MMC Consultation Document
From Mmc
Modernising Medical Careers (MMC) England
Recruitment to specialty training -
Proposals for improvements in 2008:
Part 1: A fair and reliable selection process
Part 2: The offer to applicants
Document for discussion and feedback
Deadline for responses 25 September 2007
Distributed by the England MMC Programme Board
12 September 2007
Initial distribution
Members of the MMC England Programme Board are consulting their constituencies. See appendix 1 for a list of Programme Board Members.
The Programme Board has also written to the following bodies to request their views:
Academy of Medical Royal Colleges
Academy of Medical Sciences
British Medical Association (BMA)
Chief Executives and Directors of Workforce of strategic health authorities
Committee of General Practice Education Directors (COGPED)
Conference of Postgraduate Medical Deans in the UK (COPMeD)
Department of Health Workforce, Research and Development and the MCC team
Devolved Administrations for Northern Ireland, Scotland and Wales
English postgraduate deans
Hospital Consultants and Specialists Association (HCSA)
Medical Practitioners Union (MPU)
Medical Research Council
Medical Schools Council
Methods Consulting Ltd
MMC UK Co-ordinating Group
National Association of Clinical Tutors (NACT)
National Association Medical Personnel Specialists (NAMPS)
National Coordinating Centre for Research Capacity Development (NCCRCD)
NHS Employers
Office of Strategic Health Authorities
Postgraduate Medical Education and Training Board (PMETB)
Remedy UK
Royal Colleges and Faculties
UK Foundation Programme
This document is available from the MMC website at <A HREF="http://www.mmc.nhs.uk/">www.mmc.nhs.uk</A>
Please send your views in writing by email by 10.00am on Tuesday 25 September 2007
To: Terry Hanafin
Chief Operating Officer
MMC team
Department of Health
<A HREF="mailto:mmc.programme@dh.gsi.gov.uk">mmc.programme@dh.gsi.gov.uk</A>
Contents
Page
1. Purpose of this document 4
2. The decision-making process and where to send your views 5
3. Discussion and proposals for feedback 7
Part 1: A fair and reliable selection process 7
Presents proposals for consideration for recruitment and
selection in 2008 and possibilities for 2009
Part 2: The offer to applicants in 2008 23
Presents proposals for changes for flexibilities
in education and training
Appendix 1 - MMC England Programme Board and membership 32
Appendix 2 - The offer to applicants in 2008 (diagrams) 34
Appendix 3 - The “mixed economy” of offers to applicants in 2008 38
Current views from some Royal Colleges and Faculties
1. Purpose of this document
The purpose of this document is to draw on the lessons from this year’s experience, and the feedback from applicants and stakeholders, to improve processes for 2008. It sets out proposals for 2008 to review with stakeholder representatives before moving forward with process design and implementation.
This document presents proposals in two parts for consultation with representative bodies. The proposals from each part are summarised in section 3.
Part 1: A fair and reliable selection process contains proposals for recruitment and
selection in 2008 and covers possibilities for 2009.
Part 2: The offer to applicants contains proposals for flexibilities in education and training in 2008.
Policy decisions for 2008, for recommendation to Ministers, need to be made at the MMC England Programme Board meeting on 1 October to allow sufficient time to design implementation before recruitment starts in early January 2008.
The deadline for responses to the proposals in this document is 10.00am on Tuesday 25 September 2007.
See the decision-making process and where to send your views in section 2.
Scope for change
The scope for change in 2008 is very limited because of the length of time required to plan, design and test major changes. One of the major criticisms of the introduction of changes in 2007 was that it was overambitious. The Douglas Review found that, “A key, if obvious, lesson is that major changes to medical training and appointments systems should be introduced only after careful piloting...”
For significant changes, 2009 and beyond is a more realistic timeframe. The independent review currently being undertaken by Sir John Tooke will inform major changes for 2009 and beyond. An interim report from the Tooke Inquiry is due to be published in October 2007. Sir John Tooke has confirmed that he will not make recommendations that could be implemented in 2008.
Sir John Tooke has had the opportunity to comment on a late draft of this discussion document and he has confirmed that there are no proposals in it that are likely to conflict with his recommendations.
There are practical improvements that we can achieve in the time available for 2008 concerning details of process that are extremely important to both the junior doctors who apply and to those running the process, including the senior doctors who shortlist and sit on interview panels.
Proposals based on consultation and views
The proposals in this document are based on discussions and feedback that have been continuing throughout 2007. They take into account views from a wide range of perspectives; from applicants, consultants, representatives of the medical profession, educational and human resources experts, NHS employers, health service managers, and a recently received BMA document, Outline Proposal for 2008.
Feedback has been considered through both informal consultation and formal review:
Representatives of the medical profession and the NHS have direct involvement through representation at the MMC England Programme Board (see appendix 1 for a list of Programme Board members)
The Douglas Review Group, which involved stakeholder representatives, highlighted key issues and opinions in a report published on 3 August 2007, available from <A HREF="http://www.mmc.nhs.uk/">www.mmc.nhs.uk</A>
The MMC England senior management team, working on behalf of the Programme Board, has ongoing discussions with stakeholders including junior doctors, the BMA, the Royal Colleges, NHS Employers, deaneries and strategic health authorities
The Programme Board has received copies of submissions to the Tooke Inquiry from major stakeholders.
The decision-making process and where to send your views
Main points on timing
Recruitment to specialty training in 2008 needs to begin in January 2008
Design and implementation planning requires a period of three months
The MMC England Programme Board must take decisions for recommendation to Ministers on processes for 2008 at its meeting on 1 October 2007 to allow time for design and testing before recruitment starts in January 2008.
The Tooke Inquiry, which will deliver the main recommendations for change for 2009 and beyond, will make an interim report in October 2007. Major changes require a considerable period of design and piloting
Decision-making process and involvement of stakeholders
The medical profession and representatives from the NHS are directly involved in decisions about MMC for 2008 in England through their representation on the MMC England Programme Board (see appendix 1 for list of members). The Programme Board makes recommendations to Ministers.
The decisions of the Programme Board will be informed through:
Members consulting their constituencies
Commissioned working groups, workshops and discussion groups to develop and test ideas, involving junior doctors and stakeholders
Periodic consultation with stakeholders
Programme of wider discussion and involvement at national and local level from September 2007 to January 2008
Piloting and validation of major change proposals
Key dates for 2008 decisions:
25 July 2007 First meeting of Programme Board
12-25 Sep 2007 Consultation with stakeholders on proposals for 2008
17-18 Sep 2007 Stakeholder workshop to develop detailed recommendations on recruitment and selection for 2008 (and ideas for 2009)
1 Oct 2007 Programme Board decisions for recommendation to Ministers
Mid Oct Announcement of decisions for 2008
Oct-Dec Plan, design and test for implementation
Nov/Dec Information and guidance on 2008 processes
Jan 2008 Start of 2008 application process
Planning for 2009:
To develop ideas for 2009, a programme of wider discussion and involvement at national and local level will run from September 2007 to January 2008, including a series of focus groups with doctors in training.
