Specialist Register Research Articles

GMC proposes workplace assessment and exam for doctors seeking CESR or CEGPR

Doctors who wish to join the specialty register by obtaining a certificate of eligibility for specialist registration (CESR) or a certificate of eligibility for general practice registration (CEGPR) might be subject to a workplace based evaluation of their practice and could be asked undertake a formal test of knowledge in their specialty, the General Medical Council has recommended. Applicants who have not practised in the UK as a licensed doctor for at least six months in the previous three years …

CESR=CCT, says chairman of Academy of Medical Royal Colleges

Employers should view the certificate of eligibility for specialist registration (CESR) as identical to the Certificate of Completion of Training (CCT), the chairman of the Academy of Medical Royal Colleges has recommended. Speaking at the joint royal colleges’ conference for staff and associate specialist doctors last week, Neil Douglas said that colleges need to work to remove the “stigma” associated with the …

Space-time clustering of childhood central nervous system tumours in Yorkshire, UK.

BackgroundWe specifically tested the aetiological hypothesis that a factor influencing geographical or temporal heterogeneity of childhood central nervous system (CNS) tumour incidence was related to exposure to a transient environmental agent.MethodsInformation was extracted on individuals aged 0-14 years, diagnosed with a CNS tumour between the 1st January 1974 and 31st December 2006 from the Yorkshire Specialist Register of Cancer in Children and Young People. Ordnance Survey eight-digit grid references were allocated to each case with respect to addresses at the time of birth and the time of diagnosis, locating each address to within 0.1 km. The following diagnostic groups were specified a priori for analysis: ependymoma; astrocytoma; primitive neuroectodermal tumours (PNETs); other gliomas; total CNS tumours. We applied the K-function method for testing global space-time clustering using fixed geographical distance thresholds. Tests were repeated using variable nearest neighbour (NN) thresholds.ResultsThere was statistically significant global space-time clustering for PNETs only, based on time and place of diagnosis (P = 0.03 and 0.01 using the fixed geographical distance and the variable NN threshold versions of the K-function method respectively).ConclusionsThere was some evidence for a transient environmental component to the aetiology of PNETs. However, a possible role for chance cannot be excluded.

Pathways to practice: overseas trained psychiatrists’ experiences of the processes involved in commencing professional practice in Australasia

There are significant shortages in the psychiatric workforce in Australasia, particularly in the rural and remote regions of Australia and New Zealand. In response to these shortages, mental health services have recruited large numbers of overseas trained psychiatrists (OTP). These are specialist psychiatrists, trained and recognised as such in other countries. Our objective was to ascertain how OTPs experience the processes of commencing professional practice in Australasia. OTPs were surveyed to identify the pathways to obtaining specialist registration and College Fellowship in Australasia and to explore their experiences as they engaged in this process. Although limited by a low response rate, the data does highlight a level of discontentment among those OTPs surveyed. The key issues identified related to the examination process, poor communication between different agencies (including the RANZCP), visa and residency related issues, medical board registration difficulties and notable differences between Australia and New Zealand. There is a negative perception among OTPs regarding the existing pathways to registration as specialist psychiatrists and the attainment of Fellowship. We submit that the RANZCP has a central and important role in resolving some of the underlying issues and supporting OTPs as vital and valued members of the workforce in Australia and New Zealand.

The EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry and Laboratory Medicine: version 4 – 2012

Laboratory medicine's practitioners across the European community include medical, scientific and pharmacy trained specialists whose contributions to health and healthcare is in the application of diagnostic tests for screening and early detection of disease, differential diagnosis, monitoring, management and treatment of patients, and their prognostic assessment. In submitting a revised common syllabus for post-graduate education and training across the 27 member states an expectation is set for harmonised, high quality, safe practice. In this regard an extended 'Core knowledge, skills and competencies' division embracing all laboratory medicine disciplines is described. For the first time the syllabus identifies the competencies required to meet clinical leadership demands for defining, directing and assuring the efficiency and effectiveness of laboratory services as well as expectations in translating knowledge and skills into ability to practice. In a 'Specialist knowledge' division, the expectations from the individual disciplines of Clinical Chemistry/Immunology, Haematology/Blood Transfusion, Microbiology/ Virology, Genetics and In Vitro Fertilisation are described. Beyond providing a common platform of knowledge, skills and competency, the syllabus supports the aims of the European Commission in providing safeguards to increasing professional mobility across European borders at a time when demand for highly qualified professionals is increasing and the labour force is declining. It continues to act as a guide for the formulation of national programmes supplemented by the needs of individual country priorities.

