Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Educational Organizations: The Scottish Council for Postgraduate Medical Education K. M. Parry To cite this article: K. M. Parry (1979) Educational Organizations: The Scottish Council for Postgraduate Medical Education, Medical Teacher, 1:3, 157-159 To link to this article: http://dx.doi.org/10.3109/01421597909023834
Published online: 03 Jul 2009.
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Date: 08 November 2015, At: 17:43
EDUCATIONAL ORGANIZATIONS
The Scottish Council for Postgraduate Medical Education Downloaded by [University of California, San Diego] at 17:43 08 November 2015
K.M. PARRY K . M . Parry, MB, CH.B, FRCP(ED.), MRCGP, FFCM, DCH, is Secretary, Scottish Council for Postgraduate Medical Education, 8 Queen Street, Edinburgh EH2 IJE, Scotland.
It has never been true to say- and how much less is it true today-that once a doctor has passed his final examinations and is entering practice his education has been completed. William Osler wrote at the beginning of this century (Osler 1900): “More clearly than any other, the physician should illustrate the truth of Plato’s saying that education is a life-long process. The training at medical school gives a man his direction, points him the way, and furnishes him a chart, fairly incomplete for the voyage, but nothing more.” There is a great variation in the way individual doctors continue to learn after completing a formal undergraduate course. Once established in a particular field of practice, they learn from their own experience, from colleagues with whom they work, from attending seminars and lectures, from reading, and from membership of medical clubs and societies; but it is in the interval between graduation and full establishment in practice that the need for training varies most noticeably from one specialty to another.
Standard Pattern of Training Until fairly recently, there was no formal description of what a doctor should learn or the skills that he should acquire before becoming established in a specialty. He worked towards two objectives: the requirements of an appropriate higher diploma examination, e.g. MRCP or FRCS, and the expectations of the employing authorities responsible for hospital appointments. Since the inception of the NHS, however, a relatively standard pattern of training has emerged for most hospital specialties. Apart from certain requirements laid down by the Royal Colleges for their higher diploma candidates, for example, minimum experience in general and accident surgery before taking the FRCS, a new graduate gained his experience through a series of junior hospital appointments. He ‘learnt by doing’, and he demonstrated his competence by passing an examination. Thereafter, he was eligible for further training as Medical Teacher Vol 1 No 3 1979
a senior registrar, in which he would pursue a more definite programme of training over three or four years. Senior registrar committees, representative of the universities and colleges, were established regionally to oversee such training. Higher Training Committees
The development of increasing specialization and the desire to promote high standards of training nationally led to the formation of the joint higher training committees. The first committee was established by the Royal College of Surgeons in association with a number of specialist surgical bodies. Joint committees for higher medical training and for psychiatric training followed, and similar responsibilities were assumed by other Royal Colleges. The broad aims of higher training were set out by these committees and Colleges and training programmes were inspected. Several colleges award certificates of ‘accreditation’ on completion of higher training. The tradition of postgraduate training for general practice is of much more recent origin. Through the efforts of the Royal College of General Practitioners, three-year training schemes, involving rotations through hospital posts and a year in a selected general practice, have been developed. The Joint Committee on Postgraduate Training for General Practice has now been established to oversee training throughout the UK. General practice differs from the hospital specialties in that it is not necessary for those in training to take the relevant membership examination, although success in that examination is increasingly becoming recognized as a valuable indication of a doctor’s basic understanding of general practice. Role of University Medical Schools
In recent years the Royal Colleges and equivalent bodies have increasingly given guidance on the content of
157
@f)Ihe Seottish Council for Posglraduael Medical flucation UNIVERSITIES
Downloaded by [University of California, San Diego] at 17:43 08 November 2015
ABEmEm DLNDEE mINBUflM
ScOttiSil
Hare and Health De-t: olief Medical Officer. SeCretaIy.
chief M i s t r a t i = Wcal Offioers (6)
ma
/ \/
\
Royal Colleges and Faculties. B r i t i s h W c a l Associatiol. Scottish Ccmnittees for: General W c a l Senrices. Hospital Medical Services. Hospital Jmior Staff. chainran of Dental Ccmnittee of comcil.
