Modernising Medical Careers Research Articles

Waiting times and decision-making behind acute plastic surgery referrals in the UK

Over the past decade, Accident and Emergency (A&E) departments in the United Kingdom have struggled to cope with a doubling in patient attendances and the combined impacts of the ‘four-hour rule’, the European Working Time Directive and Modernising Medical Careers. Our previous prospective study suggested that A&E referrals to Plastic Surgery may not always be clinically motivated, but could have been affected by lack of blinding to the Plastic Surgery department participating in the study. The current study aims to corroborate those findings retrospectively, thereby overcoming this bias, and to conduct a detailed analysis of the reasons for observed referral behaviours. Medical notes of one hundred consecutive A&E referrals to a single Plastic Surgery Unit were retrospectively reviewed, documenting patient demographics, referral reason, time taken for referral and review, patient transfer time and referral appropriateness, defined by the need for hospital admission, surgery or senior review. ‘Appropriate’ and ‘inappropriate’ referrals were compared statistically for Referral Time, Transfer Time and Review Time using the independent samples t-test. To explore the reasons for observed referral patterns, six semi-structured interviews were carried out with all grades of A&E staff members using the previously-documented ‘framework analysis method’ of deductive analysis to investigate emerging and assumed themes systematically. 73 referrals from A&E to Plastic Surgery were included in the study, most commonly for adult males with upper limb injuries. The most frequent treatment outcomes were conservative management or wound exploration with no identifiable deep injury. Mean Referral Time and Review Time was 1:53 hours and 0:58 hours respectively. 69% of referrals were considered Appropriate according to the study definition. As in the previous study, inappropriate referrals were referred significantly more quickly than appropriate ones, whereas review time was similar irrespective of referral appropriateness. Interview themes analaysis revealed junior doctor inexperience, resource constraints and unintended consequences of targets and protocols to be major non-clinical determinants of whether a referral was made. This study confirms that priorities other than clinical need may influence A&E referral behavior and provides valuable insights into the challenges and drivers determining it. A significant proportion of referrals from A&E to Plastic Surgery are inappropriate and quicker referrals are more likely to be inappropriate. Many junior doctors currently lack the confidence and competence to manage routine cases that fall under the remit of Plastic Surgery. Significant change is needed to address the current situation. The insights of this study may help to inform such change.

Evolving Trauma and Orthopedics Training in the UK

The ever-growing population of the UK has resulted in increasing demands on its healthcare service. Changes have been introduced in the UK medical training system to avoid loss of training time and make it more focused and productive. Modernizing medical careers (MMC) was introduced in 2005. This promised to reduce the training period for a safe trauma specialist, in trauma and orthopedics, to 10 years. At around the same time, the European Working Time Directive (EWTD) was introduced to reduce the working hours for junior doctors in training, to improve patient safety and also work-life balance of junior doctors. Introduction of the assessment tools from Orthopedic Competency assessment project (OCAP) will help tailor the training according to the needs of the trainee. The aim of this article is to review the changes in the UK orthopedic surgical training over the past two decades.

Consultant Attitudes to 'St' Higher Surgical Trainees

The Modernising Medical Careers 2005 report on SHO training concluded that there was a need to minimise the SHO years that had, until then, involved short-term posts, poor training opportunities and indifferent career progression. In response to this, 'run-through training' was introduced in August 2007. However, numerous problems were highlighted with this system, including lack of confidence in the selection process, concern about how to counsel failing trainees, concerns about staffing the wards at the junior level if all trainees were to have realistic anticipation of promotion and difficulty reconfiguring hospital services to support high-quality training. Consequently, run-through training was uncoupled at CT2 and ST3, reverting back to a system of competitive entry into higher surgical training. Nevertheless, junior doctors in new core training posts could still potentially progress to higher surgical training programmes with as little as nine months of experience in their chosen subspecialty.

Survey of UK radiology trainees in the aftermath of 'Modernising Medical Careers'.

