Reports recommend shorter training for hospital doctors and longer training for GPs in Scotland
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《英国医生杂志》
Health services in some parts of Scotland will survive only if radical changes are made to developing the doctors of the future, two detailed reviews of medical education and workforce planning say.
The reports include proposals for shorter, more focused training for hospital doctors, longer training for general practitioners, an increase in medical student numbers, and incentives designed to retain staff already in post. They also identify an urgent need to increase the number of consultants and general practitioners in Scotland.
Scotland faces a considerable challenge in increasing medical staffing at a time when the country抯 population is in decline. "We are short of doctors, making expansion of services difficult and reform both a challenge and a necessity," says Securing Future Practice, a report from a working group led by Sir John Temple, past president of the Royal College of Surgeons of Edinburgh. Scotland has more doctors per 100 000 population than the United Kingdom as a whole, but less than many other European countries, such as France, Germany and Spain.
The report recommends that Scotland should move towards a trained doctor service, with much less care being delivered by doctors in training. This should include a simplification of the confusing system of doctors?grades to produce three types of doctor—doctors in training; trained doctors who are both "judgment safe" and competent in their field; and trained doctors who are judgment safe and have acquired additional competencies in their chosen field.
The report says there is a need for more effective training pathways to deliver competent clinicians more quickly: the average age for a first appointment as a consultant is 37 in Scotland, which means that the training is too long. It recommends shorter, more focused, and better managed training programmes for hospital doctors.
By contrast, general practice should introduce a minimum three year training period, a year longer than at present, to prepare doctors fully for working in what is described as a widely challenging field of medicine.
The report also recommends a range of measures to retain existing staff. These include flexible career and employment packages, family friendly policies, step-down options for doctors nearing the end of their careers, improved working conditions, and financial rewards for staying in post.
An accompanying report, Review of Basic Medical Education in Scotland, has been produced by a group chaired by the former chief medical officer, Sir Kenneth Calman. It recommends that Scotland should train an extra 100 medical students a year to help meet the future demand for new doctors. It also recommends that more places should be offered to Scottish students, who are more likely to work in the Scottish NHS. At the moment only half the places in Scottish medical schools are filled by students from Scotland.
The reports were welcomed by the BMA. Its Scottish secretary, Dr Bill O扤eill, said: "A wide ranging review of the medical workforce in Scotland is long overdue. These reports offer many solutions to problems in undergraduate and postgraduate medical education and training. It is essential that the Scottish Executive act on these proposals now to deliver a future for the medical workforce and patients in Scotland."(Edinburgh Bryan Christie)
The reports include proposals for shorter, more focused training for hospital doctors, longer training for general practitioners, an increase in medical student numbers, and incentives designed to retain staff already in post. They also identify an urgent need to increase the number of consultants and general practitioners in Scotland.
Scotland faces a considerable challenge in increasing medical staffing at a time when the country抯 population is in decline. "We are short of doctors, making expansion of services difficult and reform both a challenge and a necessity," says Securing Future Practice, a report from a working group led by Sir John Temple, past president of the Royal College of Surgeons of Edinburgh. Scotland has more doctors per 100 000 population than the United Kingdom as a whole, but less than many other European countries, such as France, Germany and Spain.
The report recommends that Scotland should move towards a trained doctor service, with much less care being delivered by doctors in training. This should include a simplification of the confusing system of doctors?grades to produce three types of doctor—doctors in training; trained doctors who are both "judgment safe" and competent in their field; and trained doctors who are judgment safe and have acquired additional competencies in their chosen field.
The report says there is a need for more effective training pathways to deliver competent clinicians more quickly: the average age for a first appointment as a consultant is 37 in Scotland, which means that the training is too long. It recommends shorter, more focused, and better managed training programmes for hospital doctors.
By contrast, general practice should introduce a minimum three year training period, a year longer than at present, to prepare doctors fully for working in what is described as a widely challenging field of medicine.
The report also recommends a range of measures to retain existing staff. These include flexible career and employment packages, family friendly policies, step-down options for doctors nearing the end of their careers, improved working conditions, and financial rewards for staying in post.
An accompanying report, Review of Basic Medical Education in Scotland, has been produced by a group chaired by the former chief medical officer, Sir Kenneth Calman. It recommends that Scotland should train an extra 100 medical students a year to help meet the future demand for new doctors. It also recommends that more places should be offered to Scottish students, who are more likely to work in the Scottish NHS. At the moment only half the places in Scottish medical schools are filled by students from Scotland.
The reports were welcomed by the BMA. Its Scottish secretary, Dr Bill O扤eill, said: "A wide ranging review of the medical workforce in Scotland is long overdue. These reports offer many solutions to problems in undergraduate and postgraduate medical education and training. It is essential that the Scottish Executive act on these proposals now to deliver a future for the medical workforce and patients in Scotland."(Edinburgh Bryan Christie)