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Royal College of Physicians Trainees Committee Minutes of the forty-second meeting Tuesday 29th May 2007 1.00 – 3.00pm Rosenheim & Pickering Rooms Present – Trainees: Dr. Roger Duckitt Chairman Dr. Tim Felton Deputy Chairman Dr. Sundari Ampikaipakan East Anglia representative & Committee Communications Officer Dr. Kapil Bhargava North West Thames Dr. Adam Bray South Western Dr. Peter Chamberlain Mersey Dr. Rishi Dhillon North East Thames Dr. Paul Dunckley Oxford Dr. Sara Fairbairn Wales Dr. Jessie Felton South West Thames Dr. Joseph Footitt South East Thames Dr. Kenneth Hodson Northern Dr. Juliane Kause Wessex, Committee Flexible Training Officer Dr. Stuart Kendrick Northern, Committee Secretary Dr. Fraz Mir East Anglia Dr. Arumugam Moorthy Trent Dr. Jonathan Myers North East Thames, Committee Deputy Secretary Dr. Amit Patel North West Thames Dr. Rebecca Rose Yorkshire Dr. Ian Rowe West Midlands Dr. Preeti Shah North West 1 Present – College officers: Mrs. Liz Avital Deputy Head of JRCPTB Mr. Stephen Beglan Training Events Co-ordinator & CMT Enrolment Supervisor, JRCPTB Miss Helen Brough Manager, Membership Dr. Rodney Burnham Registrar Dr. Patrick Cadigan Director of Training, JRCPTB Dr. Mike Cheshire Clinical Vice-President Elect Dr. Bob Coward Specialist Registrar Adviser Miss Linda Cuthbertson Press & PR Manager Mr. Martin Else Chief Executive Prof. Ian Gilmore President Ms. Julie Hollings Director of Corporate Communications Mrs. Winnie Wade Director of Education In attendance: Mr. Tom Waterman Committee Administrator 1. Welcome and apologies The Chairman thanked those present for their attendance at his first meeting as Chair; he welcomed to the Committee, and offered his congratulations to Dr. Kapil Bhargava, Dr. Peter Chamberlain, Dr. Rishi Dhillon, Dr. Paul Dunckley, Dr. Joseph Footitt, Dr. Kenneth Hodson, Dr. Arumugam Moorthy, Dr. Rebecca Rose, Dr. Ian Rowe and Dr. Preeti Shah, who had all been recently elected to the Committee and were attending their first meeting. Also welcomed to the Committee were, from the College, Miss Helen Brough, Manager of the Membership Department, and Ms. Julie Hollings, Director of Corporate Communications. Dr. Duckitt informed the Committee that, following his succession to the position of Chair, Dr. Ampikaipakan had been elected to the vacant position of Communications Officer; Dr. Kendrick had been elected to the role of Secretary, succeeding Dr. McCann who had recently stood down from the position (but would remain on the Committee); and Dr. Myers had been elected to the newly created position of Deputy Secretary. Dr. Duckitt gave the Committee’s thanks to Dr. McCann for her work in the role to date. The Chairman also conveyed the Committee’s thanks to Dr. Rachael Ellks and Dr. Sanjay Sastry, who had both recently resigned from the Committee. In addition, it was reported that Dr. Robin Ray and Dr. Mary Wain had also left the Committee since the last meeting. 2 Apologies were received from: Dr. Mary Armitage, Clinical Vice-President (outgoing) Mr. Jim Benson, Senior Manager of Examinations Dr. Chris Clough, Medical Director, JRCPTB Prof. Jane Dacre, Academic Vice-President Dr. Thomas Johnson, South Western representative Dr. Sundeep Kaul, Trent Dr. Fiona McCann, Oxford Dr. Narbeh Melikian, South West Thames Dr. Kamran Shafiq, Yorkshire 2. Minutes The minutes of the previous Trainees Committee meetings – the full meeting, held 24th January 2007, and extra-ordinary meeting, held 17th March 2007 – were approved without amendment. 3. Matters arising from the minutes not covered elsewhere on the agenda Study Leave Funding The issue of study leave funding had been discussed in the previous meeting proper, with Prof. Jane Dacre reporting a central review of the Multi-Professional Education and Training (MPET) levy was underway. Dr. Felton and Dr. Duckitt enquired as to whether there had been any feedback from the Postgraduate Deans Liaison Committee (PDLC) on the issue; Dr. Burnham informed the Committee that the PDLC would be meeting and discussing the issue later that week. Dr. Kendrick reported that at the previous meeting, the Deans had suggested that, whilst they appreciated the difficulties trainees were experiencing with study leave funding, they were unfortunately not in a position to identify a solution at present. Dr. Duckitt informed the Committee that the issue of study leave funding had also been raised at the most recent meeting of the Academy Trainees Group (ATG), and was being discussed by the Royal Colleges at present. The Trainees Committee had discussed the matter in the morning session (an informal trainees-only meeting, held prior to the main meeting), and there had been two areas of concern raised – firstly, resulting from the removal of ring-fenced funding provided by MPET, there would no longer be guaranteed financial support for trainees to take study leave; also, this had been discussed alongside the issue of time being available to take study leave, where some trainees were encountering difficulty. Dr. Felton iterated that current study budgets were being reduced to an extent whereby trainees could no longer be funded to attend courses