A new charter for medical training has been launched in Scotland in a bid to raise quality and patient safety.
The charter from the Royal College of Physicians of Edinburgh follows its recent warning that Scotland is in danger of producing a generation of inadequately trained doctors.
The RCPE adds that training can only be improved however, if all involved parties (including the Scottish government, NHS boards and training-related organisations) recognise the fundamental problems which exist and commit to the charter’s implementation in practice.
The charter is relevant to all doctors working within the medical specialties in the hospital sector and was developed in response to an erosion in the balance between the time that medical trainees have for training and providing direct patient care, and their consultants have for overseeing this training.
Successive independent inquiry reports and multiple surveys conducted by the royal colleges had indicated that this has become a major problem within the NHS throughout Scotland and the whole of the UK, with trainees often simply and inappropriately used to plug gaps in hospital rotas at the expense of their training.
The charter is based on five guiding principles:
1. Patient safety and care is paramount;
2. All parties recognise that training and service elements must be balanced;
3. Trainees are valued for their service (patient care) contribution;
4. Trainees are actively involved in the training process; and
5. Training is fair, based on principles of equality and fosters the development of professionalism
The charter then lays out 26 detailed commitments (covering the areas of patient care and safety, recruitment and induction, balancing training with service provision, ensuring quality training, assessment and curricula, and support and development).
Key commitments include:
1. The duties, workload and work patterns of trainees should ensure patient safety;
2. Trainees and their trainers should receive protected time for clinical training;
3. Trainee numbers will be based on accurate workforce planning;
4. Trainees should receive supervision and support with their clinical case-load and work at a level appropriate to their level of competence;
5. Trainees have access to a sufficient breadth and depth of clinical work to enable them to achieve clinical competencies;
6. Processes for recruitment, selection and appointment are open, fair and effective with specific details regarding training posts available at the time of application;
7. Trainees receive equitable access to personal, ring-fenced study leave budgets to support their training needs; and
8. Trainees are supported in monitoring and accurately documenting working patterns.
The charter was developed by the RCPE’s trainees and members’ committee, which represents approximately 4,000 medical trainees, and is backed by the RCPE.
Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said: “In recent years increasing pressures upon the NHS have reduced the amount of time that can be devoted to medical training. As a result, many trainee doctors are currently receiving an inadequate level and quality of training, and their consultants have insufficient time to oversee this training effectively. This has the potential to seriously undermine the future provision of high quality and safe patient care in Scotland and throughout the UK.
“Having recognised these problems, and as a major contributor to the training of doctors, the RCPE has developed a charter for medical training which we believe can lay a solid foundation for beginning to tackle the problems which exist and securing the future level of care needed by patients. However, we simply will not be able to make progress in decreasing the potential risk to patient safety and improving the quality of training if all involved do not commit to the implementation of this charter. This issue has to be considered urgently at a national level by the Scottish government and all stakeholders. Consensus then needs to be reached on how we can tackle these problems together, and a timescale agreed and resources identified for implementing the recommended measures.”
The charter has been submitted to the Scottish and UK governments and circulated widely to all of those involved in training. It represents the views and practical experiences of RCPE trainees and trainers, and builds on earlier GMC standards and other source documents.
Dr Kerri Baker, chair of the RCPE trainees and members’ committee, said: “Patients and the public, in general, may be largely unaware of the extent to which trainee doctors prop up the NHS. Trainees, often experienced doctors in their own right, are frequently the first point of contact for patients and are fully committed to providing them with the highest quality of care. But, in addition to providing direct patient care, trainees also need to be able to access training which will enable them to become fully trained and to function safely and efficiently as the consultants of the future.
“It has now reached the point where the need to plug gaps in hospital rotas, increasing work intensity - in part due to working time regulations - and the reduced availability of trainers, by the same mechanisms, are preventing trainees’ ability to receive adequate training. Almost 60% of trainees who responded to a recent survey believed they would not be adequately trained by the time of completing their training. It is, therefore, essential that trainee doctors are better supported and are provided with protected training time if we wish to secure the future safety and quality of patient care.
“The charter does not provide all of the answers, but by clarifying the roles and expectations of trainees and their trainers, and encouraging a consistent approach to trainees’ experiences nationally, we believe the charter could afford trainees greater support, strengthen their training and reassure patients.”
Read the charter.