The stakeholder workshop set for 17-18 September 2007 will start the development of ideas for 2009 recruitment. Following that, a smaller working group will steer the development of proposals for recruitment in 2009, involving stakeholders in further large workshops and piloting.
Where to send your views
To respond to the proposals in this document for processes in 2008, please send your views in writing by email by 10.00am on Tuesday 25 September 2007 to:
Terry Hanafin
Chief Operating Officer
MMC team
Department of Health
<A HREF="mailto:mmc.programme@dh.gsi.gov.uk">mmc.programme@dh.gsi.gov.uk</A>
This document is available from the MMC website at <A HREF="http://www.mmc.nhs.uk/">www.mmc.nhs.uk</A>
3. Discussion and proposals for feedback
Part 1: A fair and reliable selection process
Introduction
Selection fairness and reliability is a major challenge when there are many more potential applicants than training posts available, as is the case in recruitment to specialty training in England.
The process cannot change the fact that there will be an excess of suitably qualified applicants in 2008, but we can make process design changes to improve its fairness and reliability.
For example, in 2007, there were questions about whether the application form and selection method was fit for recruiting the best doctors to the right specialty in the right location.
This paper proposes improvements in the planned approach to recruitment and selection to speciality training that can be achieved within planning timescales for 2008. It also considers the possibilities for changes in 2009 and beyond that need longer for design and piloting and evaluation, subject to the findings of the Tooke Inquiry (interim report due in October).
Context
The working assumption for 2008 is that competition will be even higher, with a possible average competition ratio in England of about 3:1 applicants to places, compared with about 2:1 in 2007.
Whilst many of the applicants will be seeking entry to year one (ST1), there will still be people applying to higher levels (ST2, 3, 4 etc.) and there will be fewer posts available at these levels in 2008. New applicants for 2008 posts will almost certainly be joined by many of those who did not find a run-through training post in 2007.
In the 2007 selection process, there were major concerns about the use of an application form based primarily on “white boxes”, which applicants completed to demonstrate that they met the person specification. It was suggested that a better way would be to use structured, CV-based application forms.
A CV-based application form that is specialty and level specific could reasonably support applications to ST2 and higher levels, where applicants tend to have more experience. Surveys show that junior doctors would support this approach as it allows applicants to bring out their experience for selection purposes.
Many applicants to ST1 also have excellent CVs. However, selection into ST1 is more challenging in that applicants from Foundation Programme training have limited or no experience in the specialty to which they are applying, but carry with them an assessment of competences and end of Programme certification. Doctors who have trained outside the UK or that have had other career or service posts may have more experience in their chosen specialty, but little or no experience of assessment of competences. This makes it difficult to agree fair selection criteria that do not put some applicants at a disadvantage.
The 2008 recruitment and selection to specialty training needs to start in January 2008. A period of about three months is necessary to design the implementation. Therefore, the MMC England Programme Board needs to take decisions for 2008 at its meeting on 1 October 2007.
Any major change in process will need longer in order to test thoroughly its validity and security. Decisions are subject to the findings of the Tooke Inquiry, but it is useful to consider possible options for the future before deciding plans for 2008.
The proposals in this part on recruitment and selection should be considered together with those in part 2, which include the possibility of a second round of competition, open or closed, between ST 2 and ST3 and above.
When considering the following proposals, it is important to note the difference between a selection system and selection methods. A selection system might comprise the following:
Application form submission
Long listing
Shortlisting
Interview and/or selection centre
Each element of the selection system will be delivered through a selection method or methods. It is entirely possible for a selection method to be used at more than one point in a selection system. For example, selection centres can be used for both shortlisting and as a replacement for, or an addition to, the interview phase of selection.
Issues
The MMC England Programme Board is considering options for change in the following selection and recruitment elements for 2008:
Shortlisting
National or local application form
The number of applicants’ preferences and how preferences should be treated (i.e. concurrently or consecutively)
National computer system or local deanery’s own system
The size of Units of Application (UoAs)
An integrated national timetable
Other issues
3.4 Issue 1 – Shortlisting
Issue
This issue refers to recruitment for hospital specialty training and not GP training for which the Programme Board has agreed that the successful approach used in 2007 can also be used in 2008 (i.e. invigilated machine-markable tests for shortlisting followed by selection centres.
Many view local processes of shortlisting as a tried and trusted method, with structured (CV-based) application forms followed by interviews. This was the system adopted in Round 2 of the 2007 application process.
This method has high validity for ST2 and above where applicants are likely to have had the chance to gain experience relevant to the speciality to which they are applying.
Ideally, selection to ST1, will need improvements to deal with the fact that application is constrained by the limited clinical experience of applicants in the specialty to which they are applying. However, it may not be possible to introduce the most appropriate selection methods for ST1 in 2008, as significantly new methods will require piloting before implementation.
The following discussion considers the possible options for selection methodologies before arriving at the proposal for 2008.
Discussion
The MMC England Programme Board’s current view is that a local selection process is the best way forward for 2008 for all specialty training levels, ST1 and higher.
However, the Programme Board is keen to improve the methodology for selection to ST1, given the high volume of applicants and the challenge of establishing selection criteria for these applicants with limited experience. The following summarises possible options for shortlisting to ST1 that have been considered by the MMC England Programme Board in determining how far improvements could go in 2008.
Option 1
Continue with the 2007 process - a national online application form incorporating “white space” shortlisting questions
As highlighted in the Douglas Review report, certain elements of the 2007 application form are clearly opposed by junior doctors and consultants. The use of “white space” was open to plagiarism and stakeholders have expressed major reservations about the use of this system for 2008. The Programme Board does not consider this a viable option.
Option 2
Remove shortlisting altogether and interview all eligible applicants
The Programme Board considers that this option would be impractical given the very high volume of interviews requiring consultants’ time, the administrative workload and high costs. This is particularly true if the number of preferences is kept at four and all four have to interview all eligible applicants.