Reiional Committeesfor Postgraduate Medical Education UNIVERSITIES Executive Officers :
158
Medical Teacher Vol 1 No 3 1979
postgraduate medical training, the standards that should be achieved, and the quality of the training to be provided, but the needs of postgraduate education do not stop there. Although primarily concerned with undergraduate education and with research, the university medical schools make important contributions to postgraduate medical education by way of a variety of courses, and by providing, through their associated teaching hospitals, the main base for senior registrar training. The universities also provide opportunities for the budding specialist to develop his own interests, and to make individual contributions to the advancement of medical knowledge through research and preparation for higher university degrees.
Downloaded by [University of California, San Diego] at 17:43 08 November 2015
Role of Health Authorities Health authorities also play an important part in postgraduate education and training. As the employers of doctors in training they must ensure that the trainees are not so overburdened with service work that they have no time or energy for study. Furthermore, the trainee’s work must be so arranged that he gains the experience he needs under proper supervision, and does not waste time on repetitive or medically unproductive tasks which contribute little to his further education. This applies particularly to senior house officer and registrar posts in hospitals, and there is still a great deal of scope for improving standards of early training. The number of registrars greatly exceeds the number of senior registrar posts, and although competition for the latter encourages high standards of practice, imbalance between the number of junior and senior training posts in some popular specialties can cause hardship and disappointment. Councils for Postgraduate Medical Education The Royal Colleges, the universities and the National Health Service authorities are autonomous bodies, and as they are all closely involved in postgraduate medical education and training, some coordination of their activities is necessary; this is the task of the Councils for Postgraduate Medical Education. It is not always realised that there are, in effect, three separate health services in the UK, each with its own Department of Health and Secretary of State. Each postgraduate council is the principal source of advice to its own health department. The three postgraduate councils -one for Scotland, one for England and Wales and one for Northern Irelanddirectly represent the university medical schools, the Royal Colleges and faculties, and the NHS authorities in their respective countries. They are independent bodies, though they work closely together within mutually agreed UK policies. The Scottish Council for Postgraduate Medical Education was formed in 1970 on the principle of tripartite representation referred to above, and its primary purpose is to bring together the several interests of its constituents (Figure 1). With the exception of its Dental Committee, the Scottish Council has no standing Medical Teacher Vol 1 No 3 1979
committees. Instead, recommendations on the particular problems on which it has been asked to advise are drawn up by multidisciplinary working parties, which are disbanded when their task has been completed. Examples of the advisory work undertaken in this way include recommendations on: 1. The establishment of postgraduate medical education centres. 2. Vocational training in general practice. 3. Selection of postgraduate teachers of general practice. 4. Postgraduate medical education of women doctors. 5. General professional training. 6. Financial responsibilities for postgraduate medical and dental education. 7. Continuing education for general practitioners. 8. Postgraduate education and training of doctors in community medicine. 9. Postgraduate medical teaching aids and library facilities.
In addition, a number of surveys have been undertaken into the adequacy of training in various fields. The Council’s task is a coordinating one, and only exceptionally does it take direct responsibility for the postgraduate training of individual doctors. This is the responsibility of the regional committees for postgraduate medical education, of which there are five in Scotland. They, like the Council, are tripartite in composition, and carry much of the responsibility for the implementation of training programmes for individual doctors. An important function of the regional committees is the provision of careers advice, and in consultation with the professional colleges the regional committees appoint specialty advisers who are responsible for, among other things, giving career guidance to doctors who seek it. Such guidance must be based on reliable information, and the Council’s booklet, Careers in Medicine, gives detailed and regularly updated information about opportunities in most fields of medical practice, together with an account of the current requirements for specialization in each branch of practice. Medical care is constantly changing in response to the needs of society and advances in medical knowledge. The continuing education of doctors must reflect these changes and hence the framework of any organized system of postgraduate medical education has to be flexible and widely based. The councils and regional committees have been established in that way, and it is hoped that they will continue to serve the needs of doctors and their patients imaginatively and effectively. Reference Osler. W . . Lancet, 1900, ii, 73-75.