which were essentially mandatory. Whilst there was some support for the proposal of trainees contributing to course funding, 3 the general view was that those courses which were stipulated as necessary by the curriculum should be provided as part of a training programme, and that the possibility of trainee responsibility should only be applied to those courses which could be considered extra-curricular. Further to this, it was felt that there may be difficulties inherent in trainees being required to differentiate between essential and desirable courses. Also, there was an issue of regional variability in study leave funding between different Deaneries; presently, the Specialty Advisory Committee (SAC) for Histopathology at the Royal College of Pathology (RCPath) was working on mapping which areas of the UK were and were not being funded for study leave, and it was suggested that once completed, this would provide a more substantial grounding on how to tackle the issue on a national basis. Following this, it was proposed that the Committee should wait to receive feedback from the PDLC and other relevant committees, in addition to completion of the RCPath study leave funding map, before deciding what action to take on the issue. Extra-ordinary Trainees Committee meeting Dr. Duckitt thanked those members who had attended the extra-ordinary meeting of the Committee, held in March, and suggested that as the meeting had centred on a small number of specific issues – namely Modernising Medical Careers (MMC) and the Medical Training Application Service (MTAS) – which would be covered later in the current meeting, any issues arising from those minutes could be discussed later on in the agenda. Following this, both sets of minutes were received. 4. To receive a report from the Chair The Chairman suggested that, whilst most of the issues which would make up the Chair’s report would be covered in greater depth elsewhere on the agenda, there were two additional items he wished to raise; firstly, he gave thanks to the President and Chief Executive for their support in arranging for his attendance at the European Federation of Internal Medicine Congress the previous week. The Congress had provided an opportunity to discuss the challenges confronting trainees elsewhere in Europe, those being, chiefly, pay conditions and the application of the European Working Time Directive (EWTD), which Dr. Duckitt noted seemed to be applied more rigorously in Britain than elsewhere. It was felt that the group would provide excellent potential for forging links, research opportunities, possible exchange programmes, and also some shared, internet-based e-learning, which would tie in with work currently being done by the College. In addition, the Chairman reported that he was involved with a membership group which had initially been set up by Sir Richard Thompson – currently delivered as a working group chaired by Mr. Clive Constable – and was investigating some of the issues which had been, and would continue to be discussed by the Trainees Committee, such as how 4 the College could engage trainees more fully in its operations, and the extent to which the College provides benefits in return for membership. 5. To receive a report from the President The President’s report was tabled. The Chairman suggested that, barring any questions from members immediately resulting from the report, it would be prudent to devote more time to the major issue on the agenda, namely that of MMC/MTAS. 6. MMC and MTAS Two draft position papers were circulated amongst the Committee: ‘Modernising Medical Careers for Trainees in the Medical Specialties: A Report by the Trainees Committee’, tabled by Dr. Felton, and ‘Foundation Training: The lessons from the implementation of Competency Based Medicine’, tabled by Dr. Myers. The President suggested that the Committee was already aware of the pertinent information to date, and reported that the College would continue to pursue its position of working with the MMC and MTAS review group to reach the fairest result for patients, trainees and consultants. Prof. Gilmore iterated that some recent criticism of him and the College had been misplaced, and stressed that he and the College officers were keeping well abreast of the situation and the feelings of doctors involved. It was felt that the Department of Health (DoH) MMC/MTAS review group was encountering some difficulties, in that a lag existed between the group meeting and making recommendations, and those recommendations being released, resulting from a period of legal consultation in the interim; this lag in turn would often lead to rumours being circulated, thus increasing the potential for false information to be received. There had been clear recommendations made for the end of appointment rounds 1 and 1- B, and clear suggestions made regarding the operation of round 2 – essentially that it should be Deanery-based and revert to a system similar to that in which junior doctors have confidence. Extra posts had been agreed, particularly in ST3 and the high competition specialties such as neurology and cardiology, where there was a belief that the capacity at trainee and consultant level existed for expansion; however, some