The Devolved Administrations were able to interview applicants for all of the preferences for each country in 2007, but this was not possible in England because the number of interviews necessary for the large number of applications per post would exceed interview capacity. This is illustrated in the figures below:
|
|
England |
Northern Ireland |
Scotland |
Wales |
UK total |
|
Posts (as recorded at the end of round 1) Eligible applications per post Shortlistings per post |
15,554 6.6 2.1 |
525 4.2 2.2 |
2,004 4.6 2.8 |
1,029 4.1 1.9 |
19,112 6.2 2.1 |
|
Increase (over Round !a) in interview load from interviewing all eligible applicants (excluding general practice assessment centres) as a % of shortlistings (exc. general practice assessment centres) |
58,500
222% |
900
92% |
2,600
56% |
1,800
108% |
63,800
190% |
England had approximately 50% more applications per post in Round 1 in 2007 (at 6.6 compared with 4.2, 4.6 and 4.1 for the other three countries). England has similar shortlistings to posts as Northern Ireland and Wales, but Scotland has more.
Most significantly, England would have had to increase the number of interviews actually undertaken in Round 1a by 222% (i.e. more than trebled the number) to have interviewed all eligible applicants for all of their English preferences.
However, if we were to guarantee an interview for all eligible applicants for their first preference only in Round 1 in 2008, then this option would be more feasible. (See more on this later under Issue 2)
Option 3
Introduce
a nationally agreed shortlisting process that ranks applicants based
on a structured CV based application form with relevant indicators.
For ST1, there can only be limited CV based indicators to differentiate between F2 applicants. This would make it very difficult to ensure fairness or equity within a national shortlisting scoring system. However, it may be possible for different deaneries and specialties to use different indicators and to have weightings according to the level of competition for that specialty in that geography. This would effectively change this option from a national to a local process as for ST2 and above.
Option 4
Use
an invigilated shortlisting test that is machine-marked, similar to
the Clinical Problem Solving (CPS) test used for GP training
selection
There is good national evidence of the validity of this method and reasonable support from stakeholders (except for the BMA Junior Doctors’ Committee). However, it would need time for design, planning, piloting and testing in other specialties. It would select out unsuitable applicants (estimates suggest 15-20%). The Programme Board is proposing to pilot and validate this method in 2008 where there is local agreement between deanery and specialty.
Option 5
Use
invigilated assessments for shortlisting (such as those typically
used at selection centres) with interview at second stage.
Assessments could include written, interactive exercises and/or
simulations that have been piloted and validated.
As with option 4 above, this option has high potential validity and stakeholder support, but would need time for design, planning piloting and evaluation. Selection centres could select out 50% of applicants or more, which makes this method particularly suitable for high competition specialties. The percentage screened out could vary to reflect differences in posts available, competition ratios and historical fill rates.
The Programme Board has agreed to pilot and validate this method in specialties where there is local agreement between deanery and specialty.
Proposals for shortlisting in 2008
Selection into specialty training for 2008 for ST1, ST2, ST3 and ST4 should be through local processes of shortlisting, followed by interviews, using a nationally agreed timetable. Although we would prefer to have a different method for shortlisting for ST1, we have been unable to agree an appropriate method that could be implemented within the timescale for 2008.
There would be no national shortlisting scoring system. Shortlisting would be through consideration of structured (CV-based) application forms using a national, specialty-specific form containing a common core and specialty-specific questions.
Different deaneries and specialties would use different CV indicators, weightings and specialty-specific criteria according to the level of competition for that specialty in that geography. The CV-based indicators and specialty-specific criteria to be used for shortlisting must be based on the national person specification for that specialty and level of post.
These local processes would be guided by a brief set of national “rules”. These could be based on those for Round 2 this year amended in the light of experience. The national rules would include a national recruitment timetable.
Exceptions to having purely local processes could be:
GP recruitment for which the Programme Board has already agreed that in 2008 the national invigilated machine test can be used for shortlisting, followed by selection centres as used successfully in 2007
Obstetrics & Gynaecology, which may be able to use the national cascade/harmonisation method that was used in Round 2 in some deaneries this year.
very small specialties, where a national shortlisting and interview process could be used (as in histopathology this year).
A method of machine-marked tests for clinical problem solving and non-clinical judgements (often referred to as situational judgement testing), should be piloted in 2008 where there is local agreement between deanery and specialty. (See option 4 described above)
A method using selection centres should be piloted in 2008 where there is local agreement between deanery and specialty. (See option 5 above)
Your views on proposals for shortlisting in 2008
Do you agree that selection in 2008 should be through local processes of shortlisting followed by interviews using a nationally agreed timetable?
Do you agree that shortlisting should be through consideration of structured (CV-based) application forms using a national, specialty-specific form containing a common core?
Do you think that the selection process in 2008 should be different in application to ST1 compared to ST2 and ST3 (ST4 in paediatrics and psychiatry)? If so, how should it be done for each?
What do you think needs to be considered within the piloting in 2008 of the two selection methodologies, the machine-marked tests and the selection centre method?
3.5 Issue 2 – National or local application form
Issue
The proposal in Issue 1 was that shortlisting should be carried out locally in Units of Application (UoAs) through consideration of structured (CV-based) application forms using a national, specialty-specific form containing a common core. The CV-based indicators and specialty-specific criteria to be used for shortlisting must be based on the national person specification for each specialty.
However, the core part of the application form could be either a national form or could be specific to each deanery/UoA.
Discussion
|
National common core (common to all UoAs for a specialty) |
Local core (specific to each deanery/UoA) |
|
Advantages:
|
Advantages:
|
|
Disadvantages:
|
Disadvantages:
|
Proposal for 2008
The proposal is to use a national specialty-specific form containing a common, structured CV-based core.
However, a cut-off date will need to be defined so that if a national form has not been agreed by the cut-off date, then a national form will not be used because there would be insufficient time to complete its IT design, build and test.
A compromise would be to have a minimal core application form, which would still have cost efficiency benefits.
Your views on a national or local application form for 2008
Which is your preference for 2008 and why - a national specialty-specific form containing a common, structured CV-based core, or local application forms?
What important improvements would you wish to see made to the application forms for 2008?
3.6 Issue 3 – the number of applicants’ preferences and how preferences should be treated (i.e. concurrently or consecutively)
Issue
In 2007, in Round 1 of the recruitment process, applicants were able to define four preferences in terms of specialty, level (ST1, ST2, ST3 or ST4) and geography or Unit of Application (UoA). Each applicant’s four preferences were then considered concurrently by each of the four UoAs/specialties specified.
The consequence of the four preferences being considered concurrently was that very strong applicants, (as assessed from their application forms) were shortlisted for three or four interviews, using up a lot of the available interview capacity. This crowded out other applicants who did not receive an invitation to any interview in the original Round 1, as there were no interview slots left for them. 34% of all eligible applicants with a first choice Unit of Application (UoA) in England were not shortlisted for any interviews in the original Round 1 of 2007.
The number of interview slots is limited because six hospital consultants are needed for each interview and they have to be taken off their usual duties. Very high numbers of interviews have a detrimental effect on the service and Trusts will not support unlimited release of consultants. There is also strong reluctance from consultants to spend time on interviews that are not productive.
