In this week's BMJ, father and son, Anthony and George Madden discuss Modernising Medical Careers, the programme of reform of junior doctors' training, and ask is it still fit for purpose?
Modernising Medical Careers (MMC) began as an attempt to address longstanding problems with the senior house officer grade, say Dr Anthony Madden, Senior Clinical Lecturer in Anaesthesia at the University of Bristol, and George Madden, a final year medical student at the University of Birmingham (now a Foundation Year 1 doctor in the West Midlands). But it has since expanded in scope to reform all levels of postgraduate medical training and bears little resemblance to the proposals that were approved during consultations.
There is now a real danger, they warn, that it will deliver a generation of highly specialised doctors who lack the breadth of experience and flexibility that will enable them to manage unusual clinical problems or change as medicine advances. This cannot be good for patients, NHS employers or the Government.
So, has MMC lost its way?
The current plans are disappointing for doctors, who need a robust, modern training system which satisfies the 'five principles' for reform, they explain. Specialist training will not be as broadly based as originally envisaged, nor will it be easy to move between programmes. The idea of individually tailored programmes also seems to have been forgotten, career advice is currently lacking, and the provision for flexible training is uncertain.
MMC therefore fails to meet most of the principles on which it was supposed to be based, they write.
For workforce planners, MMC will mean a reduction in the number of Senior House Officers, their most flexible medical staff, and a reduction in their time spent providing a service in favour of training. A workforce made up of doctors forced into specialties they did not really want is not a happy prospect either.