Key themes

1. Workforce needs – specialists or generalists?

The review will examine evidence on whether we have the right balance between generalists and specialists in order to meet the changing needs of patients and the service. It will also consider the way we might need to structure medical training to make sure we have doctors who can provide that care.

There is an underlying assumption that there is only one appropriate outcome of successful training, which all doctors must meet, with any other outcome being a failure.

The review will look at whether there are alternative models for training including

  • the timing of the CCT
  • the content and length of training depending on the specialty
  • exit points within training
  • the timing of sub-specialty training (at present specialty and sub-specialty training are often undertaken at the same time)
  • the way in which competencies acquired during training are recognised, and
  • the balance between generalism and specialism.

The review will also consider whether there is an enhanced role for CPD and credentialling to support sub-specialty training post-CCT.

2. The breadth and scope of training

The review will consider how we can help trainees gain the right mix of knowledge, skills and behaviours to prepare them for the range of environments in which they may need to provide care in the future.

Attention should be given to

  • the structure of training
  • the balance between needing to give trainees sufficient exposure to acutely ill patients and emergency interventions while recognising that training will increasingly be delivered in the community, and
  • whether enough time is given to trainees to reflect on their practice and learn from their experiences.

3. The needs of the health service

There is a tension between service and training when working in a system based on trainees delivering the service, particularly at nights and weekends.

They also frequently work in under-supported roles and may be asked to undertake tasks outside their level of competence.

The review will consider the role trainees should have within the service and how the competing needs of the service and training can be addressed.

4. The needs of the patient

There is a lack of transparency for patients and the service about the standard of practice that both trainee doctors and trained doctors have attained.

The review will look at ways of developing training structures that provide clarity about the competencies attained by individuals and the roles and responsibilities of trainees and trained doctors.

5. Flexibility of training

Trainees - and subsequently, trained doctors – find it difficult to move into another specialty to which they may be better suited or when the nature of medical practice, or patient or service needs, have changed.

In general, they have to begin again in a training programme for the new specialty or sub-specialty rather than focus on gaining the additional knowledge and skills required for the new area of medicine.

Trainees’ needs and expectations are changing with more of them wanting to move in and out of training with prior learning being recognised. Many doctors in training need to balance life and work and need support in maintaining their skills within different training and work contexts.

The review will examine how to achieve more flexible models of training which would allow trainees and trained doctors to move more easily between specialties and into and out of training. It will also look at ways of supporting and valuing training that combines medical practice and academic or management careers.