Modernising Medical Careers Research Articles

Have changes in colorectal surgery training impacted on mortality in cancer patients? A retrospective cohort study of 51,562 procedures.

The aim of this study was to explore whether there were any differences in consultant colorectal surgeon training and adjusted 90-day postoperative colorectal cancer mortality rates (AMR). We undertook a retrospective analysis of outcomes data published on the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. A total of 51,562 procedures for patients in England diagnosed with large bowel cancer between 2010 and 2015, registered under 551 consultants were included. Consultants were split into two cohorts. The first group were the pre-Calman Trained Consultants (pre-CTr), who completed their training before 1998. The second group-the post-Calman Trained Consultants (post-CTr)-included those who received their Certificate of Completion of Training (CCT) under the Calman Training Principles (CTC, 1998-2007) and the Modernising Medical Careers Curriculum (MMC, 2008 and onwards). The outcome measure was an AMR. The pre-CTr cohort (n=84) consisted of 3.6% female colorectal consultants (n=3/84), whereas the post-CTr cohort (n=467) consisted of 14.3% female colorectal consultants (n=67/467) (p=0.006). In this cross-sectional analysis over 5 years, the average pre-CTr undertook a greater number of colorectal resections than their post-CTr peers: median procedures (interquartile range, IQR): 104 (59) vs 89 (57) respectively, p=0.008. The median AMR was significantly greater among pre-CTrs compared with post-CTrs, median AMR (IQR): 2.7% (2.0) vs 2.1% (2.9), p=0.022. These data indicate that the implementation of the MMC and Calman training principles for colorectal training is associated with a statistically lower AMR compared with other historical training periods. This merits further exploration.

Surgical academic reach: the higher degree effect quantified

IntroductionProof of professional specific academic attainment is embedded within the Joint Committee on Surgical Training 2013 general surgery curriculum, mandating that all higher general surgical trainees (HST) obtain three peer-reviewed...

Planning my career in a climate of change.

#### Dear Caroline Many changes are proposed for the NHS—what advice can you give for making career choices when the climate seems so unpredictable? Jilna Shukla, currently on F3 and F4 year out, based in the United Kingdom The only constant in medical training is change. When I first started working in medical education back in 1998, the major change du jour was the creation of specialty registrar posts. Since then we have had the Modernising Medical Careers reforms, the introduction of the European Working Time …

Doctors' views about their work, education and training three years after graduation in the UK: questionnaire survey.

ObjectivesDoctors who graduated in the UK after 2005 have followed a restructured postgraduate training programme (Modernising Medical Careers) and have experienced the introduction of the European Working Time Regulation and e-portfolios. In this paper, we report the views of doctors who graduated in 2008 three years after graduation and compare these views with those expressed in year 1.DesignQuestionnaires about career intentions, destinations and views sent in 2011 to all medical graduates of 2008.Participants3228 UK medical graduates.Main outcome measuresComments on work, education and training.ResultsResponse was 49% (3228/6538); 885 doctors wrote comments. Of these, 21.8% were unhappy with the standard of their training; 8.4% were positive. Doctors made positive comments about levels of supervision, support, morale and job satisfaction. Many doctors commented on poor arrangements for rotas, cover and leave, which had an adverse effect on work-life balance, relationships, morale and health. Some doctors felt pressured into choosing their future specialty too early, with inadequate career advice. Themes raised in year 3 that were seldom raised in year 1 included arrangements for flexible working and maternity leave, obtaining posts in desired locations and having to pay for courses, exams and conferences.ConclusionsMany doctors felt training was available, but that European Working Time Regulation, rotas and cover arrangements made it difficult to attend. Three years after graduation, doctors raised similar concerns to those they had raised two years earlier, but the pressures of career decision making, family life and job seeking were new issues.