BackgroundFollowing implementation of Modernising Medical Careers (MMC) in the UK, potential radiology trainees must decide on their career and apply sooner than ever before. We aimed to determine whether current trainees were sufficiently informed to make an earlier career decision by comparing the early radiology experiences of Traditional and Foundation Trainees.Methods344 radiology trainees were appointed through MMC in 2007/08. This cohort was surveyed online.ResultsResponse rate was 174/344 (51%). Traditional Trainees made their career decision 2.6 years after graduation compared with 1.2 years for Foundation Trainees (57/167, 34%). Nearly half of responders (79/169, 47%) experienced no formal radiology teaching as undergraduates. Most trainees regularly attended radiology meetings, spent time in a radiology department and/or performed radiology research. Many trainees received no career advice specific to radiology (69/163, 42%) at any point prior to entering the specialty; this includes both formal and informal advice. Junior doctor experiences were more frequently cited as influencing career choice (98/164, 60%). An earlier career decision was associated with; undergraduate radiology projects (-0.72 years, p = 0.018), career advice (-0.63 years, p = 0.009) and regular attendance at radiology meetings (-0.65 years, p = 0.014).ConclusionEarly experience of radiology enables trainees to make an earlier career decision, however current radiology trainees were not always afforded relevant experiences prior to entering training. Radiologists need to be more proactive in encouraging the next generation of trainees.

Improving Core Surgical Training in Plastic Surgery

Since the introduction of the European Working Time Regulations (EWTR) and Modernising Medical Careers (MMC), concerns have been raised regarding the quality of early surgical training. Recurring issues include the lack of time spent in the operating theatre and outpatient clinic with increased time spent on service provision. As a means of restoring the quality of early surgical training, the Joint Committee on Surgical Training (JCST) has devised a set of SMART (specific, measurable, attainable, relevant, time-framed) standards to be met by core surgical trainees (CSTs). These include the following scheduled weekly activities: four half-day sessions (18 hours) supervised in the operating theatre, one half-day session (4.5 hours) in supervised outpatient clinics and two hours of structured teaching.

Post-EWTR: Is the UK Still a Centre of Excellence for Surgical Training?

Surgical training in the UK has undergone a radical transformation over the past few years. The limitation of working hours imposed by the European workingTime regulations (EWTR) and a shorter path to consultancy through Modernising Medical Careers has resulted in a shortening of training hours between qualification and completion of specialist training. Some estimate total training hours have reduced by 50%, from 30,000 in the old system to just 15,000 currently. Quite reasonably, there is concern that the current generation of surgical trainees will be less skilled and less competent than their predecessors.

Tips for GP trainees wishing to undertake an international experience

International work … what does it mean these days? Is it largely medical aid or development work? A surf-laden Antipodean stint or a cutting-edge research fellowship overseas? Does it even need to take place outside the UK? Many GP trainees already have experience of international work by the time they reach vocational training; often during the undergraduate elective period. International experiences, in addition to those mentioned above, can range from expedition medicine, to health policy work within global organisations. Working with refugees and asylum seekers in the UK can provide a hugely valuable international experience without the need to venture abroad. On reaching GP training, fresh prospects can present themselves alongside existing opportunities. The Tooke report into Modernising Medical Careers confirms that time out programmes should be: > ‘… positively facilitated and encouraged … as it enriches the skill base and professional life of doctors, as well as promoting research and development and the global health agenda.’1 In addition to providing new perspectives on medicine, health systems, and the role of primary care in different countries and cultures, international work offers opportunities to develop a vast array of skills that are transferable to the UK setting. Among these are clinical, managerial, educational, and leadership components that contribute to a more effective and motivated NHS workforce.2–4 In the Global Health Partnerships report, Lord Crisp indicates that while the UK has much to offer other …

The role of the medical registrar

The medical registrar in the acute on-call and out-of-hours setting is usually considered to be one of the busiest and most challenging jobs in the entire hospital. This is perhaps a reflection of the changes in the structure and organisation of acute medicine precipitated by the European Working Time Directive and Modernising Medical Careers. As well as the general feeling that medicine is being increasingly viewed as a default referral option by other specialties who are themselves becoming ever more sub-specialised. This article explores what the pragmatic role of the medical registrar broadly should be. The Medical Workforce Unit at the Royal College of Physicians is launching an initiative, part funded by the Department of Health, to answer this difficult question.