159
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Educational Organizations: The Scottish Council for Postgraduate Medical Education K. M. Parry To cite this article: K. M. Parry (1979) Educational Organizations: The Scottish Council for Postgraduate Medical Education, Medical Teacher, 1:3, 157-159 To link to this article: http://dx.doi.org/10.3109/01421597909023834
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 9
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [University of California, San Diego]
Date: 08 November 2015, At: 17:43
EDUCATIONAL ORGANIZATIONS
The Scottish Council for Postgraduate Medical Education Downloaded by [University of California, San Diego] at 17:43 08 November 2015
K.M. PARRY K . M . Parry, MB, CH.B, FRCP(ED.), MRCGP, FFCM, DCH, is Secretary, Scottish Council for Postgraduate Medical Education, 8 Queen Street, Edinburgh EH2 IJE, Scotland.
It has never been true to say- and how much less is it true today-that once a doctor has passed his final examinations and is entering practice his education has been completed. William Osler wrote at the beginning of this century (Osler 1900): “More clearly than any other, the physician should illustrate the truth of Plato’s saying that education is a life-long process. The training at medical school gives a man his direction, points him the way, and furnishes him a chart, fairly incomplete for the voyage, but nothing more.” There is a great variation in the way individual doctors continue to learn after completing a formal undergraduate course. Once established in a particular field of practice, they learn from their own experience, from colleagues with whom they work, from attending seminars and lectures, from reading, and from membership of medical clubs and societies; but it is in the interval between graduation and full establishment in practice that the need for training varies most noticeably from one specialty to another.
Standard Pattern of Training Until fairly recently, there was no formal description of what a doctor should learn or the skills that he should acquire before becoming established in a specialty. He worked towards two objectives: the requirements of an appropriate higher diploma examination, e.g. MRCP or FRCS, and the expectations of the employing authorities responsible for hospital appointments. Since the inception of the NHS, however, a relatively standard pattern of training has emerged for most hospital specialties. Apart from certain requirements laid down by the Royal Colleges for their higher diploma candidates, for example, minimum experience in general and accident surgery before taking the FRCS, a new graduate gained his experience through a series of junior hospital appointments. He ‘learnt by doing’, and he demonstrated his competence by passing an examination. Thereafter, he was eligible for further training as Medical Teacher Vol 1 No 3 1979
a senior registrar, in which he would pursue a more definite programme of training over three or four years. Senior registrar committees, representative of the universities and colleges, were established regionally to oversee such training. Higher Training Committees
The development of increasing specialization and the desire to promote high standards of training nationally led to the formation of the joint higher training committees. The first committee was established by the Royal College of Surgeons in association with a number of specialist surgical bodies. Joint committees for higher medical training and for psychiatric training followed, and similar responsibilities were assumed by other Royal Colleges. The broad aims of higher training were set out by these committees and Colleges and training programmes were inspected. Several colleges award certificates of ‘accreditation’ on completion of higher training. The tradition of postgraduate training for general practice is of much more recent origin. Through the efforts of the Royal College of General Practitioners, three-year training schemes, involving rotations through hospital posts and a year in a selected general practice, have been developed. The Joint Committee on Postgraduate Training for General Practice has now been established to oversee training throughout the UK. General practice differs from the hospital specialties in that it is not necessary for those in training to take the relevant membership examination, although success in that examination is increasingly becoming recognized as a valuable indication of a doctor’s basic understanding of general practice. Role of University Medical Schools
In recent years the Royal Colleges and equivalent bodies have increasingly given guidance on the content of
157
@f)Ihe Seottish Council for Posglraduael Medical flucation UNIVERSITIES
Downloaded by [University of California, San Diego] at 17:43 08 November 2015
ABEmEm DLNDEE mINBUflM
ScOttiSil
Hare and Health De-t: olief Medical Officer. SeCretaIy.
chief M i s t r a t i = Wcal Offioers (6)
ma
/ \/
\
Royal Colleges and Faculties. B r i t i s h W c a l Associatiol. Scottish Ccmnittees for: General W c a l Senrices. Hospital Medical Services. Hospital Jmior Staff. chainran of Dental Ccmnittee of comcil.
