Current state of medical recruitment in England

British Medical Association (BMA) finds nearly three quarters of all medical specialties had unfilled training places last year, and many specialties were suffering year-on-year recruitment shortfalls. 

The BMA has warned that a shortage of doctors across most specialities of medicine is putting patient care at risk. The BMA obtained data from 2013 onwards, on the current state of recruitment into pre- and postgraduate medical education and training.

Analysis of the data revealed that:

  • Although still highly competitive, fewer people are applying to medical school.
  • Foundation programme posts and applications are decreasing.
  • Applications to specialty training are decreasing.
  • Nearly three quarters of all medical specialties faced under-recruitment in 2016.
  • There are geographical variations in recruitment trends, with the northern regions bearing the brunt of the recruitment crisis.

To address this workforce crisis, the BMA is calling for greater career flexibility, improved health and wellbeing services, rota gaps to be tackled, maintaining the NHS’s ability to recruit from overseas and improved workforce planning.

Full briefing: The state of pre and post-graduate medical recruitment in England,
September 2017

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The clinical academic workforce of the future

A cross-sectional study of factors influencing career decision-making among clinical PhD students at two research-intensive UK universities | BMJ Open

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Image source: Nottingham Trent University – Flickr // CC BY-NC-ND 2.0

Objectives: To examine clinical doctoral students’ demographic and training characteristics, career intentions, career preparedness and what influences them as they plan their future careers.

Results: Respondents were mainly in specialty training, including close to training completion (25%, n=80), and 18% (n=57) had completed training. Half (50%, n=159) intended to pursue a clinical academic career (CAC) and 62% (n=198) were at least moderately likely to seek a clinical lectureship (CL). However, 51% (n=163) had little or no knowledge about CL posts. Those wanting a CAC tended to have the most predoctoral medical research experience (χ2 (2, N=305)=22.19, p=0.0005). Key reasons cited for not pursuing a CAC were the small number of senior academic appointments available, the difficulty of obtaining research grants and work-life balance.

Conclusions: Findings suggest that urging predoctoral clinicians to gain varied research experience while ensuring availability of opportunities, and introducing more flexible recruitment criteria for CL appointments, would foster CACs. As CL posts are often only open to those still in training, the many postdoctoral clinicians who have completed training, or nearly done so, do not currently gain the opportunity the post offers to develop as independent researchers. Better opportunities should be accompanied by enhanced career support for clinical doctoral students (eg, to increase knowledge of CLs). Finally, ways to increase the number of senior clinical academic appointments should be explored since their lack seems to significantly influence career decisions.

Full reference: Lopes, J. et al. (2017) The clinical academic workforce of the future: a cross-sectional study of factors influencing career decision-making among clinical PhD students at two research-intensive UK universities. BMJ Open. 7:e016823.

Struggling GP trainees given option to extend training for up to 18 months

Trainee GPs that struggle to meet required levels after the standard three years of training will now be able to extend their training by up to 18 months, Health Education England (HEE) has said | GP Online

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GP trainess who fail one or more exams at the end of their usual three years will be able to extend their training by 12 months, with a further exceptional six months. The move brings GP trainees more in-line with other medical specialties, which are currently allowed to extend their training by 12 months with a further exceptional 12 months.

The BMA welcomed the change, as it warned current system ‘unfairly disadvantage’ some of the more diverse groups of doctors. It is hoped the change will help prevent doctors who initially struggle to pass exams being lost to the profession.

The announcement comes alongside a commitment to make it easier for doctors from other specialties to enter GP training.