specialties, such as gastroenterology, had expressed concern over the high ratio of trainees to consultants and as such, had been reluctant to take extra posts. Prof. Gilmore highlighted that the most important issue to be discussed would be that of giving a clear steer to the independent inquiry chaired by Sir John Tooke, which would be investigating the application process and making recommendations for 2008-09. Part of that would involve investigating where problems arose under the MTAS process, and also the relative roles of the Royal Colleges in the process, along with those of the Postgraduate Medical Education and Training Board (PMETB), MMC, MTAS and the DoH. It was reported that informal preliminary meetings to discuss the College’s input to 5 the inquiry had taken place, and Prof. Gilmore reported that following the meeting, there would be an open forum held at the College where any fellow or member would be invited to give his or her thoughts on the situation, and views on the outcomes the College should be looking for from the Tooke review. Finally, the President commended the position papers tabled by Dr. Felton and Dr. Myers, and felt that they raised a number of significant issues to be added to the debate. Dr. Duckitt acknowledged the President’s interest and concern at every stage of the discussion of MMC and MTAS, and that he had represented a very balanced and well- steered course, both before and since the fallout from MTAS. Dr. Felton raised the issue of the Royal College of Surgeons withdrawing from the MTAS review group; Prof. Gilmore suggested that there would likely be little or reduced impact from this move as the work of the group would soon be coming to a close. Dr. Kendrick reported that many people held the impression that the DoH may be looking to involve the College in taking responsibility for the problems arising over MTAS; a DoH statement had been released suggesting that the DoH’s actions had been taken with the full agreement of the Royal Colleges. Whilst Dr. Kendrick was aware that this was not wholly the case, many trainees were of the opinion that the College had been complicit and more centrally involved in the process than it actually had been. Prof. Gilmore stated that this had been one of the motivating factors behind the composition of his recent open letter to the Secretary of State for Health. The Chief Medical Officer’s (CMO) report into reform of Senior House Officer (SHO) grade posts, ‘Unfinished Business’, had been approved by all levels of the profession, but it was felt that the package of proposals contained therein were modified following approval, and became increasingly restrictive as they were implemented over time; also, it was clear that the College had not agreed to specific sections, such as run-through training. As a result of pressure being applied to have programmes installed for 2007, Prof. Gilmore felt that the profession had collectively lost sight of the key objectives, and as a result, MMC had become much more rigid than initially planned. The President noted that as a result of the current situation, some damage had been done to the College’s relationship with both junior and senior doctors, but it was not felt that this was irrevocable, and it would be important to ensure that this was the case. It was iterated that the College was steering its own line at present, and was keen to make clear that any support given to completing the process would be conditional on significant clinical engagement. Dr. Duckitt read an excerpt from the Secretary of State’s letter of response to Prof. Gilmore’s letter, and it was felt that it suggested a strong commitment to the medical profession’s involvement following the Tooke review. There was some discussion of the two Committee position papers tabled earlier; Dr. Felton suggested that the report was an attempt to identify the key problems associated with MMC and MTAS, and to offer solutions that did not involve a retrograde step of 6 reverting to the previous system, which had been called for by a large number of trainees. The paper reported on the increasing support for an uncoupling of Core Medical Training (CMT) and Higher Specialty Training (HST); also included was a Trainees Committee position statement produced by Dr. Patel in January 2006, highlighting the need for MTAS to be suitably tested, audited and trialled before deployment, and provided evidence that the Committee had been concerned about MMC for some time. The document tabled by Dr. Myers was concerned more specifically with Foundation training, and examined in depth the background to MMC. Dr. Myers suggested that the paper was essentially a mandate for the Tooke inquiry, proposing a review of Foundation schools and MMC as a concept, examining whether streamlining trainees towards different specialties early on is one area which could be developed. Prof. Gilmore congratulated Dr. Felton and Dr. Myers on their papers, and reported that he agreed with the majority of their proposals and suggestions; it was suggested that with regard to leaving CMT and entering HST, the proposal could contain even more flexibility than that already stated. Dr. Felton stated that the