Reiional Committeesfor Postgraduate Medical Education UNIVERSITIES Executive Officers :
158
Medical Teacher Vol 1 No 3 1979
postgraduate medical training, the standards that should be achieved, and the quality of the training to be provided, but the needs of postgraduate education do not stop there. Although primarily concerned with undergraduate education and with research, the university medical schools make important contributions to postgraduate medical education by way of a variety of courses, and by providing, through their associated teaching hospitals, the main base for senior registrar training. The universities also provide opportunities for the budding specialist to develop his own interests, and to make individual contributions to the advancement of medical knowledge through research and preparation for higher university degrees.
Downloaded by [University of California, San Diego] at 17:43 08 November 2015
Role of Health Authorities Health authorities also play an important part in postgraduate education and training. As the employers of doctors in training they must ensure that the trainees are not so overburdened with service work that they have no time or energy for study. Furthermore, the trainee’s work must be so arranged that he gains the experience he needs under proper supervision, and does not waste time on repetitive or medically unproductive tasks which contribute little to his further education. This applies particularly to senior house officer and registrar posts in hospitals, and there is still a great deal of scope for improving standards of early training. The number of registrars greatly exceeds the number of senior registrar posts, and although competition for the latter encourages high standards of practice, imbalance between the number of junior and senior training posts in some popular specialties can cause hardship and disappointment. Councils for Postgraduate Medical Education The Royal Colleges, the universities and the National Health Service authorities are autonomous bodies, and as they are all closely involved in postgraduate medical education and training, some coordination of their activities is necessary; this is the task of the Councils for Postgraduate Medical Education. It is not always realised that there are, in effect, three separate health services in the UK, each with its own Department of Health and Secretary of State. Each postgraduate council is the principal source of advice to its own health department. The three postgraduate councils -one for Scotland, one for England and Wales and one for Northern Irelanddirectly represent the university medical schools, the Royal Colleges and faculties, and the NHS authorities in their respective countries. They are independent bodies, though they work closely together within mutually agreed UK policies. The Scottish Council for Postgraduate Medical Education was formed in 1970 on the principle of tripartite representation referred to above, and its primary purpose is to bring together the several interests of its constituents (Figure 1). With the exception of its Dental Committee, the Scottish Council has no standing Medical Teacher Vol 1 No 3 1979
committees. Instead, recommendations on the particular problems on which it has been asked to advise are drawn up by multidisciplinary working parties, which are disbanded when their task has been completed. Examples of the advisory work undertaken in this way include recommendations on: 1. The establishment of postgraduate medical education centres. 2. Vocational training in general practice. 3. Selection of postgraduate teachers of general practice. 4. Postgraduate medical education of women doctors. 5. General professional training. 6. Financial responsibilities for postgraduate medical and dental education. 7. Continuing education for general practitioners. 8. Postgraduate education and training of doctors in community medicine. 9. Postgraduate medical teaching aids and library facilities.
In addition, a number of surveys have been undertaken into the adequacy of training in various fields. The Council’s task is a coordinating one, and only exceptionally does it take direct responsibility for the postgraduate training of individual doctors. This is the responsibility of the regional committees for postgraduate medical education, of which there are five in Scotland. They, like the Council, are tripartite in composition, and carry much of the responsibility for the implementation of training programmes for individual doctors. An important function of the regional committees is the provision of careers advice, and in consultation with the professional colleges the regional committees appoint specialty advisers who are responsible for, among other things, giving career guidance to doctors who seek it. Such guidance must be based on reliable information, and the Council’s booklet, Careers in Medicine, gives detailed and regularly updated information about opportunities in most fields of medical practice, together with an account of the current requirements for specialization in each branch of practice. Medical care is constantly changing in response to the needs of society and advances in medical knowledge. The continuing education of doctors must reflect these changes and hence the framework of any organized system of postgraduate medical education has to be flexible and widely based. The councils and regional committees have been established in that way, and it is hoped that they will continue to serve the needs of doctors and their patients imaginatively and effectively. Reference Osler. W . . Lancet, 1900, ii, 73-75.
159
