Introduction - Medicine and MMC
You can obtain more information on Modernising Medical Careers from the MMC website at www.mmc.nhs.uk/ . In summary however, for MMC as it applies to medicine the most important concepts are those of core medical training (CMT) and higher specialist training (HST). A depressing amount of jargon and many confusing abbreviations have been spawned by MMC. The two years of Core Medical Training are usually abbreviated to CMT 1 and CMT2. These terms are equivalent to the first two years of specialty training in MMC which is generically referred to as ST1, ST2. Thus core medical training represents the first two years of specialty training in MMC as it applies to medicine.
The original design of MMC included run through training. This meant that, once accepted into core training, trainees would progress automatically into higher training in a medical specialty; provided they achieved the necessary competencies at each stage. The emphasis was very much on a competency based system and at one stage it was even being suggested that the MRCP examination would disappear.
MMC and Medicine in 2007
By 2007 the Foundation Programme (F1, F2) had been established but in that year SHO posts were abolished and replaced by entry into Core Medical Training. This was open to both F2 graduates and non foundation trainees; who comprised junior doctors who were already in SHO medicine posts or were overseas doctors with similar experience. Depending on their level of experience and what components of MRCP they had passed, they applied to enter either the CMT1 or CMT2 years. Those SHO’s or equivalent doctors who had passed MRCP PACES were expected to apply for the first year of higher specialty training (ST3) in whatever specialty they wished to pursue. The later years of specialty training (ST4-6 or more) in 2007 were still being occupied by specialty registrars (SpR’s) in the Calman training system who were continuing their training in this system. Thus, as the Calman SpR’s progressively completed Calman training, the posts that they would vacate would progressively become available for re-designation as ST posts.
2007 was a very difficult year for Schools of Medicine and Postgraduate Medical Education (PGME), (as well as a very distressing one for junior doctors!), because we had to judge how many CMT posts we could create. For every successful applicant who was given a run through CMT post we had to have a slot available later on for them in Specialty Training. This meant we had to estimate what became known as the “bandwidth” which was the number of existing SHO posts that we could confidently convert into CMT posts in that year. The remainder of the medical SHO posts were either re-allocated to medical training slots in the GP training programme or were re-designated Core Training FTSTA (Fixed Term Specialty Training Appointments) which were recognised for 1 year of core medical training but did not have run through status. Thus the Trusts were able to maintain the equivalent junior doctor manpower that they had had with SHO’s. This was very important for the safety of patients and for Trusts to still be able to comply with junior doctor hours constraints.
Medicine 2008 - 2010 - After the Tooke Report - Uncoupling
The Tooke report from the enquiry set up under the leadership of Professor Sir John Tooke, at the time the Dean of the Peninsula Medical School, had responded to widespread opinion that run through was a bad idea. Much of this opinion had been voiced prior to 2007 (including from the Heads of this School) but had not been heeded. Apart from the difficulties of balancing numbers of CMT posts to match entry into ST posts, run through training meant that the choice of ST3 posts available to graduates from the CMT2 year was restricted to what was available in the same PGME region that they were currently training in. Numbers of available posts could drop to zero in some years and so this was rapidly confirmed to be unsatisfactory.
The Tooke report therefore has recommended “uncoupling” of the CMT and ST programmes so that entry to core training is just to a two year programme and then, on graduation from this, there would be nationally based application into the individual specialties for higher training. This, we believe, will now come into full operation in 2010 and the last run through trainees will move to ST3 in 2009. For 2008/9 the training diagram has changed to the format below. Those trainees who have run through status are first of all offered available posts within their own PGME region and can chose one of these if it meets their aspirations. If not, they can apply to the pools of posts that PGMEs have been asked to contribute to. These are supposed to be about 20% of their posts in terms of total numbers and otherwise mostly represent those of their posts that their local run through trainees do not want to apply for. However, if run through trainees are unsuccessful in applying nationally to their chosen specialty, they can fall back on a guaranteed place in their local School of Medicine. However this is unlikely to be in their preferred specialty.
For those who do not have run through status in 2008 and 2009 and for all graduates from core training in 2010 it will only be possible to apply to the national pool. Individual specialties organise these and for each specialty the recruitment process is normally organised by the PGME in which the Lead Dean for that specialty is based.
Run through trainees can only proceed to a higher training post if they have successfully completed their ARCP at the end of Core Training. Similarly this will be needed by trainees who are applying to the national pool.