Bernard Ribeiro on post CCT training

Posted by: Witch Doctor | April 23, 2008

Bernard Ribeiro on post CCT training

MISTRUST!

The Witch Doctor, having been around for many centuries, remembers well the days when fully trained senior registrars would devote a year or so learning a new skill before becoming consultants. This sometimes meant travelling to a foreign land to work at the feet of “the master.” The extra training was not really necessary to give a competitive edge in the job market, because in those days a senior registrar was pretty much assured of a consultant post. It was rather so that they would become the best they could be, in their chosen branch of medicine or surgery.

The Witch Doctor remembers one surgical senior registrar, in particular, who brought back important new vascular surgery skills to a large UK city before he became a consultant within the same health board. Everybody benefited. His surgical skills were impeccable. Patients were in the safest hands possible when they had their ballooning (or burst) aortas repaired, and this surgeon acted as a nucleus for training others in what were then new techniques.

A good thing, you would think.

FOUR HANDS - TWO HANDS LEARNING

The President of The Royal College of Surgeons, Mr Bernard Ribeiro, however, seems to have been criticised in some way for promoting post-CCT fellowships. He says himself in his latest newsletter to the college:

“So why now? There have been those who have been suspicious about my motives for pressing for post-CCT fellowships. Let me try and allay those suspicions. First, it has nothing to do with the creation of a subconsultant grade. The fellowships are designed to enhance the skills of trainees about to embark on consultant practice in a challenging area of surgery. It will inevitably involve a niche area of subspecialist practice.

As a member of the MMC programme board, I have argued the case for additional training posts in surgery and other disciplines where there is a case for consultant expansion. It was clear that further NTNs could not be created while we still had a large pool of post-CCT trainees waiting for consultant jobs.We currently estimate there are 86 CCT holders in surgery who are in transition between formalised training and consultant appointments. The College’s proposals for post-CCT fellowships developed by Professor Norman Williams and Professor Tony Mundy during the course of 2007 were approved by Council in December 2007. Professor Norman Williams was tasked with developing a programme with the specialist associations that would identify centres able to provide such enhanced training without detriment to existing trainees.

The aims of the national surgical fellowship scheme are:

1. To provide an opportunity for post-CCT trainees to obtain skills and experience in their specialty that are not readily available to them within their training programme.

2. To provide a cadre of superspecialists who will deliver their services within a larger group of specialists based within a regional centre

3. To develop research networks within each surgical specialty with the specific aim of conducting large multi-centre clinical trials particularly related to innovative surgical therapy and to provide an improved evidence base for our discipline.”

“These fellowships are not a passport to a subconsultant grade; on the contrary, they will provide successful fellows with new skills in an accredited centre where training will be monitored and quality assured by this College and the relevant specialty association. This will in fact make them more competitive.”
“

POST-CCT FELLOWSHIPS

Since reading the Tooke Report, The Witch Doctor has been wondering whether the concept of post-CCT training would be accepted because of the possibility of it becoming mixed up with a sub-consultant grade ie getting stuck at Level 8 rather than Level 9 of the Skills Escalator perhaps?

The problem, of course, is one of mistrust and suspicion over this government’s agenda for the medical profession and for the future of the NHS.

This mistrust is a very sad state of affairs, My Black Cat, which will not be easily reversed.

The MTAS/MMC affair is reverberating throughout the whole of medicine.

But the problem is not really about the training of junior doctors. It is about the role of the doctor in a complex system which was was discretely being reorganised in a way that excluded the medical profession.

What a lot of damage has been done!

a red apple ……………………