The issue is whether we should use the same process for 2008 and if not, how many preferences should be allowed and what process should be used for considering the preferences.
Discussion
The aim of a system that allows applicants to state preferences is to achieve equity, fairness and to try to maximise utility or satisfaction.
National co-ordination of applications according to preferences can maximise the number of people who get an offer from a high-ranked preference that suits them. It can avoid the problem for applicants of receiving a low-ranked offer and having to choose between that and the possible offer that might come later from a higher ranked choice of UoA.
However, a major concern about the nationally co-ordinated process in 2007 was that many applicants who were considered good or, even excellent, were not being invited to interviews in Round 1.
The figures from 2007 show that, of all the eligible applicants making their first choice application to an England UoA:
the 6% of applicants with the maximum four shortlisted applications accounted for 19% of the total shortlistings (i.e. interviews)
the 16% of applicants with three or more shortlisted applications accounted for 45% of the total shortlistings
the 32% of applicants with two or more shortlisted applications accounted for 72% of the total shortlistings
only 66% had any application shortlisted, leaving 34% with no shortlistings (i.e. interviews).
The figures for the UK as a whole are very similar.
It is essential to create a process that avoids that situation as far as possible. There are a number of possible options, as follows:
Option
1 - Allow more
preferences and consider them concurrently
Some stakeholders hold the view that applicants should have more than four preferences, the aim being to improve an individual’s chances of success.
In fact, modelling shows that increasing the number of preferences allowed, and considering them concurrently, disadvantages many good applicants. It increases the number of multiple interview slots taken up by very strong applicants, so crowding out even more of the other applicants.
Some of the major drawbacks of this are:
a higher percentage of applicants than the 34% this year would be denied the opportunity of an interview in Round 1
potential waste of interview time as more preferences increases the number of interviews per filed posts. This is wasteful, especially as each interview may involve six consultants who have to be taken away from patient services
more unfilled posts at the end of the first interview round.
In addition, large or unrestricted numbers of applications per applicant, considered concurrently, would place an impractical heavy burden on deaneries and the consultants who do the shortlisting.
For example, when a UoA receives a very large volume of applicants for an ST1 in a particular specialty, it may have a reaction from the consultants doing the shortlisting. It will have to introduce more and more “desirable” criteria to differentiate between applicants, as the essential criteria will not sufficiently differentiate between applicants. It may still have far too many applicants on a shortlist than the capacity for interview slots. It would then have to introduce random selection as the only practical and legally sound method. Applicants are unlikely to find this acceptable.
One idea for overcoming this burden on deaneries and consultants is to take shortlisting and interview scores from the first or second preference deanery and, for unsuccessful applicants, pass their scores onto the applicants’ remaining preferences. However, we understand that only Obstetrics and Gynaecology (O+G), General Practice and Histopathology currently have their shortlisting and selection processes standardised across the country, allowing scores to be cascaded between deaneries.
It would be not possible to standardise the shortlisting and interview processes for other specialities in time for the 2008 recruitment. So, we will need to limit the number of preferences allowed for 2008.
Option 2 – Have fewer preferences and consider them concurrently
Modelling different assumptions produces different figures, but the pattern is the same i.e. the more preferences allowed and considered concurrently, the fewer posts are filled. The ratio of interviews to filled posts rises significantly and the percentage of applicants not interviewed in Round 1 increases.
Modelling shows that reducing the number of preferences considered concurrently reduces significantly the percentage of applicants without an interview in Round 1, as well as reducing the ratio of interviews to filled posts and increasing the fill-rate.
Modelling a range of different assumptions shows that limiting the number of preferences that can be considered concurrently to one or two produces the best results.
Option 3 – Consider preferences consecutively
This option involves UoAs/deaneries first considering only those applicants who put that UoA as their first preference. Then, those applicants that are not shortlisted, or that are interviewed but not appointed, have their applications passed to their second preference UoA/deanery for consideration. And so on, for as many rounds as possible in the available time.
The benefit for applicants is that they know that the first offer made to them will be the highest preference for which the applicant has been successful. So, there should be no dilemma of whether to refuse an offer in case a better one comes along later (as happened in 2007 in the extended part of Round 1 and in Round 2).
This option is very efficient in its use of consultants’ and deanery time and it produces high fill rates relatively quickly that reflect applicants’ preferences.
The disadvantages include the fact that it is possible in a few cases that an applicant would find if they were not offered a post by their first preference that their second preference’s posts or even third were filled and maybe by someone who is not as strong an applicant as they are. The choice of preferences is very important because applicants who put high competition UoAs/specialties as their first, second and even third preferences risk not receiving an offer of appointment.
Another disadvantage is that if a strong applicant has an off day at the interview, there would be fewer second chances because of higher fill-rates in Round 1.
Option 4 – A mixture of concurrent and consecutive consideration of preferences
This option is a compromise between the earlier options. It would involve a first round where applicants’ first two preferences for UoA/speciality are considered concurrently followed by interviews for those shortlisted. The applications of those unsuccessful in the first round would then be sent to those of the applicant’s third and fourth preference UoAs/deaneries that still have vacancies in the chosen specialty and level.
This option gives all applicants two chances in the first round to be shortlisted and, if shortlisted, to be interviewed. It overcomes the problem of a strong applicant having an off day at one interview, as they are likely to have a second interview in the first round.
This option has the efficiency of option 3 in terms of unfilled posts at the end of the round and the ratio of interviews to filled posts. It provides a good balance of giving applicants’ reasonable chances for success while keeping the burden on deaneries and consultants to a reasonable level.
Proposal for 2008
The proposal is for either Option 3, consider preferences consecutively, or Option 4, a mixture of concurrent consideration of the first two preferences, followed consecutively by consideration of the third and fourth preferences.
Option 3 will reflect applicant’s preferences, and produces high fill-rates very quickly. It is very efficient in its use of consultants, deanery staff and applicants’ time.
Option 4 provides a good balance of giving applicants increased chances in Round 1 while not increasing the burden on deaneries and consultants to an unreasonable level in terms of interviews per filled post and total number of interviews required.
Your views on proposals for preferences in 2008
Which is your preferred option and why?
Do you have any further advice to improve the use of preferences in 2008?
3.7 Issue 4 - national computer system or local deanery’s own system
Issue
The proposal in Issue 1 was that shortlisting should be carried out locally in Units of Application (UoAs) through consideration of structured (CV-based) application forms using a national, specialty-specific form containing a common core. This could be managed using a national computer portal for applications followed by local handling, or by entirely local processes.
The issue as to whether or not a national computer system should be used is possibly the most contentious issue in the decisions to improve recruitment in 2008.
