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The Department of Health publications on modernising medical careers1,2 sets out principles for the reform of postgraduate medical education, following the consultation document Unfinished Business published by the chief medical officer in 2002.3 Although focusing on the senior house officer (SHO) grade, the last of the training grades to be reformed, MMC has far reaching implications for medical education and training, including the introduction of a new foundation grade.
Foundation programmes will encompass the current pre-registration house officer (PRHO) year (which is currently under review again by the General Medical Council) and a second year, F2, equivalent to first year SHO. The first F2 pilots were introduced in August 2003; pilot F2 rotations were developed by most acute trusts in 2004. An important objective of foundation programmes is the development and enhancement of core or generic clinical skills essential for all doctors. These include competence in the assessment and management of critically ill patients, good communication, teamworking, time management, high standards of clinical governance, and expertise in using evidence. The recently established NHS university (NHSU) offers an e-learning facility designed to support the MMC foundation curriculum.
Foundation programmes should be trainee centred, competency assessed, service based, quality assured, flexible, coached, structured, and streamlined. They “must widen rather than narrow options and choices and provide doctors in training with a broader perspective of medicine as a whole.”2 From August 2005 medical training should start with a 2 year foundation programme; trusts, deaneries, and medical schools will need to match current PRHO posts (F1) with equivalent numbers of F2 programmes, and develop suitable F2 rotations by 2006. This provides an opportunity for genitourinary medicine (GUM) and sexual health.
Experience of GUM at foundation level has many potential advantages both for trainees (for example, clinical experience relevant to many subsequent career choices; better understanding of HIV issues; communication skills; multiprofessional teamworking) and for the specialty (for example, possible career choice; sexual health skills for those becoming GPs). Trainees recently published their positive views on their experience of GUM in an F2 pilot “taster” programme in north Warwickshire.4
F2 programmes often consist of three 4 month placements, and should include some general practice exposure. Unfortunately, additional funding for new F2 posts is generally unavailable, except to match expansion in numbers of medical trainees in recent years. Therefore, F2 programmes are usually constructed by incorporating existing posts, mostly stand alone SHO posts, trust grade posts (thereby conferring educational recognition), or new GP placements. Incorporating GUM into foundation programmes is therefore a challenge, because the specialty is under-represented at SHO level.
We would strongly encourage our colleagues in the specialty to consider how GUM can be included in foundation training. The West Midlands deanery has included formal 4 month placements in GUM. In one rotation, this is with general practice and trauma and orthopaedics; the exact specialty mix should not be crucial as the foundation programme is intended to provide a range of basic skills regardless of specialty mix and future career choice. An alternative, successfully introduced in Oxford, is to provide GUM experience to foundation trainees during their GP placement. Such exposure may help to develop GPs (and other doctors) with an interest in sexual health, in keeping with the national strategy.5
Colleagues in the specialty who are interested in providing GUM placements in foundation training programmes can raise the issue with postgraduate deans, GP deans, associate deans with responsibility for MMC/foundation training, district clinical tutors, or trust MMC leads. Basic training in sexual health principles should be regarded as a core skill of relevance to all foundation trainees. It is in the interest of the specialty to grasp the opportunity now, while foundation programmes are being developed to establish GUM in early postgraduate training as widely as possible.
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