27 February 2010

Foundation Training

An inordinate amount of effort has been put into the reorganisation of the training of junior doctors. The Foundation Training programme was the trail blazer. Dr Grumble has no idea how much it has cost. There have been direct costs and there have been hidden costs. Both are likely to be have been substantial and, in the current climate, no longer affordable. Ensuring better training is laudable, essential even. But how much has this all-singing, all-dancing Foundation Training delivered on its objectives?

Dr Grumble sometimes looks at his Foundation doctors and asks himself how much their jobs and their training differ from the training he had. The truth is that surprisingly little is different. Some things are a bit better. Some things are a lot worse. Quite a lot is much the same.

Dr Grumble felt as a house physician that he belonged to a well defined team or firm as we called it. In the teaching hospitals we were overflowing with staff. The great man (and it almost always was a man) was accompanied by an enormous entourage. Doctors came from around the globe to learn. Everywhere there was a great hunger for learning. There was a wonderful esprit de corps. Much of this has gone. Staffing has been pared down to the bone. Doctors no longer come from abroad. Shift work is the norm and with that the feeling of belonging has evaporated. Esprit de corps is no more. Foundation doctors are with us for too short a time to settle in and thrive. It's not the learning environment it once was.

Meanwhile the documentation of the Foundation doctor's learning has grown beyond belief. There is an array of supervisors and assessors who have pages and pages of online boxes to tick. The documentation makes it look as as if a lot has gone on. In reality it is a shallow charade. Hours are spent struggling with eportfolios. The boxes to tick are overwhelming and get in the way of a quality educational relationship.

But don't listen to Dr Grumble. Nobody else does. Certainly not in the Foundation School. Listen to a junior doctor. This is what Nick says:

Training is now a mess. It is virtually impossible, thanks to the shift patterns worked by all doctors, to find time to spend with patients in the company of a senior doctor who can teach you. The workplace assessments hinder this because they are badly thought out, have no appreciable evidence base, and cast spending time with trainees as a box-ticking exercise for senior doctors who find that process as loathsome as most trainees do. You cannot make up for that deficiency in clinical time with your seniors with any amount of well-intentioned “modern adult education”; helpful though things like ALS and simulation training are, they must be adjuncts to and not substitutes for training on the job. Education is haphazard at best, with trusts given the impossible job of delivering the entire Foundation curriculum to a group of shift-workers in disparate geographical locations. Foundation education sessions are therefore variable in quality to say the least, particularly at F2 level where nights and A&E rotas are commoner. Outside education courses, although they are the single most useful things you can do to further your career, are almost never funded and rarely allowed as study leave during the Foundation Programme.

Nick has a degree in English. You need a degree in English to get a good job these days. And to write a decent blog.


Nick. said...

Thank you - I'm very flattered that both yourself and the Jobbing Doctor have picked up on my post!

One thing I should have said was that the MEE are taking submissions from individuals about this, and so if you or any of your readers would like to offer their comments, you can download the form at the MEE website.

Thanks again,

Anonymous said...


half the locum GPs in inner cities barely understand English, and its as bad in some of our hospitals

this is one of those professions where good native language should be mandated

its a much bigger problem than the politically correct are prepared to admit

phatboy said...

"Doctors no longer come from abroad."

Are you sure about that? My girlfriend had a baby about 6 weeks ago at West Middlesex, which is a teaching hospital. We had a Chinese medical student, three African midwives and a doctor from the Carribean. The baby was seen by a paediatrician who looked and sounded Indian. On the ward, all of the staff were from abroad, quite a few from easten Europe.

All of the staff were excellent, although stretched very thin, but none of them were British by birth (of if they were then they were all putting on some very funny accents to confuse us!)

Dr Grumble said...

That's the problem with comments. Exaggerate a bit and you will be found out. Actually Dr Grumble has a Russian doctor and an Arab doctor already working alongside him and a doctor is coming from Japan soon. But it is not on the scale it once was. Or so it seems anyway.

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