There is a considerable loss of confidence in the computerised system amongst junior doctors and the medical profession, echoed in the media and within the wider public. The IT system for 2007 did not “crash” as many believe, but it was very slow just before the closing date for applications and many applicants experienced difficulties in completing and submitting their application forms. Two security breaches led to a decision to close the system and switch to local processes.
On the other hand, the Foundation Programme and GP recruitment successfully used the same national computer system to process applications in 2007. This brought considerable benefits to both applicants and deaneries from the reduced burden of work for them and from the opening up of options for processes not possible without the computer.
An independent audit of the MTAS system, as part of the Douglas Review, found that the system was stable, performed acceptably and contained the necessary functionality to be fit for purpose.
Since the security breaches, security has been increased to the highest level with the help of independent specialists.
Members of the Programme Board currently hold different views on the issue, for example:
Some members currently prefer not to use a national computer system, and to avoid the risk of repeating the problems experienced in 2007 by using local deanery systems.
Some members feel that the potential benefits of a national computer system, for both applicants and recruiters, outweigh the risks.
The final decision is linked to those for issues 2 and 3 outlined above. Only with a national automated process could the system handle, for example, multiple preferences and algorithms for ensuring that a successful applicant receives only one offer from the highest preference for which they have been successful.
The alternative is to have applicants apply to each deanery/UoA who will use whatever system for processing applications they have.
Discussion
|
National computer portal |
Local processes |
|
Advantages:
|
Advantages:
|
|
Disadvantages:
|
Disadvantages:
|
Proposal for 2008
The MMC England Programme Board does not currently have an agreed preference on this issue.
If a national computer system were to be used, it would only provide a national portal followed by local selection processes, except for those small specialties where national selection processes are agreed.
The design of the system would be informed by applicants and stakeholders to improve the application form and associated features.
There will be a firm cut-off date after which changes to the computer specification will not be allowed – to avoid those problems in 2007 caused by late changes not allowing sufficient time for testing.
The national computer system will have strengthened security to an extremely high level (which has been independently validated), however, it is not possible to eliminate all risks.
Your views on a national or local computer system
What is your preference for IT support in 2008?
What specific improvements would you like to see from a user perspective?
3.8 Issue 5 – The Size of Units of Application (UoAs)
Issue
Some of the Units of Application (UoA) in 2007 were very large geographically and in terms of travel time. For example, an applicant living in North London who successfully applied to the London/KSS UoA could potentially be allocated to a rotation in East Kent (although the UoA did try to take account of applicant’s wishes).
This raises the issue of whether the larger UoAs should be made smaller, or whether it is possible that applicants can apply to a sub-division of a UoA, so that they have more control over the location of their appointment.
Discussion
It would be better for applicants to be able to apply for a geographical area that is meaningful to them and could allow them to work in the offered training post without unreasonable long daily travel to and from work and without the need to move home.
The BMA’s Junior Doctors Committee has proposed that the UoA should be the rotation or school of specialty training. If the UoA were to be the deanery specialty school, then it would increase the number of UoAs from 10 to about 28 in England.
This is a large number and it means that the applicant’s choice of preference will need to be very carefully fine-tuned to avoid only choosing high competition specialty schools. The competition ratio information available from UoA is currently by specialty, level and the current UoAs – it is not available for each rotation. It is already difficult for deaneries to confirm post numbers as the process progresses and circumstances change. It would be even more difficult to confirm posts at the level of rotation or specialty school.
Proposal for 2008
The larger UoAs should be reviewed to reduce the internal travel time to a reasonable level, provided that the national computerised system can safely make the changes in the time available before 2008 recruitment starts in January.
Your Views
What do you consider are urgent issues to address for 2008 in terms of size of UoAs?
3.9 Issue 6 – an integrated national timetable
Issue
3.9.1 The MMC Programme Board favours an integrated national timetable rather than different dates for opening and closing rounds and making and closing offers.
Discussion
An integrated national timetable avoids the “stick or twist” dilemma.
For example, if offers are made and responses required by different dates for different UoAs or specialities, then an applicant can receive an offer from a lower preference and have to make a decision whether to accept this or reject it in the hope that they may receive an offer from a higher preference later. They would be required to stick with the offer they were made first, if they have accepted it.
If applicants were to be allowed to renege on offers they had accepted (if they received a higher preference offer later on), then the UoA will probably need to hold more interviews initially to allow for that possibility of wastage with some applicants changing their minds about acceptances when other UoAs start making their offers later on.
Having a national timetable avoids these problems.
Proposal for 2008
The proposal is for an integrated national timetable with all deaneries/UoAs and specialties (including GPs having the same dates for opening and closing rounds and for making and closing offers). We will propose to the Scottish, Welsh and Northern Irish administrations that all four countries should use the same timetable.
The recruitment to the Foundation Programme and to Academic Clinical Fellow posts are excluded from the proposed integrated national timetable as it has been agreed that they will be held separately and before the main recruitment to specialty training.
Your views on proposals for an integrated national timetable
Should there be an integrated national timetable for 2008 recruitment to specialty training (excluding Academic Clinical Fellows whose recruitment will be separate and earlier)?
3.10 Issue 7 – Other issues
Your views
Eligibility Criteria – should the 2007 entry requirements and eligibility requirements be changed for 2008 recruitment? For example, should the maximum limit of 12 months of training in a specialty for entry to ST1 remain (as proposed by the BMA Junior Doctors’ Committee)? Should the maximum permitted period of experience for applications to ST2 be increased or even removed (also proposed by the BMA Junior Doctors’ Committee)?
The issue of whether applications can be accepted from overseas doctors who are working in this country, or can gain entry to work here in the future under the Highly Skills Migrant Programme (HSMP), is excluded from this consultation, as it is currently the subject of discussion between Ministers of various Government Departments. So, the question here refers to other aspects of eligibility criteria.
Long listing – should long listing be carried out by each Deanery/UoA or be done nationally e.g. by one lead Deanery for all applicants nationally or for a particular specialty?
What other issues do you think need urgent consideration for 2008?
Part 2: The offer to applicants in 2008
This section presents proposals for introducing greater flexibility in education and training in 2008.
It considers what should be the offer to applicants to specialty training in 2008 and, in particular, whether to continue with run-through training or whether to introduce a break between core training and higher specialty training, with competitive entry to higher specialty training.
Important note - All trainees that were offered and accepted run-through training in the 2007 process will continue to have run-through training, even if changes are introduced for 2008 and later years.
Appendix 2 on page 34 provides diagrams to illustrate four possible models of offers to applicants in 2008.
Appendix 3 on page 38 shows the potential for a “mixed economy” of offers to applicants in 2008 with current views from some Royal Colleges and Faculties.