Medical Interviews and Professional Development, 2nd edn

It is that time of year again. Junior doctors have frantically applied for jobs and are anticipating interviews. The aftermath of the Medical Training and Application Service has meant that training posts are in high demand. Those fortunate enough to be short-listed need to be well prepared for the interview. We have been to many interviews through our training equipped with our curricula vitae, logbooks and with a little interview practice from seniors together with haphazard reading around of current political/specialty affairs. Nowadays, the interviews have become more structured. Many have become complicated ordeals involving sections testing both personality and clinical know-how. We believe that interviews should be treated as an examination, with preparation being the key to success. Various juniors have asked us for advice regarding interviews and we have recommended this book. There are various books on the market that tackle the issues raised in interviews. However, as a busy clinician, it is difficult to find the time to go through reams of text and such detail is seldom required. Chinmoy Maity, a medical registrar, wrote the first edition based on information he had collected from various sources for interview purposes. The second edition has been thoroughly revised and updated to take into account current legal, ethical and social issues. It is divided into sections covering medical interviews, medicolegal issues, medical ethics, medicosocial issues, clinical governance, research, publications and statistics. Each of the sections starts from the basics and, since no previous knowledge is required, it is an excellent book for all levels of trainee. For example, the medical interview section begins with the structure of the interview process, moving on to useful guidelines on presentations and answers for the commonly asked questions including the duties of a doctor, the poorly performing colleague, complaints procedure, business plans, etc. Although written by a physician, the book is also useful for the surgical trainee. The medicolegal issues covered tackle consent, defining capacity, competence and confidentiality. Clinical governance is comprehensively explained and related to current practice. The book handles up-to-date issues in the NHS. Topical subjects including the European Working Time Directive, Modernising Medical Careers, the Postgraduate Medical Education and Training Board, Primary Care Trusts and the National Patient Safety Agency are all discussed in an easy-to-understand, bitesized manner. Although the days of critically appraising a paper as part of the interview have gone, statistical questions are still the make-or-break questions in interviews. Ever wondered about the difference between descriptive, inferential and diagnostic statistics? This book makes statistics simple and relevant to clinical practice. It has taken all the parts of statistics that are relevant and usually asked about and simplified them into answers that are easy to read and understand. Overall, this book has been a life-saver with regards to preparing for interviews. It provides the knowledge required to give extra confidence. The style of writing makes it a pleasure to read. The volume of text is made manageable by the various figures and bullet points. This also makes it good as reference material and as a last-minute refresher book. We would definitely recommend it as a building block on which to prepare for interviews. Though it lacks up-to-date information on the Intercollegiate Surgical Curriculum Programme and the implications of the Tooke Report on surgical training, it is nevertheless comprehensive enough for all grades from house officer to consultant surgeon. We regard this book as one of the most valuable investments we have made.

UK Foundation-Year 1 Doctors—A Survey Uncovering Infrequent Theater Experience Regardless of Time, Place, or Surgical Specialty

Doctors in the United Kingdom are expected to choose a broad career path after approximately 16 months of finishing medical school. We aim to investigate how much surgical exposure foundation-year (FY)1 doctors would have by the end of their first year after finishing medical school and whether this is sufficient to make an informed decision on a career in surgery. Cross-sectional survey via a 10-part questionnaire sent to 1341 FY1 doctors at the end of their first clinical year across secondary and tertiary hospitals within 9 foundation schools in the United Kingdom. A total of 389 FY1 doctors responded. More than half (52.2%) of the FY1 doctors were unable to attend theater more than 5 times during their rotation. Length of surgical rotation, surgical specialty, type of hospital, and prior interest in surgery had no significant effect on theater attendance (p > 0.05). More than half (50.9%) of the FY1 doctors did not feel like they had had sufficient experience to make an informed decision about a career in surgery. Poor theater attendance is common among FY1 doctors, which may lead to ill-informed specialty career decisions. The Modernising Medical Careers program and European Working Time Directive are likely contributing to this lack of exposure. Protected and logged theater sessions for all FY1 doctors could ensure sufficient exposure. New initiatives need to be employed to increase surgical exposure among FY1 doctors to ensure that specialty choices in their second FY are informed ones. The proposed changes to the United Kingdom's junior doctor's training in the "Shape of Training" report may mean that changes in exposure in the early years are even more pertinent.

Influence of training changes on the stability of specialty choices of UK medical graduates: surveys of the graduates of 2002 and 2008.