Read the full news story here

Incorporating emotional intelligence and mindfulness training in modern medical education

Although the study of medicine and the tradition of medical students gaining clinical experience on hospital wards have not significantly changed over the years, the experience of physicians practicing in the current climate has changed dramatically | Postgraduate Medical Journal

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Physicians are confronted with increasing regulations aimed at improving quality of care and are often overwhelmed by their position in a tug-of-war between administrators, staff, colleagues and most importantly, patients. With more than half of the US physicians experiencing professional burnout, questions arise regarding their mental health and work-life balance. Blendon et al. reported an overall decline in the public’s confidence and trust in physicians, which may be explained by cultural changes as well as displeasure with medical leaders’ responses to healthcare needs. As the next generation of physicians emerges in this evolving healthcare environment, adaptation to new practices and regulations will be imperative. Emotional intelligence (EI) and mindfulness provide a possible solution to the struggles physicians will invariably face.

The term EI, which refers to a person’s ability to recognise, discriminate and label their own emotions and those of others, was coined by Salovey and Mayer and popularised by Goleman. Mindfulness is the process by which an individual actively observes his or her thoughts and feelings without judgement. With foundations in Eastern meditation, mindfulness is now an accepted method of stress reduction in Western culture.

Full reference: Shakir, H.J. et al. (2017) The need for incorporating emotional intelligence and mindfulness training in modern medical education. Postgraduate Medical. Journal Published Online First: 06 June 2017.

Evaluation of the Educational Supervision Agreement for Wales

In a bid to promote high-quality postgraduate education and training and support the General Medical Council’s (GMC) implementation plan for trainer recognition, the Wales Deanery developed the Educational Supervision Agreement (EdSA) | BMJ Open

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Results: At the point of data collection, survey respondents represented 14% of signed agreements. Respondents believed the Agreement professionalises the Educational Supervisor role (85%, n=159 agreed), increases the accountability of Educational Supervisors (87%; n=160) and health boards (72%, n=131), provides leverage to negotiate supporting professional activities’ (SPA) time (76%, n=142) and continuing professional development (CPD) activities (71%, n=131). Factor analysis identified three principal factors: professionalisation of the educational supervisor role, supporting practice through training and feedback and implementation of the Agreement.

Conclusions: Our evidence suggests that respondents believed the Agreement would professionalise and support their Educational Supervisor role. Respondents showed enthusiasm for the Agreement and its role in maintaining high standards of training.

Full reference: Webb, K.L. et al. (2017) A mixed-methods evaluation of the Educational Supervision Agreement for Wales. BMJ Open. 7:e015541.

Excellence By Design: Standards For Postgraduate Curricula

These newly developed standards aim to make postgraduate training more flexible for doctors | General Medical Council

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Image source: GMC

They provide a framework for the approval and provision of postgraduate medical education and training across the UK. All medical colleges and faculties are required to update all 103 existing postgraduate medical curricula against the GMC’s new standards, with a target to complete the process by 2020.

During our approval processes, organisations † must describe and give evidence to show how our standards and requirements set out in this document have been addressed in the design and development of the proposed curriculum. For a curriculum to be meaningful, it must address many interdependent factors, such as:

  •  clinical safety
  • expected levels of performance
  • maintenance of standards
  • patient expectations
  • equality and diversity requirements
  • strategic workforce issues and system coherence
  • operational and professional perspectives.
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Image source: GMC

Our curriculum approval process will make sure all of these different dimensions have been appropriately considered and addressed effectively during the development process.

Improving teaching about medically unexplained symptoms for newly qualified doctors in the UK

Yon, K. (2017) BMJ Open. 7:e014720

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Objectives: Medically unexplained symptoms (MUS) present frequently in healthcare, can be complex and frustrating for clinicians and patients and are often associated with overinvestigation and significant costs. Doctors need to be aware of appropriate management strategies for such patients early in their training. A previous qualitative study with foundation year doctors (junior doctors in their first 2 years postqualification) indicated significant lack of knowledge about this topic and appropriate management strategies. This study reviewed whether, and in what format, UK foundation training programmes for newly qualified doctors include any teaching about MUS and sought recommendations for further development of such training.

 

Conclusions: There is an urgent need to improve foundation level training about MUS, as current provision is very limited. An interactive approach covering a range of topics is recommended, but must be delivered within a realistic time frame for the curriculum.

Read the full article here