Introduction
A major criticism of the implementation of Modernising Medical Careers (MMC) in 2007 was that it had lost the core principle of flexibility in training, as stated in the principles underpinning senior house officer (SHO) training reforms (Unfinished Business).
This paper therefore proposes flexibilities to be introduced to the postgraduate training structure for trainees who will be appointed in 2008, in the light of stakeholder feedback.
Context
Changes in 2008 in the context of further change in the future
The interim report of the Tooke Inquiry is due in October 2007, after key policy decisions for 2008 need to be made. Sir John Tooke has confirmed that he will not be making recommendations that would be effective for 2008. A balance therefore has to be struck between:
the need to address key issues identified by the service and profession that require urgent attention
introducing changes for 2008 that are likely to be refined again for 2009 in the light of the Tooke findings. This could leave a situation with three different cohorts in subsequent years, in terms of the duration of the programmes and posts offered – those from MMC 2007, those from 2008 changes and those from 2009 onwards.
Workforce planning
This paper considers the structure of training. Training must be linked to workforce planning and there are separate debates around the shape and mix of the workforce we require, different patterns of working, the move towards self-sufficiency and numbers of UK trained medical students, and issues around global recruitment. These issues are beyond the scope of this paper, but a national process is being established for closer links in the future between workforce planning and training.
The number of training posts available must be determined by patient and service need. The training structure should support the supply of doctors to meet those needs, while not wasting resources unnecessarily training an excess of doctors who will therefore not progress into specialty training. The number of training posts is also constrained by available resources, including training capacity.
This means that inevitably some specialties and locations will be more popular than others and that not all doctors will be able to pursue the career of their first choice, nor necessarily in the location of their choice.
A fundamental aim is to establish a training structure that attracts and rewards the best people, building a strong medical workforce for the future.
England/UK
These proposals are from the MMC England Programme Board. The Programme Board, by definition, has to consider arrangements for England only, but as proposals emerge, wider implications for the UK may need to be considered by the UK Co-ordinating Group.
3.13 Proposals
3.13.1 The proposals in this section cover:
Timing of the application process and start dates
Transferable competences and common training
Fixed term specialty training appointments (FTSTAs)
Run-through training and the possibility of “uncoupling”
Timing of the application process and start dates
Issue
Concerns expressed about the timing of the application process cover two aspects:
Only one application process each year means only one opportunity for trainees to apply, even though in the larger specialties for example, vacancies continue to arise during the year because of natural wastage.
Having only one annual start date for all grades and specialities at the beginning of August carries the risk of increased pressure on NHS staff.
It may be better to recruit more than once a year to give applicants more chances of entering or returning to training. In terms of start dates, NHS Employers, for example, would like to see staggered starts, to minimise the potential impact on the NHS.
Direction of travel for 2009
There should be more than one entry point into specialty training per year starting in 2009. The MMC England Programme Board would like to see three application processes each year with new recruits starting on 1 April, 1 August and 1 December.
The 1 August would involve the larger number of applicants, with those coming from the Foundation Programme. August could therefore have staggered start dates within the month to reduce the pressure on the NHS.
Proposal for 2008
Urgent consideration should be given to the possibility of introducing staggered start dates in 2008. However, a 1 April start date is not feasible for national recruitment in 2008. The application process for this would have had to start in September 2007.
The Programme Board agreed that it might be possible to introduce two entry points for national recruitment in 2008 i.e. 1 August and 1 December.
In 2007, there was a low fill rate for training in anaesthesia. The Royal College of Anaesthetists is well advanced with selection processes (standardised application form, shortlisting criteria and interviews) and with the agreement of the deaneries, would like to have an earlier recruitment before other specialties in 2008. The first entry point would be in April 2008 as well as the proposed August and December 2008 start dates.
Your views?
What is your view on the proposal to move to three staggered application processes with staggered start dates in future, beginning with two in 2008 (August and December)??
Do you agree that, provided appropriate mechanisms are in place there could be an early recruitment for the specialty of anaesthetics in 2008 to enable a start date of 1 April as well as 1 August and 1 December? Are there any other specialties that could have an early recruitment starting in April 2008?
Transferable competences and common training
Issue
Many Royal Colleges have expressed concerns to the Tooke Inquiry about trainees having to choose their specialty too early in their careers.
The concept of being able to change specialty by taking advantage of transferable competences is included in the competency-based training system promoted through the MMC reforms, but has not yet been sufficiently developed to facilitate movement between specialty training programmes as originally envisaged.
Discussion
Prospective agreement of transferable competencies between specialities should allow trainees to change specialties and enter at a higher level or, if accepted into another specialty, to move more swiftly through the training programme (subject to agreement with PMETB). However, flexibility for radical changes in career plans, for example from psychiatry to surgery, is always likely to be complex and more difficult in terms of workforce planning and educational design.
However, even in those specialities with Core Training (Medicine, Surgery, Psychiatry and Acute Care Common Stem) where initial broad based training more closely followed the initial principles of MMC, the mechanisms for selecting from second year training (ST2) into third year (ST3) (or ST3 to ST4 in Psychiatry and Paediatrics) are as yet unresolved. In many smaller and medium sized deaneries, training numbers in many specialities significantly reduce choice when moving from core to higher specialty training.
Proposal for 2008
Many specialities have already undertaken considerable work in this area. Further work needs to be undertaken, including the agreements required with the Postgraduate Medical Education and Training Board (PMETB), as a matter of urgency.
Your views?
What are your views on transferable competences to allow easier movement between specialties and increase flexibility in both training and workforce planning?
What further work do you think needs to be undertaken in this area?
Fixed term specialty training appointments (FTSTAs)
Issue
There is lack of clarity about the purpose of FTSTAs. Their potential to act as “taster” attachments, allowing experience in a specialty before a run-through training application, has not been regarded as successful by trainees or other stakeholders.
There may be relatively few entry points to specialty training available above year one (ST1) in the future. Trainees successfully completing a one-year FTSTA would therefore have limited opportunities to apply to run through training at the next level. This would explain why many trainees view these appointments as inferior to run-through training posts. The large volume of applicants and tough competition ratios may have further exacerbated the drive to obtain a run-through training post and the view that FTSTAs were second-class training posts.
Discussion
Both run-through training and FTSTAs do provide service commitments and FTSTA appointments may provide increased flexibility for workforce planning. Employers need to know the numbers of each type of posts to align the service and training needs.
Without further intervention, the opportunities in 2008 for those successfully completing FTSTAs to enter run-through training at ST2 and ST3 levels will be limited. These places would only be available because of attrition or through the extra capacity created as a planning contingency in some deaneries.
More opportunities could be made available in two ways:
By increasing the number of posts at ST2 and above, although with limited resources this might be through a temporary reduction of ST1 posts and would need to be considered against workforce planning needs.