To explore the impact of Modernising Medical Careers (MMC) training on the stability of medical career choices in the UK. Graduates of 2002 and 2008 from all UK medical schools, 1 and 3 years postgraduation. Questionnaire surveys were conducted of 2002 and 2008 graduates from all UK medical schools 1 and 3 years post graduation. Doctors gave their specialty choice(s) and rated the influence of each of 11 factors on their career choice. 2008 graduates were a little more likely than graduates of 2002 to retain their year 1 choice in year 3 (77.3% vs. 73.3%; p = 0.002). Among 2008 graduates, the percentage retaining their year 1 choice varied between 42% (clinical oncology) and 79% (general practice). Enthusiasm for a specialty, student experience and inclinations before medical school were associated with choice retention; consideration of domestic circumstances and hours/working conditions were associated with changes of choice. 2008 graduates were more likely than 2002s to be influenced by enthusiasm for a specialty, self-appraisal of their skills, working hours and their domestic circumstances; and less likely to be influenced by their experience of jobs, a particular teacher/department or eventual financial prospects. Post-MMC, graduates were less likely to change their career choice and more likely to be motivated by personal factors and self-assessment of their suitability to a particular area of work.

Almost one in four emergency medicine trainees plans to leave UK or leave specialty

Almost a quarter of emergency medicine trainees do not plan to work in either the specialty or the United Kingdom once they have completed their training, a survey has found. Almost 900 trainees (81% response rate) from all four UK countries responded in July 2013 to the survey,1 which was carried out by the College of Emergency Medicine. The survey asked about trainees’ plans, ambitions, and opinions about working as an emergency medicine consultant, as well as the impact of the Modernising Medical Careers programme and run-through training. Around two thirds (68%) of respondents said that they expected to take up a consultant post once they had completed their specialist training. But …

Перший досвiд впровадження британського варiанта екзамену за системою OSCE наприкiнцi дворiчної iнтернатури

Postgraduate training in anaesthesia and intensive care has been shaping up throughout many years to become, perhaps, the most demanding and complex training programme in medicine. In 2004 thanks to the Modernising Medical Careers move to uncouple training programmes – postgraduate training in anaesthesia and intensive care split into 2 years of Core Training and 5-6 year Specialist Training. In order to apply for Specialist Training you have to pass FRCA Primary exam and reach all the competencies set by the Royal College of Anaesthetists. FRCA Primary exam consists of written MCQ/SBA exam and SOE/OSCE. It proved to be a fair and unbiased way of examining the level of knowledge and practical skills trainees gain during the first 2 years of their training. We decided to run a pilot OSCE exam, which was modified to meet Ukraininan residents programme in order to trial a new examining technique at the end of their 2 year training. A lighter version of OSCE exam was trialled – 8 clinical stations in comparison with 17 original stations. The format of exam was representative of the original – 2 examiners for each station, who were only able to ask preset questions and give marks for the model answers to reduce bias of the exam. Results showed that British and Ukrainian teaching programmes vary. Despite the average mark of 49.9% we identified the areas, where our residents showed good level of knowledge and lacking such. Majority of the residents would have failed the exam during this first attempt. It is important to note that Ukrainian residents had no preparation prior to the exam when the British residents would spend 6 months to a year studying for this exam. We asked for a feedback only after all the residents got their Certificates of Training and were pleasantly surprised to receive high praise fot the exam and the training they received prior to it. We can conclude that the pilot project was a positive and educational experience for both groups – residents and examiners. It is our aim to improve the level of postgraduate training in anaesthesia and intensive care and by introducing new innovative techniques we are able to get one step closer towards reaching our goal.

