QUESTIONS FOR THE SAC/BCS
What are the chances that the whole concept of run through training will be abandoned, and
what are the SAC views on whether this is desirable?
The whole concept of run-through training is likely to be reviewed in detail by Sir John
Tooke’s review. The Royal College of Physicians of London is strongly advocating
uncoupling of CMT (ST1 and 2) from ST3, with competitive entry into specialties at ST3
level. This view is supported by the SAC in Cardiology and by the BCS. It believes that
it is not possible to select trainees in foundation year 2 for run-through training into
medical specialties, when they may not yet have had exposure to that specialty, and
certainly are unlikely to have had a chance to demonstrate the excellence that we seek
in cardiology trainees.
If an SHO fails to get into ST3 this year how many further opportunities will they have in years
to come, and what are their job options if they fail to get a position (given the apparent
discrepancies between post numbers and applicants).
This issue will also be subject to Sir John Tooke’s review. Of course, entry into
Cardiology SpR training has always been competitive, and there have always been
more applicants than training places. It is recognised that under the old system, many
applicants spent several years at SHO level trying unsuccessfully to enter their
specialty of choice. However, it is the injustice of the “one strike and you’re out”
system of MMC/MTAS that has led to so much outrage. We will support at the very
minimum (i) the possibility of a third year of core medical training with the option to re-
apply to enter into ST3 for those who were unsuccessful at the first attempt, and (ii) an
end to the single annual appointment process. Greater flexibility will also be required
to accommodate trainees who wish to spend periods abroad, in research etc.
How many opportunities will an ST3 post holder have to get MRCP before leaving the ST
grade, and how will this affect run through of those behind him?
This is one of the many difficulties associated with the rigid run-through concept. The
answer to the question has not been considered. If, as the colleges hope, entry into
ST3 will once again become dependent upon achieving the MRCP, this issue may
become irrelevant.
Will current SpRs on training schemes switch to an ST title?
We have not received any information that existing SpRs will be re-designated as STs.
Will SpRs at an intermediate stage of training be allowed to have OOPE for research still,
given that presumably ST grades won’t?
As far as we are aware, there will continue to be the option both for SpRs and ST
trainees to be permitted to have out of programme experience for research. However,
such periods of research will have to be approved prospectively rather than
retrospectively as in the past.
When is the sub-specialty selection process likely to be introduced and who will it affect?
The issue of selection into sub-specialty is high on the agenda of the SAC. It will be a
necessary part of implementation of the new curriculum and hence needed from 2010.
However, some Deaneries may wish to introduce sub-specialty selection before this
date and these could pilot some of the options in the next couple of years. The sub-
specialty training affects individuals in the final two years or SpR or ST training.
How do you see consultant jobs evolving over the next 5 years as the first ST trainees
qualify?
If the meaning of this question relates to the likely number of consultant posts, the
simple answer is that this is something that has rarely been adequately signalled in
advance. There has been a period of very rapid expansion of consultant cardiology
posts in England, and with the expected slow down in the rate of expansion of funding
for the NHS, it may be that the jobs market at consultant level may become tighter.
When will the new curriculum be incorporated into training?
The new curriculum has been approved by PMETB, and will be operative for trainees
entering ST3 from August 2007.
How & when will assessments take place?
Assessments such as DOPs, mini CEX etc are workplace assessments and therefore
will be undertaken in the trainee’s place of work according to the guidance posted on
the JRCPTB website.
What will happen if doctors repeatedly fail the assessments – i.e. we need to think about this
now (hopefully few in number!)
The assessments form part of a portfolio of evidence on the progress (or otherwise) of
trainees, which is reviewed at the annual RITA assessment. Trainees who have failed
to pass their assessments could be offered targeted training through the RITA D or E
processes as currently exist.
Why do so many audits have to take place – every year for every trainee, as is suggested,
seems to be audit for the sake of it, and does not encourage worthwhile audit projects. This
suggests some 550 audits every year in cardiology alone (1 for every trainee). I’m not sure
this number is required/desirable/profitable.
A fair point. A larger scale audit that continued over more than one year would be
acceptable.
It is unclear whether a CCT in acute medicine will be attainable for those trainees who have
completed level 2(at) training in acute medicine (having done 3 years concurrently with
cardiology ST 3-5, then 2 yrs cardiology sub-specialisation ST 5-7). As it stands, it looks like
the CCT will only be awarded after a further period of training post-cardiology CCT (in ST8). I
had understood this further year was only for trainees planning to be a clinical lead in acute
medicine and was level 3 training.
It is likely that the mandatory competences in general (acute) medicine for cardiology
CCT holders will be attained in ST3 alongside cardiology training. In order to complete
the core curriculum, training in ST4 and ST5 will need to be focused on cardiology.
Hence it is likely that further training will be needed to complete the wider range of
level 2 general (acute) medical competencies if trainees wish to take part in Acute
Medicine at Consultant level. It is certainly the case that individuals who undertake
sub-specialisation in the procedural areas such as interventional cardiology or
electrophysiology will have insufficient time in ST6 and 7 to complete the further
training needed to acquire all of the competencies in general (acute) medicine. Such
individuals would need to consider post CCT training if they wish to take part in Acute
Medicine at Consultant level. However, some individuals might choose to take other
subspecialty modules such as heart failure, devices, or a limited number of imaging
modules which would allow sufficient time in ST6 and ST7 to complete level 2 acute
medical competencies.