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Our registrars in the north of England just love weaving a bit of variety into their training programmes. Not content with working in a diverse region that stretches from coast to coast and from the Scottish border to south of the Tees, and which includes urban teaching hospitals and rural outreach, they have developed a taste for anything to get out of the day job! And our consultants are delighted to see them go – it demonstrates their magnanimity as trainers as well as their ability to cope without junior support. Well, perhaps – until this year.

The region has always been fortunate in having both academics and NHS consultants with excellent track records of supervising out of programme research leading to an MD or PhD. Areas of study include falls and syncope, movement disorders, osteoporosis and stroke. The regional training committee has sometimes bent the rules to ensure that prestigious grants and fellowships are not lost and often granted extended time to complete research running behind schedule.

Several hospitals have developed ‘teaching and research fellow’ posts. These are Trust posts, usually for a year, in which the doctor undertakes a manageable research project, oversees medical student teaching in the department and takes part in the on-call rota; trainees usually obtain a good quality presentation with published abstract and a qualification in medical education.

The northern region was also at the forefront of obtaining Academic Clinical Fellow and Academic Clinical Lecturer posts following the Walport report – we have so far had one of each at registrar grade, with others undertaking research on a theme of ‘ageing medicine’ at Core Training level. Our ACF has obtained a research fellowship and is now undertaking a PhD, while the ACL has gone on to a senior academic post.

So far, so good, but for the past two years, other ‘out of programme’ activities have burgeoned. Two trainees are currently undertaking a year’s stroke training. One is taking the Liverpool Diploma in Tropical Medicine and Hygiene before working for Médecins Sans Frontières. Two, encouraged to do so for fear of a shortage of ST3 posts for run through, arranged their own out of programme year following completion of core training. We have also forged a valuable link with a centre in Australia, which has taken one trainee for a year and is about to host a second. Finally, our trainees have a reproductive track record second to none – I won’t bore readers with statistics on maternity leave and flexible training.

Such variety comes at a price which, in 2008, led us to reconsider our position regarding out of programme activity and protected academic time. Despite overfilling our 42 places with 3 additional NTNs, we have been left with 11 unfilled registrar posts in the region. Only two LATs were in post at the start of August, and both have subsequently obtained substantive posts elsewhere.

This inevitably reduces goodwill amongst trainers, some of whom have already been generous in releasing trainees to start or extend research at inconvenient times. It puts an extra strain on the remaining registrars in geriatrics, as well as those in other specialties taking part in on-call rotas, and reduces subspecialty training opportunities due to pressure of service work.

As a result of the current pressures, our regional training committee (which includes four trainee representatives) reluctantly decided to disallow further out of programme activities that do not count towards training. We have also reduced the weekly protected academic time from 2 sessions to the minimum 4 hours stipulated in the new curriculum. Trainees can apply for an additional session if they can justify it and produce tangible results. We remain fully supportive of those undertaking research leading to a doctorate and of other training that is recognised as counting towards their CCT.

The forecast for next year looks better, as a number of wanderers return to the fold. We want to keep a degree of flexibility that allows our trainees to develop into well-rounded individuals with the enthusiasm and skills that are developed through academic work, experience overseas and other forms of out of programme activity. We do not want to be a mere production line for adequately trained NHS doctors.

Roger Jay
Newcastle upon Tyne

BGS Newsletter, March 2009
Issue 20 ISSN 1748-6343 20