Surgical Training: Still Highly Competitive But Still Very Male

The likelihood of obtaining a training post varies massively between all 65 medical specialties. The competition ratio (defined as the number of applicants per post) varies from 1:1 to 12:1. There are few published competition ratios despite these being useful for junior doctors refining their career choice. Modernising Medical Careers (MMC) was a radical change, initiated in 2007, aiming to streamline, strengthen and shorten training.

Educating the Surgeons of the Future: The Successes, Pitfalls and Principles of the ISCP

Surgeons have a complex role that has proved difficult for educationalists to unravel. During the 1990s an increase in interest in an evidence-based programme for surgical training, public calls for increased accountability and a professional need for training programmes in line with modern employment law led to calls for curricular reform in surgical education. At a similar time, a report called Unfinished Business commissioned by the Chief Medical Officer proposed that the profession should consider time-limited, curriculum-based training. These factors pushed the royal colleges and the government to form a group called Modernising Medical Careers (MMC). The aim of this group was to review the structure of postgraduate medical curricula. The reforms that resulted were, perhaps, the most controversial changes ever to be made in surgical education.

National Selection into General Surgery: A Pilot Study

General surgery training in England ceased to run through to completion of training from specialty training level one (ST1) as of August 2010. Instead, a second competitive interview to enter ST3 has been introduced. As a result, up to 180 ST3 vacancies in general surgery should become available for recruitment each year in England, according to figures obtained from Medical Specialty Training (England), the successor to Modernising Medical Careers (MMC) (personal communication). The general surgery specialist advisory committee (SAC) was asked in 2008 by MMC to consider how best to appoint to these ST3 posts. Experience from other surgical specialties has shown that a national selection process offers the potential to recruit the best core surgical trainees.

Proposed Career Pathway for Clinical Academic General Dental Practitioners

The Modernising Medical Careers framework provides the opportunity for both medical specialists and general medical practitioners to follow training pathways that lead to appointments as National Health Service (NHS) consultants and to senior academic posts. Similar opportunities are available for dentists who wish to specialise. However, they are not available to dentists working in primary dental care who wish to become NHS consultants or senior academics in general dentistry. An alternative pathway is required that does not force committed primary care dentists who wish to become NHS consultants or senior academics down a path of specialisation. In this paper, the authors explore the situation in some detail and propose a career pathway with appropriate competencies for primary care dentists who aspire to become NHS consultants or senior academics. They justify why such posts should be created. The competencies have been developed using key guidelines and documents from the European Bologna Process and the Association for Dental Education in Europe, the Curriculum for UK Dental Foundation Programme Training, and the General Dental Council monospecialty curricula. It is hoped that the proposed pathway will produce highly trained generalists who will: (a) encourage and undertake research in primary dental care, where over 90% of dentistry is delivered, (b) support and lead outreach centres so that teaching and clinical cases reflect primary dental care, where students will spend their working lives post-qualification, and (c) provide a means of increasing the numbers of clinical dental academics, which have been in decline over the last 10 years.

Core Training: evidence-based medicine for doctors in training

British Journal of Hospital Medicine, September 2011, Vol 72, No 9 487 This issue of the British Journal of Hospital Medicine marks the launch of the new Core Training supplement for junior doctors, replacing the Modernising Medical Careers supplement. The first obvious change to this section is the title. Medical training continuously evolves, and we wanted to highlight the fresh approach that we are taking to publishing articles for doctors in training. These will be focused on providing up-to-date and evidence-based information of a practical nature, which will be directly relevant to clinical practice in the workplace and career development. One of the goals for this section is to ally articles to the curricula produced by the Royal colleges, and in this way support the development of competencies and allow them to be used alongside learning portfolios and workplace-based assessments. We have developed four themes to run concurrently in each issue: Clinical skills for postgraduate examinations These will explore specific clinical signs, the methods of their elicitation and (perhaps most importantly) how not to miss them, their utility, and their interpretation and presentation at the bedside or during assessments.

