Career Grade Research Articles

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AbstractSwitch from tamoxifen to anastrozole improves outcomes in early breast cancerPostmenopausal women who have taken tamoxifen for two years as adjuvant therapy are less likely to experience a recurrence of breast cancer and have improved overall survival if they switch to anastrozole compared with continuing to receive tamoxifen, according to the results of the ARNO 95 trial.1 This open‐label trial randomised post menopausal women who had undergone primary surgery for oestrogen receptor‐positive early breast cancer and had received two years of continuous tamoxifen therapy (20 or 30mg/day) to treatment with anastrozole (1mg/day; n=489) or to continue with tamoxifen (20 or 30mg/day; n=490) for an additional three years. The primary endpoint of the study was disease‐free survival (including local or distant recurrence, new contralateral breast cancer, or death); secondary end‐points included overall survival and toxicity. Disease‐free survival was improved in women who switched to anastrozole compared with those who continued with tamoxifen (HR 0.66; 95% CI 0.44‐1.00; P=0.049). Estimated three‐year disease‐free survival rates were 93.5% for anastrozole and 89.3% for tamoxifen. Switching to anastrozole was associated with improved overall survival compared with continuing on tamoxifen (HR 0.53; 95% CI 0.28‐0.99; P=0.045). Fewer patients who switched to anastrozole reported serious adverse events (22.7 vs 30.8%) compared with those who continued on tamoxifen, mainly because more patients in the tamoxifen group had endometrial events (OR 0.66; 95% CI 0.49‐0.89; P=0.0065). The authors conclude that patients switched to anastrozole after an initial period of tamoxifen therapy experience significant improvements in terms of disease‐free and overall survival. The results provide additional evidence that five years of tamoxifen is no longer the optimum adjuvant therapy for postmenopausal women with hormone‐receptor‐positive early breast cancer. 1. Kaufmann M, Jonat W, Hilfrich J, et al. Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after 2 years of treatment with tamoxifen compared with continued tamoxifen: the ARNO 95 study. J Clin Oncol, published early online, 11 June 2007; doi: 10.1200/JCO.2006.08.8054.BASHH 10th annual NCCG conferenceThe 10th annual conference for nonconsultant career grade doctors in genitourinary medicine will be held at Loughborough University on 14 and 15 September 2007.The provisional programme includes: What's new in NSU? Prostatitis Sexual behaviour in MSM: emerging issues HPV vaccines Topical issues in O&G Post‐exposure prophylaxis. Further details are available on the BASHH website: www.bashh.org/committees/nccg/index.asp Copyright © 2007 Wiley Interface Ltd.

The Impact of the Structure of the Education System on the Development of Educational Inequalities in the Czech Republic

The aim of this paper is to explore the impact of the structure of the Czech education system on the development of the relationship between a stu- dent's achievement and his/her family background. It compares the strength of the relationship between student achievement and a student's family back- ground in various stages of his/her education career (grades 4, 8 and 10) in the Czech Republic and in systems without early tracking that also exhibit high student performance (Canada, Nordic countries). In addition, the paper tests a hypothesis that systems with different levels of tracking differ not only in their structure but also in teaching methods and teachersattitudes. The analysis was conducted on data sets from the IEA PIRLS 2001, the IEA TIMSS 1999, and the OECD PISA 2003.

Non-consultant grade career posts can be fulfilling

Taiwo Ajayi explains how non-consultant career grade doctors can find fulfilment in their jobs

Second‐class doctors? The impact of a professional career structure on the employment conditions of overseas‐ and UK‐qualified doctors

Career structures and their associated boundaries both offer and restrict career opportunities and provide the potential to be sites of unfair discrimination. Yet the impact of such structures is rarely explored. This article investigates the impact of a career structure on the employment conditions of a medical career grade in which some three‐quarters of the doctors qualified overseas. The comparison of UK and overseas qualified doctors in the Staff and Associate Specialist Group provides an underexplored perspective on a professional career structure with a particular reference to reward, workload, autonomy and morale. The article draws on a quantitative study of 1,715 Staff and Associate Specialist doctors undertaken in 2004. The findings demonstrate a complex comparative picture with overseas‐qualified doctors earning more, working for longer hours, having less autonomy and a lower morale than their UK‐qualified comparators. We conclude by pointing to the potential for certain career structures to structurally and systematically disadvantage some groups.

