Many medical graduates are wasting time doing irrelevant jobs in their foundation years, a review of the training programme has been told.
The evaluation of the Foundation Programme for Medical Education England has also been warned that foundation trainees are failing to gain enough acute medical experience.
Several organisations are calling for the second foundation year (FY2) to be scrapped to enable trainees to move more swiftly into core training posts more relevant to their chosen career pathways.
This was recommended by the Tooke Review in 2008 but ignored by the then health secretary Alan Johnson.
This latest review, led by Professor John Collins, a general surgeon and academic from Oxford University, has been commissioned as part of the NHS next Stage Review.
Remedy UK, the campaign group which campaigns for training reform, has told Collins that trainees allocated FY1 jobs in areas such as radiology, pathology and anaesthetics are being given minimal levels of responsibility. On call experience is often lacking and too many FY1s are not getting experience of managing acute medical problems or working regularly as first on call doctor.
Remedy says the FY1 year should be refocused on the “core bread and butter” with two six month posts in core medicine and surgery with sufficient exposure to common on call emergencies.
It suggests FY1 could be re-branded as the “house doctor” year to emphasise the professionalism and responsibility that come with the first year job. Remedy also recommends that foundation training should be better regulated with robust trainee surveys and frequent hospital visits to ensure trainees are gaining enough acute medical experience.
Ben Dean, a former Remedy committee member and surgical trainee from the Oxford region, said: “We have got to do something about the reduction in hours and experiential learning. Ten years ago house officer jobs used to be better regulated so a training post would not be allowed if it didn’t have any training content in the job.
“When Modernising Medical Careers came along in 2006-07 numerous non training jobs were incorporated into the Foundation Programme and now there are very specialised jobs such as radiology, pathology, lab based or public health work where trainees get no acute experience of seeing patients for the first time.”
The Royal College of Physicians is also calling for trainees to move directly into core medical training after FY1. “A large proportion of our consultants and doctors in training report that for many of them the significant proportion of the experiences they have in the second foundation year are often irrelevant to their future practice when they have already decided on a set route. Our finding is that many trainee doctors don’t find any step up of responsibility as they move into second year,” said a spokesman.
He said they acknowledged that there would some serious hurdles to overcome to change the system so instead they would like to see would-be physicians who have already chosen a defined career path to be allowed to choose more appropriate career options in FY2.
The Royal College of Surgeons says the Foundation Programme as it is currently operating is failing to meet either the needs of the trainees or the service in surgery. In its submission, it says the four month placements are too short to give trainees sufficient exposure to all the elements of surgical care from a patient’s initial appointment through to post operative follow up. The RCS recommends that a single pre-registration foundation year should be followed by three years of core training. It says this proposal has near unanimous support from surgical trainees.
Shree Datta, chair of the Junior Doctors Committee, said they were very supportive of the foundation programme and the measures that had been introduced by the UKFPO to develop the programme.
“Like anything there is always room for development and nothing will ever be perfect for everyone but certainly we feel the Foundation Programme has achieved what it aimed to do in that it has made sure that most people have a broad based training,” she said.
Collins said the needs of patients and medical graduates would be central to his evaluation of the Foundation Programme: “I can give trainees my personal assurance that their views will be listened to and taken into account in considering the best way forward in managing the transition points as doctors move through their training.”
His report is expected to be submitted to the health secretary in the autumn.
Trainees can voice their opinions on MEE events being held on 19/20 May in London and Leeds.