possibility of a second round of selection with Deanery-based open competition had been considered, and in the second draft of the paper, the phrasing may be altered to make that section slightly stronger. It was felt that there would need to be some important consideration of third year CMT jobs; to create more, one solution would be to reduce the pool of CMT1/2 posts, but if trainees were to be encouraged to enter Core Training, the number of CMT posts as a whole would need to expand. There were concerns over taking people into CMT without a guaranteed outlet, although the President felt that trainees would be prepared to enter Core Training without such a guarantee, provided they were aware of the criteria set for subsequent progression into Higher Training. Dr. Burnham suggested that it would be preferable for more jobs to be available in training programmes, and reported that there were a large number of people in Fixed Term Specialty Training Appointment (FTSTAs) currently; it was felt that this number would need to be reduced, and with some management, these roles could be used for 3 rd year CMT posts. Dr. Chamberlain reported that in the Mersey Deanery, there were a significant number of trainees at ST2 level who were likely to reapply to ST2 and take another year in CMT as they did not feel ready for ST3; he suggested that as a result of the inflexibility of MMC, some trainees were using loopholes to keep themselves out of post, and the proposed uncoupling of CMT and HST could solve this. Dr. Felton iterated that the Government were keen to make CMT a two year programme, and if a third year were to be introduced, it would need to be seen as an exception rather than the norm, to prevent the situation of SHO posts lengthening that MMC was originally designed to control. Dr. Burnham suggested that it would be made clear that CMT would last a minimum of two years, and a maximum of three; the possibility of a 7 third year would afford trainees at the end of CMT2 the opportunity to try a different post for a year, and where necessary catch up on experience which may have been missed in foundation training, before making a final decision, which would remove the current problem of a person’s whole career being decided on one day. The President suggested that the papers could be reviewed by College Educators, before providing feedback as to how to progress. Prof. Gilmore stressed that the College was grateful for the Committee’s input and would be looking to hone its submission to the Tooke report accordingly. It was proposed that Dr. Felton’s paper be entered to the Tooke inquiry as representing the Trainees Committee position, in terms of how the MMC/MTAS process has impacted on trainees directly, with Dr. Myers’ paper being entered as an academic background to it. There had been some concern expressed amongst trainees that there would not specifically be trainee representation on Sir Tooke’s inquiry board, and it was felt that were the Committee papers submitted as part of the College response, it might not be viewed as the viewpoint of trainees. Prof. Gilmore felt that whilst in the past, the College had discouraged separate submissions, in this instance there would be great value in presenting the voice of College trainees, and his inclination would be to send in a submission under one covering letter, but with two distinct and easily separable parts. 7. Communications Update i. RCP Membership Dr. Duckitt reported that there had been some discussion of membership in the morning session, in light of the fact that the proportion of people who register with the College and then continue their membership was quite small; to this end, the Committee was attempting to investigate how the College could better engage with trainees. There existed four categories of College members: associate members, who were pre- MRCP trainees – or possibly physicians’ assistants –associated with the College; affiliates, who were those people who had entered HST without MRCP, and were operating at Specialist Registrar (SpR) or Consultant level, or possibly as senior clinical scientists; collegiate members, who were regular members; and fellows. Miss Brough reported that at present, there were approximately 7,000 collegiate members and 9,000 fellows, and that both figures included UK and overseas members, although retired fellows were not included (of which there were around 4,000). In addition, there were approximately 300 affiliates and 354 associates registered with the Colleges. In the preceding three years, the number of collegiate members had increased by around 9.5%. Dr. Patel noted that the spread of members across the different categories appeared somewhat ‘top-heavy’; Dr. Duckitt agreed, and stressed that this had prompted the 8 College’s attempts to engage people as early as possible. Ms. Hollings also suggested that a number of people were brought in at fellowship level, and had not necessarily progressed from being members. Both positive and negative feedback on membership had been received to date. Ms. Hollings informed the Committee that a small steering group had been set up to consider College membership, of which she, Dr. Burnham and Dr. Duckitt were members, and