Saturday, November 11, 2006

MMC - shake your head

There’s a lot of talk amongst doctors about the new training scheme (MMC) being introduced at the moment. It’s a source of despair, debate and fear for many and you can read about more of the issues including those facing house officers and more, explained by Dr Crippen.

Histopathology is one of the first specialties to start run-through training (or ‘rush-through training’ as it is affectionately known). The new scheme seems broadly similar to the Calman training that specialist registrars of my generation are doing at the moment. The time to complete training is not much shorter, unlike in some other specialties. So do we need to protest about MMC in histopathology? While other specialties are having training times cut and a subconsultant grade brought in by stealth, will things be so bad in histopathology? Or is it that they already are?

When Calman training was brought in between 1995 and 1997 the period of time junior pathologists spent in training before becoming consultants was longer. The new Calman training shortened this period. Many consultants I know who trained in the Calman scheme think their training was too short to provide the breadth of experience they need to practice independently and safely. Before Calman, there were problems with senior registrars waiting for long periods before a consultant job came along, or having to go abroad due to lack of consultant jobs in the UK. The situation is now the opposite; training has shortened and registrars are being pushed through training into vacant consultant jobs. MMC will make this process even faster and increasingly less experienced doctors will be called consultant at an earlier stage in their training. They will not be equivalent to the consultants of the past.

Even though I am ahead of MMC and will finish my training under the Calman system, I still worry that my training will not be as broad or deep as I would like before I am deemed to be a ‘consultant’.

A second problem, affecting junior doctors in all specialties, is the lack of exposure to different specialties they will have before being expected to start a run-through training scheme. Some people say that because junior doctors under MMC will rotate through more specialties during their first two years that they will get more experience. Unfortunately they will be spending a short period in each specialty, long enough to know where their ward is but not to develop many useful basic specialist skills. Many will be on rotations where the majority of the specialties they rotate through will be of little interest to them. They then need to compete for a run-through training post in their chosen specialty, which they may never have worked in before.

This system is supposed to reduce the bottleneck between the senior house officer and registrar grades by amalgamating them into a single run-through training grade. It may do this. It may simply create a bottleneck elsewhere. It also prevents the undecided senior house officer from working in a series of jobs in different specialties to gain some experience, some maturity and some idea of what they wanted to do with the rest of their career. These periods of time were not wasted. The senior house officer grade allowed doctors to change specialties fairly easily and develop a set of skills in a variety of different areas.

Of the histopathologists I know, several began training in other specialties before starting pathology, they did surgery, general medicine and GP training. Some people left pathology training for other branches of medicine. These are not people wasting their time by being indecisive. They have acquired many useful skills in understanding diseases, seeing how patients with different problems present, how they are managed and how the histological diagnosis affects them.

The new MMC style training will drastically reduce the opportunity for doctors to experience a range of specialties they are interested in and consequently gain a unique range of skills. It will produce less experienced consultants with a narrower range of experience. It has already started (in addition to other problems) to produce unemployment amongst junior doctors, with predictions that this will worsen. The situation is not good for doctors or patients.

The system of training prior to MMC had its flaws but it looks to me as if MMC has many more.


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