training (CMT), undertaken by the Joint Royal Colleges of Physicians Training Board (JRCPTB) and the Royal College of Physicians is published today in the RCP’s journal Clinical Medicine.
Just under a third of all CMT doctors in the UK responded, and the survey highlights some fundamental problems with the CMT programme which need to be addressed urgently. If not, there is a danger that foundation doctors will be deterred from applying to CMT with a resulting knock-on effect which would compromise medical specialty recruitment.
Feedback indicates that CMT doctors are spending so much time on the wards that they are missing out on training opportunities, including attending outpatient clinics and formal teaching sessions.
Doctors in CMT have already completed a 2 year foundation training programme after graduating, and are typically 26-28 years old. They see a wide variety of patients to give broad experience of the diagnosis and management of common medical conditions such as heart attacks, strokes, liver and kidney failure, asthma, epileptic seizures and conditions such as arthritis and diabetes.
Figures were similar for trainees wanting to attend formal training sessions both regionally and in their hospital.
Ninety per cent of respondents to the survey said that service provision took up 80-100% of their time, leaving very little time for training. 89% of trainees reported that they found that outpatient clinics provided either valuable or very valuable training, but 81% said they were often prevented from attending due to work pressures, The loss of formal and informal training opportunities is having a detrimental effect on the confidence of CMT doctors and their readiness to take on more responsible medical roles. Almost half of CMT2 trainees surveyed reported that CMT had not prepared them to progress to the next step of medical registrar and a similar number of CMT trainees wanted the length of CMT to be extended to 3 years. Many trainees advised they are put off acute medical specialties by their experiences in CMT citing:
It feels more like a service post than a training post.
Current CMT is not a training programme. I feel completely disillusioned by it and this is why I have changed to GP. (general practice training)
CMT doctors were also concerned about the amount and quality of consultant feedback, and the length and frequency of meetings with their educational supervisors, with most respondents wishing for longer and more frequent meetings.
Professor Bill Burr, Medical Director of the Joint Royal Colleges of Physicians Training Board, and joint author, said:
The results of the survey have confirmed the extent to which the service and training system is failing to support and value the crucial contribution made by these vulnerable young doctors to the delivery of acute medical care. Most damning of all to me are the comments made by a number of CMT doctors to the effect that they had not progressed beyond the foundation stage in spite of 2 years spent in CMT. There is a clear message here that there is a need for urgent action to address the problems which are in part due to excess demands being made on too few doctors who are inadequately supported.
Dr Fiona Tasker, clinical fellow to the RCP president, article joint author, said:
This survey has highlighted that many CMT trainees need more support from additional clinical staff on the wards to be able to participate in training opportunities. There are many dedicated supervisors who contribute to training core medical trainees and prepare them to take on the role of the medical registrar. However, not enough time is allocated to most consultants for this important teaching / mentoring role, and protected time to deliver training opportunities both on and off the wards should be factored into consultant job plans. I hope that by raising awareness of the variable training standards across the UK, this will encourage the quality of CMT to be closely reviewed, and in some cases to be significantly improved.
Dr Andrew Goddard, joint author and former director of the RCP’s medical workforce unit, said:
This survey shows the huge pressure that junior doctors in the NHS are under. Whilst it is reassuring that they put their patients first, the fact that they miss out on valuable training opportunities to do so has implications for the consultants of the future.
For more information, and to arrange interviews, please contact Linda Cuthbertson, head of PR, on 0203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk
- A copy of the article is attached to this email. The reference for this article is Clinical Medicine 2014 Vol 14, No 2: 149–56.
- An electronic survey using Vovici software was emailed to all CMT trainees registered on the Joint Royal Colleges of Physicians Training Board (JRCPTB) database. The survey was sent out on 14 June 2013 with reminders sent out after 3 and 4 weeks. The survey was closed after 6 weeks.
- A total of 2,724 trainees were emailed the survey and 871 responses were received, a response rate of 32%. Of the responses, 456 were from CMT trainees at the end of their first year of training and 392 from CMT trainees at the end their second year; response rates were 52% and 45%, respectively. Of respondents, 42% were male and 58% were female. Responses were obtained from all deaneries in England, Wales and Scotland with response rates for the nations of 36%, 38% and 31%, respectively.
- Not all responders answered all of the questions so the percentages and numbers in the press statement above relate to over 655 doctor responses, or 325 responses where the question was asked to CMT2 trainees only.