that one meeting had been held to date. The main issue discussed had been improving retention of members, and to this end the benefits of membership had been examined, along with existing subscription fees. Dr. Burnham suggested that it would be important to emphasise the existing benefits of membership, which included affording members the ability to remain in contact with the College, and particularly to have a path to input and give views to the College; it was stressed that the President greatly appreciated the thoughts and feedback of trainees on this issue, particularly as it helped strengthen the College’s position. In addition, several new benefits had been proposed, including the introduction of introductory membership for trainees, discount cards and increased regional activity and networking opportunities. ii. RCP Website re-design Miss Brough suggested that underpinning the discussion over membership was the status of the College website, and since the beginning of the year, an independent review of the website had been carried out by cScape – an external digital and website consultancy firm. Following their initial test and review, the findings were in line with previous website audits carried out. Chiefly, it was unclear as to who the principle users of the website were; it had been suggested by a number of sources interviewed that the College membership should be made the central focus of the website, and it would be important to establish the credibility of the website amongst members and fellows. To this end, there was a desire to make the membership section of the site more personal and interactive, for example displaying membership of particular committees, booked events, demonstrations of publications, subscription due dates, etc. In addition, it would be important to improve a number of user issues such as site navigation, graphic design, paid and free content, and to implement a more effectively-designed and focused homepage. Miss Brough suggested that the first phase of the project involved redesigning the membership application form, which was nearing completion, and the testing of the redesigned website was scheduled for the end of 2007. Ms. Hollings informed the Committee that Dr. Duckitt would be regularly informed of all developments through the College Membership Steering Committee. 9 8. Restructuring the Trainees Committee Dr. Duckitt reported that much of the morning session had been concerned with reviewing the broader themes to be considered by the Trainees Committee, and these had been revised to include education and training, communications and networks, and work- life balance. i. Education and Training Dr. Myers reported that within a very large subject, there were three key issues requiring action; firstly, there would need to be en examination of workplace-based assessment tools which had been in place at Foundation schools, and would be due to be installed in higher training alongside general views of competency-based medicine. The focus here would be to supply the Tooke inquiry with details as required, and to monitor the inquiry’s progress. Secondly, a review of the Gold Guide would need to take place, with specific recommendations required for the amount of time allowed for training; this would include all programmes, within specialty training and generic training, examining the differences between training programmes in different regions, and to establish those areas where good practice had been observed and identify those methods which were and were not functioning effectively. Finally, the Committee would conduct a full review of the PMETB report and examine the implications of what people felt about their training as a whole. ii. Communications and Networks Dr. Ampikaipakan suggested that the key objective in this area would be to attempt to be the voice of trainees, and to set out clear aims and objectives to that end. One example cited was the Committee’s position statement on MMC, released in January 2006 and raising the concerns held by trainees, which did not receive significant coverage or attention. It was stressed that the discussed redevelopment of the College website, and in particular that of the Trainees Committee area would play a large part in this; in the short term, it had been suggested that the Committee release a one-off promotional newsletter, to describe the aims and workings of the Committee, but also as a platform to canvas the opinion of recipients, and this could subsequently develop into a more regular e-bulletin. This could include short surveys or snap polls, and it was felt that in the long term, this could help develop a database of contact networks and also maintain links within College and with other Colleges as well. A further key factor in developing networks and improving communications was to ensure any position statements produced were released quickly and effectively, 10 feedback from members representing the Committee at other meetings was received promptly. It was suggested that a proposed trainees’ bulletin containing generic information for all trainees – not specifically Trainees Committee news – would have a lot of support, and it was felt that the College