The influence of structural and institutional change on teaching and culture in clinical settings: An exploratory study

Objectives: Learning in clinical settings is a function of activity, context and culture. Glasgow University’s Medical School has undergone significant curricular change in recent years. This has coincided with change to National Health Service consultants’ contracts, the introduction of the European Working Time Directive and the Modernising Medical Careers training initiative. We wished to explore teachers’ and students’ perspectives on the effects of change on our clinical teachers’ capacity for teaching and on medical culture.Methods: A qualitative approach using individual interviews with educational supervisors and focus groups with senior clinical students was used. Data were analysed using a “framework” technique.Results: Curricular change has led to shorter clinical attachments in the senior clinical rotation, which combined with more centralised teaching have had adverse effects on both formal and informal teaching during attachments. Consultants’ NHS contract changes the implementation of the European Working Time Directive and changes to postgraduate training have adversely affected consultants’ teaching capacity, which has had a detrimental effect on their relationships with students. Medical culture has also changed as a result of these and other societal influences.Conclusions: The apprenticeship model was still felt to be relevant in clinical settings. This has to be balanced against the need for systematic teaching. Structural and institutional change affects learning. Faculty needs to be aware of the socio-historical context of their institutions.

Developing national selection processes for entry into postgraduate specialty training: the case of trauma and orthopedics in the United Kingdom.

A large body of international research has been done investigating best practice selection across many occupational groups, but there is relatively little research on developing selection methodology for entry to postgraduate training. Hitherto, various selection processes have been used, some of which relied heavily on patronage. Developments in Medical Education, including curriculum design, formal work-based place assessment, alongside the introduction of MMC (Modernizing Medical Careers) paved the way for significant change. Trauma and orthopedics in England is the last surgical specialty to adopt National Selection and did so first in 2013. This paper sets out that journey, the implementation of National selection in 2013, what has been learned, and our goals for the future.

Orthopaedic Education in the United Kingdom

Graduate medical education in the United Kingdom recently restructured with the goal of improving trainee experience. In 2007, the Modernizing Medical Careers program changed the organizational structure of all postgraduate medical training in the United Kingdom due to concerns about excess length of training and a lack of supervision. The goals were to include standardization of education and training to produce “high quality, well trained, accredited doctors” [4]. A more formalized structure of feedback and assessment was also implemented to document the progress of trainees [4]. Additionally, the European Union’s European Work Time Directive reduced the number of hours any employee could work (including those in graduate medical education training)—from 56 hours to 48 hours per week. The purpose of this article is to introduce the reader to the educational structure of the United Kingdom, how assessment and feedback are conducted, and just how the European Work Time Directive has influenced orthopaedic surgery education.

Post-MMC doctors more certain of career choice than predecessors

Doctors who graduated after the Modernising Medical Careers (MMC) overhaul of postgraduate medical training are more confident of their choice of specialty than those who graduated pre-MMC, research has found.1 Researchers surveyed 39 115 doctors who graduated in 1974, 1977, 1983, 1993, 1996, 1999, 2000, 2002, 2005, 2008, and 2009. Doctors were asked at one, three, or five years after graduating about their choice …

MMC Reforms: have they put paid to the pluripotent medical student?

Medical students appear to fall into two broad categories: the ‘pluripotent student’ who has yet to declare an interest in any particular specialty, and the ‘specialised’ student who shows a definite commitment to a known specialty, for example, orthopaedic surgery. They are equally ambitious, and undertake extra audits, presentations, and teaching opportunities to enrich their CVs. In a recent survey of 135 final year medical students, 95% agreed that it was not important to have decided on career speciality before graduation. Whilst this view resonates in medical student common rooms, the pressure for early specialization is becoming inescapable. Moreover, the pluripotent group worries that their specialised peers have the right idea. In 2005, the Department of Health implemented Modernising Medical Careers (MMC) – an initiative to address concerns about the UK medical workforce and postgraduate training. One of its aims was to streamline postgraduate specialist training by cutting down the time taken for junior doctors to reach consultant level. This demands that graduates commit to specialist training earlier and – only 18 months following qualification – they have to choose from over 60 specialties to which they may have had little or no exposure. A measure to address this issue – the ‘taster sessions’ offered during the foundation years – has been likened to ‘three-minute speeddating chats from which you have to select your life partner’. Because of the intensely competitive nature of specialist training, the time available to explore different career options is limited. A sign on our career paths should read: ‘No Loitering’. The need to stay on the straight and narrow is now unavoidable. Professional leaders and the Department of Health have discussed the consequences of the MMC changes. Crucially, the results have yet to percolate down to the next generation of would-be doctors. Medical students are not only encouraged to consider their bespoke career path, but to actively pursue these choices through undergraduate research, audit, and teaching opportunities. The drive to display early commitment to a chosen specialty could detract from traditional broad undergraduate training, with the result that medical students are less ‘pluripotent’ and more ‘specialised’ than hitherto. This disadvantage of early career choice and the lack of information about career planning available to medical students and trainees were not overlooked by the Tooke Report on the MMC reforms. Without reliable information, students may be unable to make informed judgements about the likelihood of realizing their career aspirations. There are, perhaps, advantages for the specialised student. These include a firm commitment to a specific discipline, a focused accumulation of knowledge in that discipline, and the possibility of networking opportunities in a familiar specialty. However, the decision to specialize early may rest on only limited experience in that field, or on the persuasive advice of others. Early specialization risks, as well, the development of a blinkered view of medicine, with diminished engagement in other specialties. Compared with the pluripotent student – who would be expected to have a wider knowledge base and skill set – the specialised student may be less well prepared for foundation year posts outside the chosen discipline. DECLARATIONS

