Surgeons warn changes will fail without investment in training
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《英国医生杂志》
Surgeons in the United Kingdom are calling on the government to provide protected time for both trainers and trainees in surgery to guarantee standards in the new shortened training curriculum, details of which were formally unveiled last week by the Royal College of Surgeons of England.
The curriculum changes are part of an overall government initiative to modernise medical careers in every specialty and to shorten the training period of consultants. They will be tested in three pilots in each of the nine surgical specialties across England and Wales next year, before being adopted comprehensively in 2007.
Under the plans, specialist training will become competency rather than time based, speeding up the route to a consultant post by an average of four years, and easing bottlenecks in career progression, particularly at senior house officer grade.
The new programme entails two foundation years, focusing on generic skills, such as communications and teamwork, followed by a minimum of five years—to a maximum of eight—of structured, specialist training.
It is hoped that the modular design will also make it easier for women to combine a surgical career with having children. About 60% of medical school entrants are female, yet less than 6% of UK consultant surgeons are women.
But restrictions on working hours imposed by the European Working Time Directive have sparked fears that training quality will suffer in the truncated programme without additional investment.
Announcing the changes, Mr Hugh Phillips, president of the Royal College of Surgeons, insisted that these were not about "dumbing down" surgical skills but about more efficient use of trainees' time. "Not every surgeon needs to be trained to be a superspecialist," he said, citing the sheer volume of "lumps and bumps" procedures. "But they do need to be trained to nationally agreed standards... and capable of carrying out elective and emergency surgery," he added.
This would be impossible without protected time for both trainers and trainees, even if this was at the expense of meeting service targets, he warned. "The resources required to allow on the job training must be recognised by the Department of Health and trust executives. Failure to invest in tomorrow's doctors will seriously damage patient care."
Mr Denis Wilkin, vice president elect of the Association of Surgeons of Great Britain and Ireland, which has just issued a consensus statement on the government's proposals for modernising medical careers, said: "Not every consultant will be responsible for a trainee, but there is a clear need for a cadre of people to take responsibility for and be expert at it."
But he warned that additional provision would need to be made for training these "training captains," who would need to be given status and possibly extra pay as well, he said. The overall cost "could be substantial," he suggested.(Caroline White)
The curriculum changes are part of an overall government initiative to modernise medical careers in every specialty and to shorten the training period of consultants. They will be tested in three pilots in each of the nine surgical specialties across England and Wales next year, before being adopted comprehensively in 2007.
Under the plans, specialist training will become competency rather than time based, speeding up the route to a consultant post by an average of four years, and easing bottlenecks in career progression, particularly at senior house officer grade.
The new programme entails two foundation years, focusing on generic skills, such as communications and teamwork, followed by a minimum of five years—to a maximum of eight—of structured, specialist training.
It is hoped that the modular design will also make it easier for women to combine a surgical career with having children. About 60% of medical school entrants are female, yet less than 6% of UK consultant surgeons are women.
But restrictions on working hours imposed by the European Working Time Directive have sparked fears that training quality will suffer in the truncated programme without additional investment.
Announcing the changes, Mr Hugh Phillips, president of the Royal College of Surgeons, insisted that these were not about "dumbing down" surgical skills but about more efficient use of trainees' time. "Not every surgeon needs to be trained to be a superspecialist," he said, citing the sheer volume of "lumps and bumps" procedures. "But they do need to be trained to nationally agreed standards... and capable of carrying out elective and emergency surgery," he added.
This would be impossible without protected time for both trainers and trainees, even if this was at the expense of meeting service targets, he warned. "The resources required to allow on the job training must be recognised by the Department of Health and trust executives. Failure to invest in tomorrow's doctors will seriously damage patient care."
Mr Denis Wilkin, vice president elect of the Association of Surgeons of Great Britain and Ireland, which has just issued a consensus statement on the government's proposals for modernising medical careers, said: "Not every consultant will be responsible for a trainee, but there is a clear need for a cadre of people to take responsibility for and be expert at it."
But he warned that additional provision would need to be made for training these "training captains," who would need to be given status and possibly extra pay as well, he said. The overall cost "could be substantial," he suggested.(Caroline White)