could benefit if it were tied in with the work going on around increasing membership. Mr. Else agreed and suggested discussing the issue further. Mrs. Avital iterated that it would be advisable to meet with Ms. Kate Forrester regarding the direction of JRCPTB communications, so that the newsletter could be both tied-in and differentiated from that accordingly. iii. Work-life balance Dr. Kause informed the Committee that the issue of work-life balance would centre on three main areas, with the first being flexible training. It would be important for the Committee to increase awareness and discussion of flexible training, as this may firstly improve the proportion of flexible training posts available to trainees, and also it may help to reduce possible negative discrimination towards those trainees expressing a desire to undertake flexible training and work part time. The second area was that of the mentorship programme, currently being run by Mrs. Wade and the College Education department. The programme was designed to provide guidance to trainees, particularly around the new PMETB structure and MMC as it was felt that many trainees were not being referred to, or given appropriate career guidance by senior colleagues, and the programme had allowed trainees to have access to senior clinicians to ask for their advice. It was reported that in Wales, where the programme was being trialled, both junior and senior doctors had been very keen to be take part in the scheme, and also that those involved in the scheme had been particularly impressed with the running of the programme. The Committee were thanked for their input into the programme, particularly that of the previous Chair, Dr. Declan Chard, and in turn the level of support given to the programme by Mrs. Wade was highlighted. Further, Dr. Burnham reported that Dr. Hal Lloyd, who was heading the Wales initiative, would be attending the next Committee meeting to report on the programme. Thirdly, Dr. Kause reported that there would be a particular focus on issues specific to study leave. At present, there was currently no study leave under F2 and no time protected time was available, which had led to many trainees undertaking training under annual leave. Further, as suggested earlier under the Education and Training section, there were a number of effective Deanery-based courses being put on, and with feedback from trainees, it would be important to publicise these courses and attempt to spread good practice. 11 9. Update on PMETB Dr. Felton informed the Committee that PMETB had released a statement on their website around six weeks previously, iterating that they had not been involved with the current issues surrounding MMC. There had been another document released recently regarding the possibility of an increase to PMETB fees; despite a largely negative response to this, the fees had duly been increased. Dr. Felton reported that the most recent PMETB survey had been published, possibly in response to an increasing degree of pressure placed upon them to do so, with the new edition of the survey soon to be released. There were ongoing concerns reported regarding the Confirming Eligibility for Specialist Registration (CESR) certificate and the Certificate of Completion of Training (CCT), particularly that there was still an ongoing debate as to the legal background of both. It was felt that PMETB would be unlikely to change either, but there had been no announcement to confirm or deny this so far. Prof. Gilmore suggested that there were still some concerns over where PMETB had fitted into the MMC and MTAS situation, and this would be addressed by the Tooke review. In addition to this, the other major concern was that of a general issue the Royal Colleges had had relating to PMETB on a day-to-day basis; there seemed to be a digression between PMETB’s professed standing as a less-involved, ‘light-touch’ regulator, and the practical experience of the Colleges which had found PMETB keen to be involved in a large number of more minor decisions. To this end, the Academy of Medical Royal Colleges had produced a document drawing on both the positive and negative experiences its constituents had had when dealing with PMETB, and it was expected that this would be used as a starting point for a debate and exchange of views on PMETB, which would likely begin soon. Further, Prof. Gilmore invited trainees to send a representative to the MMC/MTAS forum being held in the College that evening, and also the brief meeting being held the next morning to discuss the College’s response to the Tooke review, as in both cases it would be important for the views of trainees to be involved. 