Tag Archives: GMC

Shape of Training – influence the next 30 years of medical training!

You have only days left to shape medical training for the next 30 years.

The Shape of Training review aims to plan how doctors should work and train in the next 30 years. This is your chance to directly tell decision-makers what you want postgraduate training to look like.

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  • Should we have more generalists and fewer specialists?
  • Should there be a speciality of General Internal Medicine (distinct from Geris)?
  • Should all medical trainees CCT in GIM before starting speciality training?
  • Should more specialities dual-accredit and therefore contribute to the acute take (hello Rheumatology, Dermatology, Renal, Oncology……)?
  • Should F2 be abolished?
  • Is training flexible enough?
  • How can trainees be supported to learn from their experiences?  
  • Is the balance right in the current system between training and service provision?

I have strong views on many of these questions (the answer to the last one is NO!)

“This review takes place in a rapidly changing environment. Medical and scientific advances, evolving healthcare and population needs, changes to healthcare systems and professional roles, the push towards more care provided in the community, the information and communications technology (ICT) revolution, and changing patient and public expectations will all affect how doctors will practise in the future. We therefore need to consider what these changes mean for the way doctors are trained.”

The survey is long, but is so important that it’s worth the effort. I recommend you put aside some time, make an extra large cup of tea, and really dedicate some brainpower to your answers. This is the best chance you will ever have of influencing the shape of medical training. Don’t let it slip through your fingers.

In particular I would consider mentioning your views on WPBAs and the ePortfolio in questions

  • 13: How do we make sure doctors in training get the right breadth and quality of learning experiences and time to reflect on these experiences?  (Better software in which reflection could be logged on the go, and reflections could be tagged and organised/visualised/shared more flexibly would help. Time spent with mentors instead of filling in paperwork would also be great)
  • 14: What needs to be done to improve the transitions as doctors move between the different stages of their training and then into independent practice? (Interoperability of ePortfolio systems would be a start)
  • 18: Are there other changes needed to the organisation of medical education and training to make sure it remains fit for purpose in 30 years time that we have not touched on so far in this written call for evidence? (yes…..)

Go on. Respond… 

The Bigger Picture

The NHS ePortfolio started as a local pilot project. It’s use was then expanded and expanded. There was no budget for this, and no vision for how trainees might want it to look and feel. It fulfills it’s purpose, is functional and allows trainees to record meetings and assessments. But is “functional” really good enough?

Here are some quotes from the ePortfolio site, and the JRCPTB (who fund the Physician version):

The NES (NHS Education for Scotland) ePortfolio has grown rapidly since its inception in August 2005 and now comprises over 20 versions for over 35,000 healthcare trainees within Scotland (Nursing, Midwifery, Dentistry and Pharmacy), across the United Kingdom (Medicine), and The Republic of Ireland (Medicine).

This ePortfolio is designed to support learning by providing a secure record of appraisal discussions, an ongoing personal development plan, workplace assessments plus reflection on clinical and other learning events. The ePortfolio links to the relevant GMC approved curricula appropriate to your stage of training.

The ePortfolio is designed to help gather and organise evidence in a way that is trainee centred and user friendly. The emphasis for this is on you as the trainee with support from your supervisor.

If the emphasis is on the trainee to gather and organise evidence, then the emphasis should be on the trainee to determine how that is done. There has been a lack of investment in the ePortfolio which has resulted in the current slow, unimaginative, frustrating version. This needs to change. As trainees we need to demand more.

Direct feedback to developers is needed to bring about improvements in day to day usability. Feedback to Royal Colleges etc is needed to communicate the need for investment in the overall structure and function of the system. We need an app and we need an overhaul of how the ePortfolio works in order to encourage trainee  and supervisor engagement. There is no obvious way in which this feedback can be given, hence this site….

Practice what you (aspire to) preach

What I don’t think the Colleges etc realise is that the ePortfolio is the only concrete thing we see as a result of handing over large amounts of money in JRCPTB fees.  Therefore in surveys it is said to be “poor value for money.”

Even more importantly the ePortfolio itself is a reflection of how training is currently viewed. It feels to many that we are aiming for competence – how uninspiring! What happened to striving for excellence? What happened to valuing the diversity and individuality of talent and interest amongst trainees? What happened to mentorship? Many trainees feel like just a number on a rota spreadsheet, getting through the day, jumping through hoops for assessments that often become tick-box exercises of no educational value. Of course competency in the required knowledge and skills is essential, but competency is a MINIMUM requirement. It often feels that this is all that is expected. Many trainees do extraordinary things but their supervisors and deaneries would never know this. One trainee’s portfolio looks just like any others, the only difference being whether they have done 6 mini-cex’s or 7.

If we want to inspire excellence, we need to show this in everything we do, and in every system we create. Trainees need a system that allows them to not only demonstrate that they have reached the minimum standard to progress, but that they are so much more than the sum of a few WPBAs. They need to be proud of their portfolio. Currently the system is failing them, with the danger of producing uninspired, undervalued, underachieving, burnt out doctors. Bad for trainees, bad for Trusts, bad for patients.

Time for a fresh look at what we expect of trainees, and what trainees can expect of the system.