Hospital Dr News

Generalist-specialist split would damage training

A proposal to separate generalist and specialist training by a review into postgraduate medical training has been rejected by the BMA.

The Association’s Annual Representatives Meeting heard that the Shape of Training review which is jointly sponsored by the Academy of Medical Royal Colleges, the GMC and other organisations with a stake in medical training, is proposing to alleviate the problems of the acute take by creating a new cadre of generalist-only doctors.

Dr Luke Boyle, a foundation doctor representing North Thames Regional Junior Doctors Committee, said one idea was to create a large “sump” of generalists, the majority working at SHO level , with only a small minority of trainees progressing to super specialist training through credentialing.

This would damage training because the generalists would only exist to provide the service. “More importantly, our patients want and deserve a specialist when they present at hospital,” he said.

Generalist and specialist training were not mutually exclusive. “What has come out of the review so far not only risks damaging the sanctity of the CCT but also risks in the future the potential for (the introduction of) a sub consultant grade.”

But another delegate said many consultants she had spoken to said it was difficult to be an excellent generalist while also being a brilliant specialist.

Acute medical units staffed by consultants who were excellent generalists should be expanded, she said.

Dr Mark Porter, chair of BMA council, said the idea of generalism had taken on a life of its own over the last few months.

“It is an idea of generalism which is separate to specialism and which everybody sees as a way of staffing our hospitals and surgeries with people who are not quite specialist but able to soak up the workload. I have both an emotional and intellectual reaction against that.

“The fact is if we go down the generalist/specialist route we will have specialists who are extremely highly trained and we will lose them entirely from the acute take. At the moment we benefit from having specialists participate in the acute take. Most specialists would actually want and welcome the opportunity to have some sort of broad view and it would improve patient care.”

The conference rejected the idea of having two separate training paths and called on the royal colleges to consider extending training programmes to allow more generalist experience to be gained in the setting of a regulated, funded training programme rather than outside training.

The meeting also called on the royal colleges to resist and reverse the growth in post-CCT fellowships and to instead seek to introduce the content of these fellowships into the training programme curricula, perhaps as optional modules, if their content is necessary to practice as a consultant.

Representatives also agreed that CCT training programmes should by definition contain all the training needed to ready a doctor for consultant practice.

Dr Ram Moorthy, an ENT consultant, said: “We’ve had this debate on the sub consultant grade numerous times before. We want the CCT to remain as the internationally recognised end point of training. What we don’t want to do is see a CCT sub consultant grade because it demoralises and denigrates our consultant colleagues, staff and associate specialist doctors. We send the wrong message to medical students and those aspiring to be doctors by saying you can go through training you can get an internationally recognised qualification that says you can provide high quality care to your patients and yet what you are going to be doing is be used by employers as cheap rota fodder.”

The Shape of Training review is expected to produce its final report in the autumn.

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