Of research and writing in paediatric training

Increasingly, regulatory authorities require that specialist qualifications in clinical medicine should include a verifiable research component. Whereas university postgraduate degrees were generally awarded after training that included participation in research, the Colleges of Medicine relied on professional competency examinations as a measure of a candidate's suitability for specialist registration.

Intensive care medicine: finding its way in the “European labyrinth”

The European Union (EU) has created recent directives to facilitate the free movement of medical specialists in its member states. Analysis of two recent surveys performed in European countries. Intensive Care Medicine training and accreditation have changed quickly over time. There is no harmonisation among European countries. Young specialists might face several difficulties in the future. Nations providing a national examination for intensive care medicine and a national register for specialists in intensive care medicine facilitate the free movement of specialists, regardless of European regulations and directives. Intensive care medicine is currently not a mother speciality. A long process needs to occur before complete harmonization of training and accreditation and free movement of specialists in Europe will happen.

Audit of ICD-10 diagnosis use at admission assessments and in discharge summaries by psychiatric trainees

Article 14 of the General and Specialist Medical Practice Order 2003 for specialties in psychiatry describes the specific conditions that a doctor must meet in order to be eligible as a specialist for the purposes of inclusion on the Specialist Register. The conditions as published by the Royal College of Psychiatrists (2003) include, among other requirements, that the psychiatrist shall demonstrate working knowledge of the epidemiology, aetiology, psychopathology, clinical features and natural history of the major psychiatric disorders in ICD-10 (World Health Organization, 1992), including age, gender and sociocultural considerations, based upon the scientific literature. Familiarity with ICD-10 diagnostic criteria is therefore an important part of psychiatric training.

Does the Intercollegiate Specialty Examination in Urology (FRCS Urol) Assess the Breadth of the Urology Syllabus?

Introduction: In January 2007, the Intercollegiate Specialty Board in Urology introduced its new two-part examination in urology (FRCS Urol). The new examination utilised validated tools, underpinned by a precise curriculum for the specialty, which facilitated the knowledge assessment of individuals wishing to gain entry to the Specialist Register for independent practice in urology. This study assesses whether the content of Sections 1 and 2 of the new examination covers the breadth of the ISCP curriculum in urology and secondly whether candidates find the examination acceptable. Methods: The six diets of the examination between January 2007 and November 2009 were studied. The content of the curriculum for urological training was analysed, as were the knowledge domains tested by the examination. Comparisons were made to correlate the effectiveness of the examination in testing various aspects of the syllabus. Subjective exit questionnaires were obtained from candidates sitting both sections of the examination. These were analysed for candidates' views about the organisation of the examinations, its coverage, appropriateness of standard and relevance to clinical practice. Results: There was a high level of concordance between the examination and the content of the curriculum although there was some disparity in the balance of the topics tested which might require fine-tuning. 86% of all candidates returned exit questionnaires with >90% agreeing that the examination was a fair test of knowledge. There was less agreement about the relevance of the MCQ paper to clinical practice. Conclusion: The post-2006 FRCS (Urol) examination is accepted as a fair test of urological knowledge by the vast majority of candidates presenting for this assessment. It also fulfils the requirements stipulated by Postgraduate Medical Education Training Board (PMETB) now General Medical Council (GMC) — Postgraduate Board for accreditation of training in the UK and Ireland. The examination is educationally valid although minor mismatches between the curriculum content and the topic areas tested would benefit from utilisation of an examination blueprint.

Doctors call for specialist registration to be simpler and fairer

Doctors call for specialist registration to be simpler and fairer

Feedback on doctors’ performance from parents and carers of children: a national pilot study

ObjectivesTo evaluate the reliability and validity of a children's carers’ feedback tool, to explore the feasibility of delivering this nationally and to determine acceptability to doctors of this assessment.Participants122 UK...

