School of Medicine Shape of Training Implementation

Transcription

1 School of Medicine Shape of Training Implementation 25 th April 2018 John Anderton Head of School of Medical Specialties, HEE NW Consultant Renal Physician Lancashire Teaching Hospitals NHS Foundation Trust

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3 Modernising Medical Careers (2005) Aim Improve patient care by improving medical education with a transparent and efficient career path for doctors" Followed publication of NHS Plan committed to increase the number of consultants in the NHS and to "modernise the Senior House Officer (SHO) grade

4 MMC and MTAS were heavily criticised

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8 Challenges with recruitment and trainee morale

9 CMT R1 applications Region % dif (2017 vs 2016) East Midlands % East of England % Kent, Surrey & Sussex % London % North East % NW Mersey NW North West % Northern Ireland % Scotland % SW Severn 137 SW Peninsula % Thames Valley % Wales % Wessex % West Midlands % Yorkshire and % Humber -15% Total %

10 Published 2013

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12 Promotion of G(I)M training without devaluation of specialist knowledge needed Robust structures for post-cct training Effective model for credentialing Academic opportunities for all trainees Understanding of length of training needed across all specialties Dual core accreditation for most specialties Implementation needs to be phased

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14 An MAU placement 24 months looking after acutely unwell inpatients 80 clinics over 3 years A Geriatric placement An ICU placement

15 IM 1-3: From August 2019 Year One (IM1) - Trainees will have exposure to Acute Care (via Unselected Take) but with a concentration upon Continuing In-Patient Care with responsibilities in General Medical and Geriatric Medical wards. Trainees will enter IM1 having completed Foundation competencies Year Two (IM2) - Trainees will continue to have exposure to Acute Care (via Unselected Take) and critical care but the focus of the year will be Ambulatory Care and Medical Out-Patient management. Entry to IMT2 will be automatic following a successful ARCP at end of IM1 year. Trainees will be encouraged to complete MRCP by the end IM2 (although it will not be mandatory for progression to IM3 Year Three (IM3) -Trainees will have greater involvement in the Acute Unselected Take. They will be expected to lead the unselected take in the medical registrar role and provide support for IM1 & IM2 trainees as well as other staff involved in the take (eg Foundation trainees, GP trainees, ACCS trainees and others) Trainees will enter IM3 upon satisfactory completion of IM2 ARCP or via other routes

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17 Group 1 specialties (dual train with Internal Medicine) Group 2 specialties (single CCT) Acute Internal Medicine Allergy Cardiology Audio vestibular Medicine Clinical Pharmacology and Therapeutics Aviation and Space Medicine Endocrinology and Diabetes Mellitus Clinical Genetics Geriatric Medicine Clinical Neurophysiology Gastroenterology Dermatology Genitourinary Medicine Haematology Infectious Diseases / Tropical Medicine Immunology Neurology Medical Ophthalmology Palliative Medicine Nuclear Medicine Renal Medicine Paediatric Cardiology Respiratory Medicine Pharmaceutical Medicine Rheumatology Rehabilitation Medicine Sport and Exercise Medicine Medical Oncology discussions ongoing with UKSTSG

18 Generic professional capabilities JRCPTB has been engaged in the development of GPCs from an early stage GPCs are mapped to the IM CiPs AoMRC group formed to facilitate integration of GPCs in specialty curricula

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20 Presentations and conditions Presentations, conditions and the underpinning clinical science are described in the form of three targets The bull s eye has the patient at the centre of knowledge, learning and care Associated professional knowledge, skills, values and behaviours are context dependent

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22 Critical care Trainees should have significant experience of critical care Flexibility in how this is delivered providing educational objectives are met Minimum 10 weeks over 3 years in no more than 2 blocks Ideally 3 month attachment to ICU in IM2 Possible 2 month attachment IM2 + 1 month IM3 Flexibility for IM1 attachment

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24 IM1: 3 posts 4months IM2: 1 post 6 months 1 post 3 months 1 post 3 months ICM Could do ICM on call/ooo work Prefer some release for clinics Programme is Sectorised Year in one place Need 1 ICM post for every 4 IM2 trainees ie total of 46 across HEENW No central funding so seeking incorporation of existing posts

25 Required numbers: already in CMT programme 6 already in CMT programme

26 Manchester-Lancashire MRI 5 (Currently 2 in programme so offering additional 3) Christie 1 SMUHT 3 (Currently 2 in programme so offering an additional 1) Tameside Interested Bolton: No Oldham 4 5 more needed Preston 3 Confirmed Blackburn 1-2 Like 6 months Blackpool 1 Barrow Possible interest Lancaster Response pending 3-4 more needed

27 Example track

28 Questions? La Femme Hydropique Gerard Dou C.17th Urine colour-wheel chart from Pinder, Ulrich, d or 1519

29 Academic Training 1 The IM curriculum will be based on competency/expertise acquired rather than "time served There should be enough flexibility to allow time for academic training within IMT1- IMT3. It will be up to TPDs and ESs to be assured that academic trainees will be able to demonstrate that they have acquired/will acquire the appropriate levels of "Competency in Practice" despite some reduction in the time they spend in any particular attachment There is no reason Academic trainees should not take OOPR at IMT2 or 3 level Recruitment of overseas ACFs or others who are not already in a programme may be an issue for recruitment as they may not be entering at the normal break point (ie currently CMT/ST1 or ST3) but will be entering at IMT3. We should be able to work around this so they can be assessed by the usual clinical recruitment panels and a view taken whether they are appointable at an IMT3 level. Those already in IM training will not require a further clinical benchmarking procedures

30 Academic Training 2 Recruitment into IMT2, by avoiding benchmarking issues, allows us to offer the award immediately and avoid the delay currently happening between ACF interview and clinical (benchmarking) interview when at ST3. The IM curriculum will be flexible to allow ACFs time out (the 3 month blocks or however taken) for those ACFs starting in IMT1, at any point ideally in the 3 years More trainees will now get PhD funding before completing 3 years IM training Eg Wellcome have changed the way they award CRTFs

31 Academic Training 3 There is anxiety related to ACFs entering academic training at the level of ST4 as opposed to the current arrangement of ST1 or ST3 The new Internal Medicine (IM) curriculum in August 2018 should not impact on academic recruitment at ST1. ACF is a run through programme, a trainee could be recruited academically into their specialty during IMT2 and then commence their ACF in IMT3. There is no inherent reason why they should not do the usual split during that year of 9 months clinical and 3 months academic. There would be no requirement for a clinical benchmarking exercise at ST2 because they are already in programme. Clinical benchmarking may be required prior to transition into ST4 then that should be readily achievable as there will be clinical selection interviews ongoing and the only requirement for the panel would be to say whether or not the individual is clinically appoint able.

32 Recruitment Points into Academic Training IMT1 IMT2 IMT3 IMT4 Foundation 2 years IM Registrar 3 years IM Senior Registrar 4+ years Consultant