Educational tools in the assessment of trainees in anaesthesia

Training in anaesthesia faces many challenges. The European Working Time Directive (EWTD) and Modernising Medical Careers (MMC) have reduced the time available for training. Similar pressures are seen in healthcare training worldwide. The population is becoming older, more obese, and with multiple co-morbidities. Surgeons have high expectations, increasingly performing complex procedures on sicker patients, whilst striving to meet service targets. In order to address these challenges, competency-based training has been introduced. The trainee has to demonstrate satisfactory competency in order to proceed to the next stage of training. This article explores the educational framework behind the assessment tools used, discussing their strengths and weaknesses. It also highlights the roles of both trainers and trainees. Although this article uses the UK curriculum and assessment process as a framework, the principles apply equally throughout the world.

Making Sense of Modern Medical Careers: The Case of the UK’s National Health Service

The ongoing debate on the re-articulation of the relationship between professions, the market and the state, pays increasing attention to the issue of professional identities and how these are reframed through processes such as socialization and training. The UK government’s Modernising Medical Careers programme (MMC), which introduces significant revisions to the structure, content and delivery of undergraduate and postgraduate doctor training, represents a recent example of an interruption of such processes within public sector professions. MMC strikes at the very heart of the medical profession by demystifying the process of forming, socializing and initiating new generations of professionals, and shifting the control over the processes and conditions of professional closure away from the profession itself. The article draws on the methodological and conceptual lens provided by Wright Mills’ ‘Vocabularies of motive’ (1940) to analyse medics’ reactions to recent reforms in medical education.

The cost of postgraduate training

The Modernising Medical Careers and European Working Time Directive have led to significant changes in the working patterns and training of junior doctors. This article seeks to explore the hidden costs incurred by trainees of various specialties and grades for postgraduate training.

Training in the MMC Era: Procedure-Based Assessments – the Parents' Perspective

The recent implementation of Modernising Medical Careers (MMC) has had a significant impact on the way that both medical and surgical trainees in the UK are trained and clinically or technically assessed. The aim of MMC is 'to drive up the quality of care for patients through reform and improvement in postgraduate medical education and training'. Surgical training has also been affected by the final stage of the implementation of the European Working Time Regulations. One of the primary changes in MMC has been the introduction of a formal assessment system of the trainees. The new system was initiated to progress towards more competency-based training rather than the total time spent in training. The trainee's progress in achieving clinical and technical competencies is assessed, as is the quality of the trainee and the training he or she receives.

The percutaneous coronary intervention specialist nurse role

British Journal of Cardiac NursingVol. 6, No. 5 Career FocusThe percutaneous coronary intervention specialist nurse roleSarah CallaghanSarah CallaghanSearch for more papers by this authorSarah CallaghanPublished Online:16 Aug 2013https://doi.org/10.12968/bjca.2011.6.5.252AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health (2000) National Service Framework for Coronary Heart Disease: Modern Standards and Service Models. DH, London Google Scholar Department of Health (2004) Modernising Medical Careers: The Next Steps. DH, London Google Scholar Department of Health (2006) Modernising Nursing Careers. DH, London Google Scholar Royal College of Nursing (2007) Advanced Nurse Practitioners: An RCN Guide to the Advanced Nurse Practitioner Role, Competences and Programme Accreditation. RCN, London Google Scholar FiguresReferencesRelatedDetails 1 May 2011Volume 6Issue 5ISSN (online): 2052-2207 Metrics History Published online 16 August 2013 Published in print 1 May 2011 Information© MA Healthcare LimitedPDF download

Attitudes of uk gastroenterology trainees to research and out of programme experience: results from the 2009 national academic training survey

IntroductionA national survey of UK gastroenterology trainees in 20071 identified high rates of participation in research and Out Of Programme Experience (OOPE). 49.6% of respondents were currently or had already...

Neurosurgical trainees' perceptions of course value and study leave budgets

With the advent of Modernising Medical Careers (MMC) in 2007 neurosurgery adopted 'run-through' training, whereby trainees apply to a neurosurgical rotation that takes them through from foundation training to its completion and the award of the Certificate of Completion of Training (CCT). This is in contrast to the post-MMC training programmes for the rest of the surgical specialties, in which trainees apply to a core surgical training (CST) rotation, followed by open competition after their second core training (CT2) year for appointment into a specialty training (ST) rotation in the surgical specialty of their choice.