10. Update on the Academy Trainees Group (ATG) The ATG met on May 23rd at the Royal Society of Medicine (RSM), and had discussed many of the issues covered in the Committee meeting so far; discussion had focused in particular on the PMETB trainees’ survey, specifically some of the immediately visible shortfalls inherent in the survey and methods by which they could be improved upon. Dr. Duckitt also reported that he had made strong representation to try and broaden the remit of the survey, to not only include Quality Assurance (QA) questions, but also a more 12 human aspect, such as trainees’ feelings on the rapid changes in their environment and training programmes, and possibly to see some of this incorporated into the 2008 questionnaire. Regarding study leave, it was reported that the Royal College of Pathologists (RCPath) were constructing a map of the country, displaying where the funding shortfalls were occurring, and it was hoped that this would assist the ATG in moving forward on this issue. Dr. Duckitt suggested that the judicial review of MMC/MTAS had been released shortly before the ATG meeting and there had been a degree of relief that the situation would finally be able to progress to the next stage of job offers. The ATG Chair, Dr. Paul Dimitri, had met with Sir John Tooke and had returned reassured that the upcoming inquiry would take a very broad perspective of the situation; not just focusing on the specific workings of MTAS or the concept of MMC, but also the different organisations involved and their roles within the process. At the ATG meeting, in line with the President’s comments earlier, it had been felt that now would be the time for the Colleges to reaffirm their role in the future delivery of training. The final discussion had been concerning selection into ST1 from Foundation training in 2008. It was reported that the GPs had felt the structured interview process they had put in place was an effective selection process, and that there was a much lesser degree of unhappiness amongst GPs than other groups. Beyond the Professional and Linguistic Assessment Board (PLAB) exam being put forward as a suggestion for knowledge assessment, there had been no clear decisions or conclusions taken on the issue, and discussions were ongoing at the present time. 11. CMT Report Dr. Cadigan suggested that much of the MMC discussion which had taken place in relation to CMT had been covered earlier in the meeting. Otherwise, it was reported that CMT had been going well; the CMT committee had met during the previous week, bringing together the heads of CMT from around the country and the structure of experience needed was being applied to Deanery programmes. There had been a high degree of recognition of the input of the College, in addition to widespread approval of the way in which the curricula had been developed. In particular, there had been substantial support for use of the e-portfolio, which had been developed by Mrs. Wade and the Education department. There had been a high degree of support from the Mersey Deanery, which was piloting the e-portfolio, and both trainees and trainers were reported to be extremely satisfied with its performance, with it being found to be a very effective link between training and the curricula. 13 12. To receive a report from the JRCPTB The JRCPTB had had its first major meeting recently, and it was felt that the new structure bringing together higher and core medical training was a very effective one and had re-energised what was the Joint Committee on Higher Medical Training (JCHMT). All of the new curricula had been approved by PMETB, some conditionally, and also the major assessment programme – the Internal Medicine curriculum – had been accepted with some modifications. Mrs. Avital iterated that the JRCPTB would likely be on target to start enrolment into ST1. Dr. Cadigan informed the Committee that it was hoped a Deputy Director of JRCPTB would soon be appointed with special responsibilities for the CMT group – the largest group of trainees – and that this was subject to financial clearance from the Federation. Regarding delivery of education, it was felt that the JRCPTB was progressing as planned, and to this end Dr. Cadigan praised the training programmes devised and implemented by the College Education department. In addition, the JRCPTB was involved in an ongoing debate regarding concerns over movement between CMT and HST, as discussed earlier in the meeting, and Dr. Cadigan suggested that the Tooke inquiry should provide a solution to the response of the Deans, which at present was felt to have been somewhat obdurate. Dr. Myers enquired as to whether those trainees signing up for CMT would be committed to run-through training; Dr. Cadigan stated that unfortunately, despite a long period of pressure, this issue had not yet been resolved, although it was felt that the Tooke review may do so. Further, Dr. Cadigan reported that the JRCPTB had not been able to obtain a satisfactory explanation of the mechanism by which trainees will move between CMT and HST, and trainees needed to be made aware that they may be allocated to an alternative Deanery during the process. Dr. Duckitt suggested that a demonstration of the e-portfolio, being developed by the JRCPTB and College Education department, would be held at the next Committee meeting, having been postponed from the present meeting; Mrs. Avital reported that it would be possible to provide Committee members with login details to access the present version of the e-portfolio from home, and that she would circulate these details following the meeting. Action: Mrs. Liz Avital Dr. Chamberlain reported that the e-portfolio was being trialled in the Mersey Deanery, where he was based, and whilst it had proved popular with trainees, who had taken to it well, there was some concern that it could be used to introduce a further assessment tool; given the number introduced in recent months, this would not prove popular. Mrs. Avital iterated that the e-portfolio would likely become more streamlined and would undergo a degree of fine-tuning over the coming months, but there would not be any major 14 additions to its current format, nor was there a plan to increase the current number of assessment tools. 