PMETB AND Me Or How I Learnt to Stop Worrying and Love Article 14

The Postgraduate Medical Education and Training Board (PMETB) was established by an act of Parliament in 2003, to set standards for postgraduate medical education and training and to ensure that those standards are met. On 30 September 2005 PMETB took over the functions of the Specialist Training Authority and the Joint Committee on Postgraduate Training for General Practice. Under article 14(4) of the regulations governing PMETB, doctors whose training or qualifications and experience, considered together, meet the requirements of a Certificate of Completion of Training (CCT) programme in one of the standard CCT specialties, may apply to PMETB for a statement of eligibility for registration. This in turn allows application to the General Medical Council for admission to the specialist register.

Gonadotrophin-Releasing Hormone Analogues for Pain Associated With Endometriosis

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Comparative clinical- and cost-effectiveness of candesartan and losartan in the management of hypertension and heart failure: a systematic review, meta- and cost-utility analysis

The UK National Health Service (NHS) currently spends in excess of £250 million per annum on angiotensin II receptor blockers (ARBs) for the treatment of hypertension and heart failure; with candesartan currently dominating the market. With the recent introduction of generic losartan, we set out to directly compare the branded market leader to its now cheaper alternative. The primary objectives were to compare the blood pressure (BP) lowering efficacy and cardiovascular outcomes of candesartan and losartan in the treatment of essential hypertension and chronic heart failure, respectively. The secondary objective was to model their comparative incremental cost-effectiveness in a UK NHS setting. The Cochrane Central Register of Controlled Trials (Cochrane Library 2009, issue 2), which contains the Hypertension and Heart Group's specialist register, Medline (1950-February 2010), and Embase (1980-February 2010) were included in the search strategy. Selection criteria were randomised studies of candesartan versus losartan in adults (> 18 years). The main outcome measures were as follows: Hypertension: mean change from baseline in trough (24 h postdose) systolic and diastolic BP. Heart failure: composite of cardiovascular death and hospital admission for management of heart failure. Two reviewers applied inclusion criteria, assessed trial quality, and extracted data. Eight (three of which met inclusion criteria) and zero trials compared candesartan directly with losartan in the treatment of hypertension and heart failure, respectively. A between-treatment difference of -1.96 mmHg [95% confidence interval (CI) -2.40 to -1.51] for trough diastolic BP and -3.00 mmHg (95% CI -3.79 to -2.22) for trough systolic BP in favour of candesartan was observed. Based on this differential, a 10-year Markov model estimates the cost per quality-adjusted life-year gained to exceed £40,000 for using candesartan in place of generic losartan. Candesartan reduces BP to a slightly greater extent when compared with losartan, however, such difference is unlikely to be cost-effective based on current acquisition costs, perceived NHS affordability thresholds and use of combination regimens. We could find no robust evidence supporting the superiority of candesartan over losartan in the treatment of heart failure. We therefore recommend using generic losartan as the ARB of choice which could save the UK NHS approximately £200 million per annum in drug costs.

Development of sports and exercise medicine in Ireland and future challenges

Lecture 25The Faculty of Sports and Exercise Medicine was set up in September 2001 and is a joint Faculty of the Royal College of Physicians and Royal College of Surgeons...

The Greek way to the Register: the establishment and operation of the Register for Clinical Chemists-Clinical Biochemists in Greece

In Greece, there is no officially organized training in clinical chemistry for scientists. The Greek Society of Clinical Chemistry-Clinical Biochemistry (GSCC-CB), following the encouragement of the EC4/RC decided to organize a voluntary Register for specialists in clinical chemistry. The following criteria for registration were defined: 1) University degree in Chemistry, Biochemistry, Biology, Medicine, Pharmacy or other relevant subject. 2) A total of 9 years of university studies and postgraduate specialization in clinical chemistry-clinical biochemistry. 3) A minimum of 4 years of postgraduate specialization in clinical chemistry-clinical biochemistry on the job. 4) The candidate must be practicing clinical chemistry-clinical biochemistry in a laboratory in a medical environment in Greece. The postgraduate specialization in clinical chemistry-clinical biochemistry includes the laboratory training and the theoretical education. The laboratory training is organized by the GSCC-CB according to the Professional Training Dossier. The theoretical education was organized in a series of 18 "Seminars" which was the content of the "Educational program" of the GSCC-CB. Successful completion of the Educational program leads to a Certificate of Competence. The Greek Register has gained equivalence with the EC4 Register and it has 218 members, more than 80 of whom are European clinical chemists.

