Has NHS programme for reforming doctors' training lost its way?

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.

It's better news for the government, which will see its 'increasing need for hospital services to be delivered by fully trained doctors' met by the shorter training, and thus longer time spent as a consultant.

However, the consequences for patients are not good. Consultants produced by MMC will have less experience than those trained in the past, they will have a more limited range of expertise, and be less able to meet the increasingly complex needs of patients, they warn.

They end by saying it is difficult not to conclude that MMC has lost its way and will not fulfil its original aims.

Article: Has Modernising Medical Careers lost its way? by George B P Madden and Anthony P Madden BMJ 2007;335:426-428 (1 September), doi:10.1136/bmj.39300.591632.DE