13. To receive a report from the Specialist Registrar Adviser i. SpR Questionnaire Dr. Coward reported that there had so far been 1,460 respondents from the two mailshots of the SpR questionnaire despatched so far, compared to approximately 1,700 from three in the previous year. An addition to the new questionnaire had been the area concerning stress and alcohol; the interim results for this section suggested that 68% of doctors reported that they knew a colleague who had required time off due to stress, with this being particularly serious in 7.2% of cases. 26% of respondents were aware of a colleague with problems with alcohol, and 43% knew of people regularly binge drinking (with binge drinking defined at a specific level.) 11.5% knew a colleague who had taken time off due to alcohol-related problems, and 0.2% described themselves as being hazardous drinkers. 17% of male, and 11% of female respondents reported regularly consuming more than 10 units of alcohol in each session of drinking, while 19% of all respondents declared themselves to be teetotal. Of the areas particularly pertinent to the issues discussed earlier in the meeting, Dr. Coward informed the Committee that 32% of all doctors responding had had their study leave fully funded, while 46% had received partial funding. Of those doctors who had not received any funding, 76% stated that their study leave training was fully self- funded, while around 20% had sought funding through various routes in the pharmaceutical industry. Regarding career patterns, 66% intended to seek a consultant post as soon as possible after attaining their CCT, 11% said that they would not, and 22% were not sure. Further to this, 25% of respondents would seek a part-time post, 35% suggested they would consider a part-time post, whilst the remaining 40% would definitely not wish to enter a part-time consultant post. ii. Flexible Training The interim results from the SpR questionnaire suggested that only 8% of respondents were flexible trainees, whilst another 9% wished to become flexible trainees. Of those flexible trainees, 49% were supernumery, 26% were in slot-sharing posts, and 18% were working part-time in full-time posts. 50% of flexible trainees suggested they would consider full-time consultant posts. iii. Out of Programme Finally, around 17% of trainees were engaged in out-of-programme training, and 54% declared themselves very satisfied with the experience whilst 21% were not. 15 Dr. Coward reported that as more data emerged, the results may change slightly, and that he would give a fuller update at the next meeting. 14. Reports from College Boards and Committees Reports from other College boards had been circulated amongst members prior to the meeting via e-mail. Dr. Duckitt suggested that this would continue, along with ensuing discussion, and any pertinent issues arising would be discussed at future meetings. 15. To consider items for future meetings Dr. Duckitt suggested that the standard format of the Trainees Committee agenda had been changed and shortened slightly, as part of a push towards more focused, action/outcome-based meetings to allow issues to be discussed in greater depth. He encouraged members to forward any suggestions for future meetings to him via e-mail. 16. Any other business Dr. Kause reported that she had recently attended the BMA safe transfer of patients by ambulance working group, and reported that there had recently been a move toward competency-based thinking, with patients grouped into levels 0-3 with regard to their condition. The main guidance involved focusing on level 1 and 2 patients, as level 3 would be dealt with in depth elsewhere, as they would often be transferred in ambulances with a junior doctor or student nurse with little or no experience of being within an ambulance; the aim of the group was to provide guidelines for dealing with such medical patients, as a physicians’ representative on the group, Dr. Kause requested that if anyone would wish feedback to be presented to the group, they should contact her following the meeting. There was an announcement made regarding the following day’s ACT seminar, and those present were invited to attend. Finally, Dr. Duckitt suggested that despite the large recent intake, there were still a number of vacant seats on the Committee; some members had proposed candidates for accession to these vacant seats, and it was suggested that this would be discussed via e-mail following the meeting. 17. Date and time of next meeting It was reported that a number of College officers would be unable to attend the next meeting on the date scheduled – Friday 28th September – and as such, an alternative date would be scheduled and circulated. 16