By deaneries deliberately “gearing” the recruitment to have fewer ST1 appointments so that more opportunities arise in future years for selection to ST3 (or ST4)
Without this type of intervention, the majority of training posts in the future (FTSTA or run-through training) will be at ST1.
Proposal for 2008
The Programme Board has requested indicative numbers for consideration and further modelling in order to advise and support doctors in FTSTAs in transition years.
Your views?
What do you see as the benefits and disadvantages of FTSTAs?
What advice do you have to support doctors in FTSTAs in transition years?
Run-through training and the possibility of “uncoupling”
Issue
A number of Royal Colleges and others have called for the “uncoupling” of specialty training – that is, building in a formal opportunity after ST2 to change direction or make a more focused career choice in the light of greater experience. It would mean adding a competitive selection process (open or closed) to some or all specialties between ST2 and ST3 (or between ST3 and ST4 in the case of Psychiatry and Paediatrics).
The change seeks to address the view that run-through training means applicants choosing a particular specialty too soon in their career. There are several drivers for change, including the need to:
introduce more flexibility in postgraduate training, making it easier for trainees to change speciality later in training, taking their transferable competences with them.
create more entry points above ST1. Trainees above ST1 would get a second chance to compete and enter specialty training.
improve accuracy in selection into specialty in the light of performance in ST1-ST2. Some specialties find it difficult to select accurately at ST1.
For example, the preferred route of entry into the speciality of clinical radiology would be for trainees to apply after completing their first two core years in medicine or surgery, via competition, although those entering directly from the Foundation years would also be eligible to apply. This allows flexibility so that those who have completed their first two years of core training can decide whether to apply for specialty training in that speciality or opt for another speciality such as clinical radiology.
Appendix 2 contains diagrams to define different models of the offer to applicants, including run-through, uncoupling with open competition and uncoupling with closed competition.
Discussion
It is apparent from discussion at the MMC England Programme Board and from feedback from the Royal Colleges and Faculties, the BMA and others, that there are variations in the interpretation of the concept of uncoupling.
For clarity, the following definition is proposed:
For specialities with a clear division between core speciality training and higher speciality training, uncoupling means that trainees would be appointed to programmes that lead to the completion of core speciality training only. After this, there would be competitive entry (open or closed) to get into higher speciality training programmes, which lead to Certificate of Completion of Training (CCT). Thus in Medicine, Surgery and Anaesthesia, trainees would be appointed to ST1 and ST2 only (or ST1, ST2 and ST3 in Psychiatry and Paediatrics).
Later in this section, there is a description of four different models of offer to applicants that show the difference between open and closed competition and its implications.
Uncoupling and competitive selection into ST3 or ST4 is not a mechanism for identifying trainees who are struggling or unsuitable for further progression; it is not a substitute for regular and rigorous assessment.
Specialty variations
Different specialties will have differing views, needs and aspirations. Therefore, some preliminary research has been undertaken with the Royal Colleges and Faculties, to understand further the different speciality needs. A letter was sent to all Presidents asking for a copy of their submission to the Tooke Inquiry and how they believed flexibility could best be ensured for 2008 candidates whilst awaiting the formal report of the Tooke Inquiry. See Appendix 3 on page 38 for a summary of responses to date.
Questions to
be resolved
There remain many unanswered questions and, before policy could be defined and agreed, some further clarification will be needed.
For example, what will happen to trainees that would be displaced by uncoupling?
Is the concept of a "mixed economy" approach to training legally sound? It may be more vulnerable to legal challenge than if a consistent approach to coupling/uncoupling was adopted across all specialties. There would need to be sound justification for adopting a different approach in different specialties rather than this simply reflecting the expressed preferences of the relevant Royal Colleges.
If Core Training is uncoupled, will trainees be able to progress to CCT provided they secure a post in higher speciality training? The Core Curricula would need to be agreed by PMETB as freestanding curricula, rather than part of run-through training.
Proposals for 2008
The feedback from some Royal Colleges and Faculties shows that there could be a combination of solutions including:
some specialties continuing to offer run-through training to CCT
some having offers for core training only followed by open competition
some having closed competition at the point of progression into ST3/ST4 within the cohort that has secured a run-through training post.
The Programme Board wishes to develop recommendations that allow this combination approach – that is a “mixed economy” of offers to applicants in 2008, provided there is objective justification for different approaches.
To support considerations it is important to ensure a clear common understanding about each possible model of offer to applicants in 2008. The following describes four possible models. See Appendix 2 on page 34 for a diagrammatic description of each offer model.
Offer model 1 – Run-through training for 2008 as offered in 2007
Benefit – Provides the security for trainees so that they may undertake a structured programme of training in their chosen specialty and location.
Risks – Could involve some trainees moving into a particular specialty too soon in their career. Few future opportunities for others to enter specialty training at higher levels.
Offer model 2 – Uncoupling with open competition after ST2 (ST3 Psychiatry and Paediatrics)
In this model, the offer would be for two years of speciality core training (three years for psychiatry and paediatrics) followed by open competition to enter specialty training at ST3 onwards (ST4 for psychiatry and paediatrics).
Open competition means that any eligible applicant can apply – i.e. competition would include:
trainees completing ST1 and ST2 in the relevant specialty
trainees in FTSTAs (from 2007)
trainees in different specialties with eligibility determined by having sufficient transferable competencies
those in research posts or UK graduates working abroad with relevant ST and ST2 competencies
doctors from the career grades with relevant ST and ST2 competencies
doctors from the EEA and overseas. with relevant ST and ST2 competencies
Academic Clinical Fellows
With open competition after ST2, there would be no requirement to distinguish between ST and FTSTA appointments. Instead, offers are made to a larger group of trainees offering two years of core training ST1-ST2 (ST3 in Psychiatry and Paediatrics). Not all of this larger group of trainees would secure training at ST3 (ST4) onwards.
Benefits – this clearly provides the flexibility sought by many. Trainees have a second opportunity to consider their career options and apply for higher specialty training in the light of their experience in ST1 and ST2. It also adds flexibility to workforce planning.
Risks – it would increase the risk of established trainees being displaced. The problems of high demand for a limited number of opportunities, as experienced in 2007, would be repeated.
A major criticism of the process in 2007 was the need for trainees to move geographical location to secure programmes with the disruption to families and uncertainty that caused. Indeed, it would mean trainees would have to experience these problems twice in their careers – at ST1 and ST3. There could be no guarantee that a trainee successful at ST1 would be successful again at ST3, or would be able to secure a programme in their preferred specialty or location.
Offer model 3 – Uncoupling with closed competition after ST2
In this model, the offer would be for two years of speciality core training (three years for psychiatry) followed by closed competition to enter specialty training at ST3 onwards (ST4 for Psychiatry and Paediatrics).