Survey of non-consultant career grade doctors in genitourinary medicine and sexual health departments 2005

Survey of non-consultant career grade doctors in genitourinary medicine and sexual health departments 2005

A forgotten tribe: a survey of the experience of working as a non-consultant career grade psychiatrist

Aims and MethodWe surveyed the experience of working as a non-consultant career grade psychiatrist (NCCG). A postal questionnaire was sent to 140 NCCG psychiatrists in the south-west region.ResultsA total of 90 doctors responded (65% response rate); 30 (33%) had never had supervision and 45 (50%) were not eligible to sit the MRCPsych examination. Only 41 respondents (46%) had administrative support for non-clinical work.Clinical ImplicationsGood supervision, comprehensive job plans and opportunities for further professional development are essential requirements for this group of doctors.

SI20 The BBTS Specialist Certificate in Transfusion Science Practice

In 1996 the BBTS introduced a certificate in Transfusion Science Practice aimed mainly at staff working in hospital transfusion laboratories who wished to have evidence of their knowledge in this field. Together with the Certificate the BBTS provided a study guide for the distance learning and a textbook, ‘Introduction to Blood Group Serology and Blood Bank Practice’. With recent changes to (state) registration and career grades as a result of Agenda for Change, the Certificate scheme was reviewed and the new Specialist Certificate in Transfusion Science Practice introduced. A new Study Guide has been issued and the latest edition of the introductory book now contains chapters on donation testing and component preparation plus up‐dated sections on immune red cell lysis. The new Specialist Certificate should now meet the requirements of a registered Health Care Scientist working in either a hospital or Blood (Transfusion) Centre wishing to attain the status of a Specialist Practitioner. The examination is very similar to that of the old Certificate except that some choice of questions have been introduced into papers three and four to reflect the wider scope of including donation testing and component production. The practical examination has now been dropped as it was not a good discriminator in terms of the overall examination. With the new ‘donation’ options it would be impossible to set a practical to assess this part of the syllabus. Competency testing has to be the responsibility of the employer. The newly formed Academic Board will be overseeing this examination, its progress and suitability. Any proposed changes would have to be approved by the Professional Affairs and Education Committee. The first of the new examinations was held in May this year and the next will be in November this year and then May 2007.

Career choices of United Kingdom medical graduates of 2002: questionnaire survey

To report the specialty choices of UK medical graduates of 2002, and to compare their choices with those of qualifiers in previous years and with the profile of career grade doctors in different specialties in England. We carried out a postal questionnaire survey in the UK and drew comparisons with official data for numbers of specialists. The response rate was 65.3% (2778/4257). A total of 22.7% of the medical graduates of 2002 (28.1% of women, 14.5% of men) expressed a preference for a longterm career in general practice, compared with 25.3% of 1999 and 2000 graduates combined. A total of 31.1% of men and 11.9% of women chose surgical specialties; 0.7% of men and 3.4% of women chose obstetrics and gynaecology; 3.4% of men and 7.9% of women chose paediatrics. There was a large mismatch between the percentage choosing each specialty group and the percentage of senior National Health Service doctors working in the same specialty group. In all, 71% of graduates regarded their career choice as definite or probable and 80% definitely or probably intended to pursue a longterm career in medicine in the UK, compared with 75% of qualifiers in 1999 and 2000. Career choices for general practice remain low: only 1 in 4 women and 1 in 7 men now choose general practice at this career stage. Very few men choose obstetrics and gynaecology, despite a recent increase in training opportunities. There is no evidence of an increase, compared with recent previous cohorts, in the percentage of junior doctors who do not want a longterm career in British medicine.

