The New SAC Curriculum

John Black Chairman SAC

Powerpoint File

The Postgraduate Medical Education and Training Board comes into formal existence in the autumn and has been set up by the government to take charge of all medical training in the NHS. Its main objectives have been stated as:

1. To safeguard the health and well being of patients.

2. To ensure that the needs of trainees are met by standards set.

3. To ensure that the needs of employers and NHS contracting authorities are met by standards set.

Doctors will have no issue with the first two of these, but may find the third somewhat sinister, implying that service needs will take priority over the provision of training. The principles on which PMETB works are:

1. PMETB is the sole competent authority.

2. "Colleges and Faculties will have a central role".

3. It will delegate nothing but will happily sub-contract.

The difference between delegation and sub-contracting may be a little subtle for some!

Its immediate agenda is to control the visiting process and assess applications under Article 14. In future, all educational visits to training units will be done on behalf of PMETB. The team must include a lay presence. Reports must be in a standard format and will be published, and disruption to service must be minimised. This means that visits will be to all disciplines in a unit and organised on a regional basis. The SAC has argued strongly to retain the visiting process, which it sees as vital in maintaining standards of education and training.

PMETB will replace the STA as the body certifying completion of training. The new accolade will be the Certificate of Completion of Training, CCT, and replaces the Certificate of Completion of Specialist Training, CCST. The sole reason for this is that General Practitioners will receive the same certificate and to have Specialist recognition in General practice is an oxymoron. However PMETB have stated clearly "the standard for the CCT will continue at the same level as the UK CCST".

Pressure for shortening surgical training comes from the Modernising Medical Careers, (MMC) group at the Department of Health, set up by the Chief Medical Officer, himself a former surgical trainee. All doctors will do two Foundation Years after qualification, the stated aim of which is to make them competent in the management of the sick patient. Thereafter, doctors will go straight into specialist training which it is hoped will be shorter and "fit for purpose". Does current surgical training need reform? The answer must be yes. What is wrong with the present system? Well, BST currently takes on average five and a half years and SHOs receive significantly less operative training since the introduction of shift working. Their knowledge of basic science relevant to surgery is often poor, since most Medical Schools have stopped teaching it. However, there is much that is right about it. The end product is of a good standard. Training meets the pattern of service and produces consultants competent in emergency and elective surgery, with one or more sub-specialist interests. Surely this is "fit for purpose"? The Intercollegiate Exam is fair and relevant.

The SAC has laid down the following principles for surgical training post MMC:

There should be a transition year after FY2, spent in general surgical posts. A likely name for this is Specialist Training 1 (ST1).

There must be an entry examination in basic sciences, particularly anatomy.

Training proper must last for six years but these are indicative years and the process will take significantly longer if acquisition of the required competences is delayed by loss of experience brought about by shorter working hours or transfer of elective surgery to treatment centres.

All trainees will have one or more subspecialty interests and general and subspecialty training will be in parallel.

CCT will be the same standard as CCST and therefore most subspecialty training will be done before consultant appointment, as at present.

The Intercollegiate examination should continue as it is.

The SAC sees the MMC initiative as an opportunity to improve training. The present five years or more spent in BST is reduced to two, namely FY2 and STI. There will be one grade of consultant, trained in emergency surgery, general surgery and one or more sub-specialties to at least the present standard, assisted by the web-based Curriculum.

As the time for implementation of these changes approaches a sense of realism is thankfully illuminating the debate.