There are two possible ways of implementing this model explained below as 3a and 3b.
Offer model 3a
Closed competition would mean competition restricted to the cohort of those who have been appointed to ST1 and ST2 as part of a run-through training programme in a particular specialty or core specialty grouping. It would be used as a tool to select trainees into the sub-speciality (for example into cardiology or geriatrics from the pool of trainees in Core Medical Training). This is the model as envisaged in the MMC reforms as described in section 6 of the Gold Guide.
Benefits - It protects the trainees appointed at ST1 and ST2 and guarantees them, subject to satisfactory progress, training to CCT-level – although this would not necessarily be in the trainee’s first choice specialty or location.
Risks – It does not allow opportunities for those doctors in FTSTAs, or without training posts to compete for entry to ST3, apart from the relatively small number of vacant training posts available at ST3 through natural wastage during the year. In other words, it does not represent true uncoupling and would consequently not address concerns about the value of FTSTAs or the limited opportunities for those not securing their preferred run-through training programme at ST1. As discussed above, it also cannot guarantee a trainee would be able to continue training in their first choice specialty or location.
It presents a difficult challenge in terms of workforce planning. Trainees progress at different rates, sometimes taking time out for various reasons. The numbers in the closed competition would not be known and this would make it difficult to know how many ST3 programmes should be on offer.
Offer model 3bFTSTAs are not offered to applicants. Instead, offers are made to a larger group of trainees offering two years of core training ST1-ST2, with competition to ST3 within that closed cohort.
Benefits – It affords some protection to trainees appointed at ST1 and ST2 and avoids applicants having to choose their specialty too early. The larger pool of trainees addresses the criticisms of FTSTAs.
Risks - Not all trainees would secure training at ST3 onwards. It also cannot guarantee a trainee would be able to continue training in their first choice specialty or location.
Your views?
Do you agree with the concept of different models of training and different offers made by different specialties in 2008? What are the reasons for your view?
Do you have a view about particular specialties – which offer model would work best and why?
Appendix 1
MMC England Programme Board and membership
Modernising Medical Careers Programme Board (England)
The MMC England Programme Board oversees and makes recommendations to Ministers for the MMC programme in England for 2008. It provides leadership to the professions and the service for the design, testing and implementation of the programme and is accountable for changes made.
The Board is co-chaired by Martin Marshall, Deputy Chief Medical Officer at the Department of Health and David Haslam, President of the Royal College of General Practitioners.
Board members represent broad professional and service interests. They have a good understanding of postgraduate medical education and support the high level principles of MMC.
A UK Co-ordinating Group lies alongside the Programme Board and its equivalents in the other three countries. This ensures congruence across the UK and the management of any divergence in policy or implementation.
Current Membership:
Academy of Medical Royal Colleges
Neil Douglas, Royal College of Physicians, Scotland
Ian Gilmore, Royal College of Physicians, England
Bernard Ribeiro, Royal College of Surgeons
David Haslam, Royal College of GPs (Co-Chair)
The BMA
Geraint Rees, BMA Medical Academic Staff Committee
Andrew Rowland, BMA Junior Doctors Committee
Ian Wilson, BMA Central Consultants and Specialists Committee
Tom Dolphin, BMA Junior Doctors Committee
Academy of Medical Sciences
Patrick Maxwell
Academy of Royal Colleges and BMA trainee/junior representatives
Paul Dimitri (AoMRC)
NHS
Barbara Hakin, Chief Executive, East Midlands SHA
Anne Rainsberry, Director of Workforce, London SHA
David Sowden, East Midlands Deanery
John Rostill, Chief Executive, Worcester NHS Trust
Ron Kerr, Chief Executive, UBHT
DH:
Martin Marshall, MMC SRO (Co-Chair)
Clare Chapman, DH Director General of Workforce
Terry Hanafin, MMC Chief Operating Officer
Mary Armitage, MMC Clinical Lead
Beverley Bryant, Head of Information Services, will also attend when substantive issues around IT are to be discussed.
Appendix
2
The offer to applicants for 2008
The following four diagrams are intended to define simply the nature of the offer to applicants. They are not intended to show all training and career routes within the MMC programme.
<P CLASS="western" STYLE="margin-bottom: 0in">Offer
model 2 – Uncoupling with open competition after ST2</P>
<P CLASS="western" STYLE="margin-bottom: 0in">
(ST3
Psychiatry/Paediatrics)</P>
<IMG SRC="consultation_html_m4d1aaa03.gif">
<IMG SRC="consultation_html_m712c78cf.gif">
Appendix 3
The “mixed economy” of offers to applicants in 2008
Current views from some Royal Colleges and Faculties
|
Offer of run-through training in 2008 |
Offer with uncoupling in 2008 |
|
Royal College of Obstetricians and Gynaecologists |
Royal College of Physicians
Core training ST1-ST2 followed by open competition to ST3 onwards. |
|
Royal College of Ophthalmologists. |
Royal College of Surgeons
Core training ST1-ST2 followed by open competition to ST3 onwards. Neurosurgery, oral and maxillofacial surgery, and possibly urology may be exceptions, with these specialities supporting run-through training appointments. |
|
Royal College of Pathologists
For histopathology |
Royal College of Anaesthetists
2 year Core training in Anaesthesia (exceptionally extendable to 3rd year (medicine)) and 3 year Acute Care Common Stem (ACCS) followed by open competition from both streams to ST3 onwards. |
|
Royal College of Radiologists
Also supports core medical and surgical training at ST1 and ST2 to be followed by competitive entry at ST3 level. |
Royal College of Psychiatrists
Core training ST1-ST3 followed by open competition to ST4 onwards.
|
|
Faculty of Public Health |
Royal College of Physicians of Edinburgh
Core training ST1-ST2 followed by closed competition to ST3 onwards. |
|
Royal College of Paediatrics and Child Health |
|
College of Emergency Medicine - core training in Emergency Medicine should cover first 3 years of specialty training, thereby allowing the creation of FTSTA3 posts as currently allowed for paediatrics and psychiatry. Suggests that proportion of offers could be run-through training, others only for Core training, followed by open competition.
Faculty of Occupational Health - has only small number of trainees, two thirds of whom are trained outside the NHS (in forces or commercial organisations) and these will not be processed through MMC. Seeks to increase numbers. Supports initially broad based training, with subsequent flexibility to move between training programmes.
Faculty of Pharmaceutical Medicine - Specialty training in Pharmaceutical Medicine takes place outside the NHS (in the private sector). Trainees enter after completing Foundation Programme and two years of post-Foundation clinical training in any medical speciality, e.g. CMT or equivalent - that is after ST2.
General Practice - Uncoupling is not meaningful for General Practice.
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