Non-consultant career grades

Non-consultant career grades

Hospital doctors’ views of their CPD and its relationship to learning in the organization

Continuing professional development (CPD) has traditionally been an autonomous, professional concern of doctors in the UK. In a changing educational and service climate, can individualized approaches to CPD be reconciled with adult learning principles and learning that is practice-based and multidisciplinary? A survey of the CPD of consultant and non-consultant career grade staff in Wales (UK) has provided some clues on how doctors perceive their learning needs in relation to those of Trust hospitals. It indicated that these doctors pursued traditional forms of continuing education (reading, lectures and meetings), gained clinical knowledge and changed their practice as a result. The majority saw themselves as accountable for CPD to their college and specialty. Trusts had yet to promote CPD as a clinical governance priority but respondents felt that appraisal helped to mediate individual and organizational perspectives of CPD. Most career-grade doctors believed their CPD activities met the needs of their employing organizations and felt satisfied with a ‘traditional’ approach to CPD. Doctors and service organizations may need to confront preconceptions regarding education and respective roles in the negotiation of CPD if team-based learning in practice is to become established.

Appraisal for career grade paediatricians

Summary Appraisal for career-grade medical staff is an annual process that leads to an agreed personal developmental plan (PDP). The PDP sets the agenda for medical and personal learning for the forthcoming year. This article outlines the process, its advantages and problems and offers advice on how paediatricians can maximise its benefits for themselves.

Non-consultant career grade doctors in genitourinary medicine: as revalidation approaches, are some jobs at risk?

The Genitourinary Medicine Non-Consultant Career Grade Group (GUM NCCG Group) was established for the purpose of looking at training and contractual issues for this heterogeneous group of doctors. In June 2003, 700 questionnaires were posted to NCCG doctors in the UK to enquire about various aspects of working conditions. A summary of the 244 replies (35% response) is presented. Eighty-four (34%) had a job plan and 81 (33%) had had an appraisal. Just over one-third (38%) had time allocated for continuing medical education (CME), audit and administration. The response of employers to attempts by NCCGs to upgrade was poor. In all, 195 (80%) said they were registered for the purpose of continuing professional development (CPD), 43 (18%) were not and six people did not know whether they were registered or not. These results give cause for real concern at this point regarding revalidation pathways. Our survey highlights that NCCGs are disadvantaged in terms of appraisal, CPD and career progression and some jobs will be at risk as revalidation approaches.

The management of Chlamydia trachomatis in genitourinary medicine clinics: a national audit in 2004

The first national audit of the management of Chlamydia trachomatis was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the UK. During the audit period of January--March 2004, 1670 data collection forms were completed (from 830 men and 840 women with chlamydia). In all, 99% (1647) were treated appropriately; 76% (1261) were followed up, of which 12% (154) required re-treatment; 71% (1186) were managed appropriately within four weeks and 942 partners (0.56 per index case) were managed satisfactorily within four weeks of the initial partner notification interview. Partner notification outcomes were significantly more successful when the index patient was followed up (P<0.0001). Outcome standards were not associated with age, gender or sexuality, but were significantly associated with ethnicity (P<0.004). GU medicine clinics are delivering high-quality care and evidence-based national outcome standards are being met.

The NHS International Fellowship Scheme

The NHS International Fellowship Scheme ([Khan, 2004][1]) is discriminatory against UK trainees and non-consultant career grade (NCCG) psychiatrists. Those who choose to come to the UK and train for membership of the Royal College of Psychiatrists should feel aggrieved. Some of the members of our

Diploma in genitourinary medicine

Who is it for? For specialist registrars in genitourinary medicine (GUM) (and compulsory by end of year 2), other trainees in GUM (non-consultant career grade doctors, senior house officers, staff grades, clinical assistants), general practitioners with a special interest. It is also taken by overseas practitioners. When did you do it? In June 2004, at the end of year 2 of specialist …