A Critical Appraisal of the Evidence of Current Methods of Assessment for Surgical Trainees

Over the past decade training pathways in the UK have been subject to extensive changes. Concerns regarding the supervision and training of junior doctors led to a number of reforms that were implemented through the Modernising Medical Careers programme and these mandated formalisation of curricula for all specialties. Consequently, the surgical royal colleges of the UK and Ireland designed the Intercollegiate Surgical Curriculum Programme (ISCP), which delineates the framework for surgical training from core trainee level through to the award of a Certificate of Completion of training.

More than half of trainees and new GPs think specialty training limits doctors’ potential

More than half of junior doctors and newly qualified GPs who completed an annual BMA survey think that the Modernising Medical Careers (MMC) specialty training programme limits doctors’ potential.1 Each year the BMA surveys a cohort of 435 doctors who graduated in 2006. This was the first group of medical graduates to follow the MMC pathway. When the 368 doctors who responded to the 2012 survey (85% response rate) were asked about aspects of the MMC programme, 54% agreed or strongly agreed …

The Impact of the European Working Time Regulations and Modernising Medical Careers on Out-of-hours ENT Cover

The implementation of the European Working Time Regulations (EWTR), coupled with the ongoing impact of Modernising Medical Careers (MMC), has necessitated a significant redevelopment of out-of-hours cover for surgical specialties in the UK. A review of the literature related to the provision of out-of-hours ENT cover gives an insight into the impact of these changes on a comparatively small surgical specialty. A 2008 survey revealed that three-quarters of junior doctors providing ENT out-of-hours care were crosscovering specialties other than ENT – a figure up from just over half of junior doctors in 2005, prior to stricter EWTR rules. Of all 'first-on-call' doctors for ENT, only 19–32% have prior ENT experience. Consequently, ENT services are provided frequently by inexperienced, non-enT doctors covering multiple other specialties, often as part of a 'hospital-at-night' team.

Low Volume of Exposure Affects Trainees' Confidence in Chest Drain Placement

Since the turn of the century, various implementations have potentially decreased the exposure of doctors in training to practical procedures. These include Modernising Medical Careers (MMC) and the European Working Time Regulations (EWTR). Both these measures resulted in training that was shorter in terms of the hours worked per week and the total length of time taken to reach consultancy, as well as doctors spending less time away from their own specialty.

Changes in surgical training: more than just European Working Time Regulations and Modernising Medical Careers

Since the introduction of European Working Time Regulations (ETWR) and Modernising Medical Careers (MMC), the impact on and changes to surgical training have been discussed in this forum, the wider medical literature and the public domain. Concerns have been raised regarding reduction in exposure to surgical techniques and procedures, and time in theatre has been shown to be of significant value. It has also led to efforts to optimise management of trainees' time and to balance service provision and training appropriately.

Ophthalmic surgical training following modernising medical careers: regional variation in experience across the UK

ObjectivesTo evaluate surgical experience among current doctors appointed into ophthalmology training posts since the introduction of the Modernising Medical Careers programme. Additionally, to identify regional variations in surgical experience and...