Security interests over intellectual property

The development of new technologies and the viral spread of communication networks have both rendered possible the rise of businesses that own very few tangible assets and owe their success almost exclusively to their intellectual property. Within this new socio-economic environment, often described as the ‘information society’, the ability to use intellectual property rights (IPRs) as the object of security interests is gradually being recognised as an attractive prospect, rather than a mere eccentricity. This article does not aspire to paint a comprehensive picture of this topic, but rather focuses on certain specific legal issues arising from the interaction between intellectual property and security interest law. Firstly, it looks at the different real consensual security devices known to English law, and evaluates their compatibility and efficiency when used in conjunction with IPRs. Secondly, it focuses on the difficulties associated with the conveyance necessary for a mortgage, and the manners in which they have been addressed by the case law. Thirdly, it examines matters of registration and priority for security interests created over trade marks and patents, paying particular attention to the provisions regulating the specialist registers and their interaction with ss. 860, 861 and 869 of the Companies Act 2006. Fourthly, this article considers the specific difficulties that copyright raises due to its unregistered nature, analysing possible solutions within the existing legal framework. Finally, it outlines some observations on the existing proposals for legislative reform of English security interest law and, more particularly, on the employment of IPRs as collateral.

Gonadotrophin-releasing hormone analogues for pain associated with endometriosis.

See https://pubmed.ncbi.nlm.nih.gov/37341141/ for a more recent review that covers this topic and has superseded this review. Endometriosis is a common gynaecological condition, characterised by the presence of endometrial tissue in sites other than the uterine cavity (excluding adenomyosis) that frequently presents with pain. The gonadotrophin-releasing hormone analogues (GnRHas) comprise one intervention that has been offered for pain relief in pre-menopausal women. GnRHas can be administered intranasally, by subcutaneous, or intramuscular injection. They are thought to result in down regulation of the pituitary and induce a hypogonadotrophic hypogonadal state. To determine the effectiveness and safety of GnRHas in the treatment of the painful symptoms associated with endometriosis. Electronic searches of the Cochrane Menstrual Disorders and Subfertility Group specialist register, CENTRAL, MEDLINE, EMBASE, PSYCInfo and CINAHL were conducted in April 2010 to identify relevant randomised controlled trials (RCTs). RCTs of GnRHas as treatment for pain associated with endometriosis versus no treatment, placebo, danazol, intra-uterine progestagens, or other GnRHas were included. Trials using add-back therapy, oral contraceptives, surgical intervention, GnRH antagonists or complementary therapies were excluded. Quality assessment and data extraction were performed independently by two reviewers. The primary outcome was pain relief. Relative risk was used as the measure of effect for dichotomous data. For continuous data, mean differences or standardised mean differences were used. Forty one trials (n=4935 women) were included. The evidence suggested that GnRHas were more effective at symptom relief than no treatment/placebo. There was no statistically significant difference between GnRHas and danazol for dysmenorrhoea RR 0.98 (95%CI 0.92 to 1.04; P = 0.53). This equates to 3 fewer women per 1000 (95%CI 12 to 6) with symptomatic pain relief in the GnRHa group. More adverse events were reported in the GnRHa group. There was a benefit in overall resolution for GnRHas RR1.10 (95%CI 1.01 to 1.21, P=0.03) compared with danazol. There was no statistically significant difference in overall pain between GnRHas and levonorgestrel SMD -0.25 (95%CI -0.60 to 0.10, P=0.46). Evidence was limited on optimal dosage or duration of treatment for GnRHas. No route of administration appeared superior to another. GnRHas appear to be more effective at relieving pain associated with endometriosis than no treatment/placebo. There was no evidence of a difference in pain relief between GnRHas and danazol although more adverse events reported in the GnRHa groups. There was no evidence of a difference in pain relief between GnRHas and levonorgestrel and no studies compared GnRHas with analgesics.

078 Incidence rates and survival trends of cancer in 0–29-year-olds by ethnic group in Yorkshire, UK

ObjectiveFew studies have examined differences in the epidemiology of cancer between ethnic groups for children and young adults in the UK. We investigated incidence rates, associated trends and survival by...

Public health standards of proficiency remain the same

The news story, ‘Fast-tracked band 5+ staff now allowed on to specialist register’ (August 18), suggests that any nurse who completes a public health modular pathway will be allowed on to the specialist part of the Nursing and Midwifery Council (NMC) register. This is not the case.