Editorials |
Modernising Medical Careers—challenge or opportunity for occupational medicine?
Modernising Medical Careers (MMC) [1] has completely changed the training of doctors following primary qualification by university medical degree. Postgraduate medical education will aim to provide competent and safe doctors with more emphasis upon communication and team working, the ultimate intention being improved patient care. The Web site for MMC reveals that it is National Health Service (NHS) based. This editorial considers the implications for occupational medicine which on the whole does not ‘treat’ patients and often functions outside of the NHS.The proposed postgraduate experience for doctors is as follows: newly qualified doctors will move into a 2-year foundation program. Year 1 will involve rotation through three posts with at least 4 months each in medicine and surgery. The training requirements are agreed with methods of assessment that all doctors must achieve to allow full registration and progress into year 2 of foundation training. Year 2 consists of three further 4-month placements to provide agreed training objectives and produce competent, safe doctors who are able to consider which specialty interest they wish to pursue.
The next phase in training a modern doctor will be specialty/general practice ‘run through’ training programmes. These posts will provide the training necessary to produce a ‘competent specialist’ in 5–7 years. Each of the 58 specialties in the UK has produced an individual curriculum for specialist training. The Faculty of Occupational Medicine curriculum, which has received conditional approval by the Postgraduate Medical Education and Training Board (PMETB), is the basis upon which all future specialists in occupational medicine will be trained.
Traditionally, occupational medicine has not recruited doctors early in their careers, and the average age of being awarded Membership of the Faculty is 43 years.
The Faculty has stated that it wants to recruit mostly from core medical training but what of the previously well-accessed route via general practice? There is concern that the new training programs may lead to a reduction in the numbers entering specialty training in occupational medicine from general practice. Alternatively, the direction of travel may change with the attraction of general practice being enhanced with reduced out of hours work and the widely reported enhancements in remuneration. The opportunity to recruit doctors to training with occupational medicine as their first choice of specialty is an enticing one and consequently the provision of training will need to reflect changing needs now. The trainees may lack the width and depth of clinical experience previously associated with those in occupational medicine. This will balance with an experience of modern undergraduate curriculum and expertise in formative learning experiences.
This leads to the challenge of promoting occupational medicine specifically in undergraduate curricula, as currently it is not a priority in many universities. If the specialty is to grow, we must enhance exposure to occupational medicine in the undergraduate curriculum, get the attention of medical students and nurture an interest in the specialty. This will lead to active involvement in workers' health for all doctors and the gaining of experience and qualifications in occupational medicine for some. The Faculty of Occupational Medicine and the Health and Safety Executive are looking for ‘champions’ to promote these issues and provide a focus around most universities. Possible strategies for generating the focus include: offering attachments or site visits to our places of work, working with the local university department, attending career fairs or simply be willing to offer some career guidance to a doctor when the opportunity arises at an educational meeting. There are resources available to assist in teaching undergraduates [2,3].
As well as those seeking to enter occupational medicine there are many who already possess experience, expertise and some qualification in occupational medicine that may appear to be excluded from this modernization.
In order to enter the General Medical Council register as a practitioner in occupational medicine certain criteria must be met. What is not clear is how those in other specialties including general practice or those working in occupational medicine but not in recognized training posts can achieve these criteria. The Faculty may look at open access to these examinations for doctors not in specialty training. Those who pass these examinations or already possess a suitable qualification (although it would appear unlikely that the Diploma will be sufficient) can apply under Article 14 for entry onto the specialist register [4].
Article 14 refers to a different route to the specialist register under the Certificate confirming Eligibility for Specialist Registration (CESR—Article 14) of the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003. PMETB [5] assesses applications for specialist registration from those doctors who have not followed a UK specialist training program that leads to a Certificate of Completion of Training (CCT) but who may have gained the same level of skills and knowledge as CCT holders; this is sometimes known as the equivalence route. The Faculty has produced a Specialty Specific Guidance [6] that is available to assist those applying or wishing to apply for entry to the specialist register. This route is also open to doctors with specialist qualifications from a non-UK country wishing to have their qualification assessed to ascertain whether or not it is sufficient to allow entry to the specialist register.
Whenever change arises, there are challenges and opportunities. When a change as fundamental as that posed by MMC is implemented, these perceptions can lead to both unrealistic pessimism and optimism. What is clear however is that MMC is here to stay. Occupational medicine can and must rise to the challenges it sets out to the specialty and convert them into opportunities. There are opportunities for both those doctors who may not even have heard of occupational medicine yet, to those who have been steeped in it for years to achieve specialist status. We must increase and improve on the profile of teaching of occupational medicine in universities. We must increase the opportunities for exposure to occupational medicine for young doctors and we must provide training to those committed to the specialty that equips them with the necessary skills, knowledge and attitudes to achieve specialist status and successfully work for the most part outside the NHS. The training focus under PMETB, despite the Faculty's best efforts, remains overly focused on the NHS and not the traditional private sector training provision. The NHS-based consultants must work with the non-NHS-based specialists to provide broad-based training programs that will equip tomorrow's occupational physicians with the correct competencies.
The specialty of occupational medicine has a profound depth in the experience its current practitioners bring from the wide diversity of routes that have led them to this specialty. The challenge for the future is to convert the threats of MMC into opportunities for occupational medicine. Focusing on raising the profile of occupational medicine both at undergraduate and postgraduate level will open the doors to those looking for either generic experience in occupational medicine or more specialized career progression. Models do exist for the integration of occupational medicine into foundation programs, which has enhanced the early experience of foundation year doctors. Development of shared postings with general practice (general practice career start programmes) offers opportunity for those moving into general practice to develop specialist interests (E. Murphy, personal communication). Developing partnerships between NHS and private Occupational Health Service providers is a key delivery method for enhancing training experiences for those wishing to achieve specialist accreditation in occupational medicine. PMETB needs to be made aware of these opportunities.
e-mail: alastairleckie{at}ohsas.scot.nhs.uk
References
- Modernising Medical Careers. http://www.mmc.nhs.uk/pages/home.
- Faculty of occupational medicine guidance on undergraduate teaching. http://www.facoccmed.ac.uk/library/docs/t_comps_ug.pdf.
- Manchester University's teaching for undergraduates. http://www.medicine.manchester.ac.uk/coeh/teachinglearning/mbchb/.
- Certificate confirming Eligibility for Specialist Registration (CESR – Article 14) – helping you make your application. http://www.pmetb.org.uk/index.php?id=article14.
- Postgraduate Medical Education and Training Board. http://www.pmetb.org.uk/index.php?id=article14.
- Specialty Specific Guidance—Occupational Medicine. http://www.pmetb.org.uk/media/pdf/5/k/PMETB_Occupational_Medicine_SSG.pdf.
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