EMAC: A co-operative venture between simulation centres and the Australian and New Zealand College of Anaesthetists

The Effective Management of Anaesthetic Crises (EMAC) course was developed in response to several factors. The increased incorporation of workplace-based assessment into the whole assessment process revealed difficulties when trying to deal with important areas such as the management of anaesthetic crises. At the same time the development of simulation centres combined with an increased interest and understanding of the role of human factors in anaesthesia offered a potential solution. A partnership between the Australia and New Zealand College of Anaesthetists (ANZCA) and the Australasian simulation centres through a working party and a workshop created a blueprint for a course. Five main topics were identified—human factors, cardiovascular emergencies, airway emergencies, anaesthetic emergencies and trauma. A two and a half day course was developed using simulation, skills stations, presentations, demonstrations and feedback-led discussion as the major teaching methods. The main aim of the course was to teach not only what to do but importantly how to do it. The course was piloted and extensive evaluation yielded positive findings with the result that it was accepted by ANZCA for both trainee and career grade anaesthetists. Further evaluations are in place and will result in a revision of the course.

Diploma of Otolaryngology-Head and Neck Surgery (DO-HNS)

Anyone planning a career in ENT (ear, nose, and throat medicine) or those with an interest in the field, such as GPs (general practitioners). The Royal College of Surgeons says it is for, “a doctor intending to undertake practice within an otolaryngology department in a non-consultant career grade or trainee position. It is also intended to provide a test for those …

A survey of study leave entitlement in 2002 amongst non-consultant career grade doctors in genitourinary medicine.

Non-consultant career grade (NCCG) doctors perform a significant proportion of the clinical work in genitourinary medicine (GUM) and it is essential that their training and educational needs are met. Seven hundred questionnaires were posted to NCCGs in the UK to investigate whether employing trusts supported the educational needs of NCCG doctors by granting/funding study leave. A summary of the 220 replies (31% response) is presented. One hundred and twenty (55%) were not granted study leave to attend the 2002 national GUM NCCG conference. Study leave was less likely to be granted to those who held posts as clinical assistant or hospital practitioner and to those doctors who were working three or fewer sessions per week in GUM. It appears from our survey that many NCCG doctors who are seeing a significant proportion of the clinical workload in GUM are not supported by their employing trusts to keep up to date.

Medical workforce speciality review for genitourinary medicine 2002/2003: England, Wales, Northern Ireland and Scotland.

This document is an updated version of that produced in October 2001 and addresses medical workforce needs for the speciality of genitourinary medicine (GUM) for the next 10 years. Data on current consultant numbers, working patterns and retirement are based on information from the Royal College of Physicians (RCP) Workforce Unit annual census undertaken on 30 September 2001. Information on specialist registrars (SpRs) is from the Joint Committee on Higher Medical Training and the GUM Specialist Registrars Group. Senior house officer data are from the RCP's General Professional Training department. Data on non-consultant career grade doctors is from the Association of Genitourinary Medicine Survey and the GUM Non-Consultants Career Grade Group. Data on incidence of sexually transmitted infections (STIs) are from KC60 returns on STIs collected from GUM clinics by the Communicable Diseases Surveillance Centre. There is considerable movement of doctors in GUM between countries in the UK both during progression from SpR to consultant and at the consultant level. Data are therefore presented as amalgamated UK data and also by country (Table 1). It is essential that workforce planning takes this lateral movement into consideration when undertaking calculations for future workforce requirements. The speciality continues to have inadequate consultant numbers and funding is also required to provide adequate number of non-consultant career grade sessions.

A level results are reliable measure of success in medical careers, report says

A level results can predict long term career success in medicine, according to a paper recently published in the BMJ by researchers at University College London (2003;327:00-00). Professor I C McManus and colleagues followed up over 500 doctors who had studied at Westminster medical school, London, between 1975 and 1982 and measured how successful their careers had been. They looked at dropout rates, how long it took students to get to different career grades, the number of research publications they had, and at measures of their stress and burnout levels. The students had …