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Specialist grade essential
- Alfred P J Lake (30 October 2005)
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Old wine in new bottle- A few suggestions.
- Sumit Kumar Jha (17 October 2005)
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Alfred P J Lake, Consultant in Anaesthesia and Pain Management Glan Clwyd Hospital
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David Greaves is right to be concerned about the issue of training time and consultant practice but I must take issue with him as to the management of his initial third approach. He is correct that new appointees today (in all specialties of course) are both less experienced and less confident and may not be able to deliver the level of service or care expected of a consultant heretofore because of this inexperience but is wrong to imagine that the necessary change can be achieved within the ‘constraints of a unitary consultant grade’. Why, indeed, are such artificial constraints still considered necessary? Additional experience gained over 3 or 4 (or perhaps more) years is, I agree, necessary to fully equip the doctor who has completed training for a full consultant role. It is (past) high time to adjust the career structure for hospital doctors to allow for varying degrees of specialisation, responsibility and out of hours working, indeed, I first wrote about this more than 20 years ago when a senior registrar myself(1) and subsequently represented(2,3,4). All doctors should be concerned about any changes to the training arrangements that may adversely affect their ability to appropriately discharge the duties required of them, particularly worrying when the end of that training programme is currently considered to be to the level at which ‘the buck stops’. The consultant grade has changed little since the inception of the NHS (though working relationships have) and it is past high time that it cease to be the only “approved” permanent career post for specialists in NHS hospital practice (following variable training) which is, unfortunately, often subject to less than adequate control and supervision. All worries about doctors of reduced training, experience and competence entering the workforce at a senior level either by completing specialist training in this country or through equivalence from the EU including the new accession countries, for example, can be addressed by introducing the career grade of Specialist which would then be the point of entry for all and allow the essential provision of the required support and supervision during the period of necessary further development with expanded training and broadening experience before achieving a consultant post. The Specialist would be, correctly, a grade subordinate to Consultant with appropriate skills and competencies fitting in with doctors having other titles who deal with patients in accordance with these. Are we not, anyway, moving to team-based activity with many of the duties performed by doctors hertofore now undertaken by others in many guises, the latest being the Anaesthetic Practitioners of the future? The future service needs to be Specialist based but Consultant led and an appropriate hierarchy for the specialty in the future could be as follows: TRAINEE Anaesthetist - Resident or Registrar, ASSISTANT Anaesthetist - the Anaesthetic Practitioner as already planned, at a junior or senior (equivalent to the present inappropriately named nurse consultant) level, ASSOCIATE SPECIALIST - broadly our current SASs in a single grade, SPECIALIST - appointment following completion of specialist training, CONSULTANT - a senior position attainable after a period as a Specialist, CLINICAL DIRECTOR - the Head of Service with the necessary level of increased control over all other grades. Why resist the move to a Specialist grade below consultant, with its obvious advantages to all, which will satisfactorily achieve David Greaves’ proposed new approach number 5. 1. Lake APJ. Chances of Promotion Essential to Viable Post. Hospital Doctor 1983; 18th. August. 2. Lake APJ. Specialist Grade Can Save the Day. Hospital Doctor 1995; 6th. April: 14. 3. Lake A. Welcome shift in roles (Specialist Grade). Hospital Doctor 2004; 18th. March: 20. 4. Lake APJ. Specialist Grade Can (still) Save The Day. (In response to - Graham Read Hospital doctors need a new career structure BMJ 2005; 330: 1397). Access at http://bmj.bmjjournals.com/cgi/eletters/330/7504/1397 Conflict of Interest:None declared |
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Sumit Kumar Jha, Senior House Officer Addenbrooke’s Hospital, Cambridge.
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I agree with Dr Greaves that the trainees in the UK now anaesthetize fewer cases and also that how well we learn depends on what we know already. He also comes across with this useful three-pronged approach to upgrading the training schemes in Anaesthesia. ‘Teach them better’, ‘Test them harder’ and ‘Look after them when they are new consultants’. I definitely agree that all three are needed. I strongly believe that the blockwise allocation of trainees to a particular surgical theatre is a better scheme of doing things. 3-month blocks seem to hold more promise than any larger blocks. The issue of important subspecialty rotations especially Paediatric and Cardiovascular surgery should be well charted out in the beginning of the training schemes. Such high-demand theatres can have a 2-month rotation. More importantly, the budding consultants should be given protected theatre time within these specialities. This is possible within the realms of the EWTD. The anaesthesia trainees are doing lot of cases in surgical, obstetric and orthopaedic theatres during out of hours. But the issue of supervised training in subspecialty theatres remains a key question to be answered. Conflict of Interest:None declared |
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