Postgraduate specialty training is changing

The last few years, particularly in the post-Covid era, has demonstrated that specialty training in many ways doesn’t meet the needs of resident doctors and doesn’t match the UK’s population demands.

In anaesthesia, recruitment into CT1 has grown increasingly competitive, creating a bottleneck which some have struggled to navigate. The difficulty of securing LED posts and the scarcity of locums often culminate in many years out of ‘training’, though with plenty of accrued experience that is difficult to credit.

This has been exacerbated by the frustrations of a training programme that, for many, feels increasingly devoid of training and solely about the provision of service. There is also a recognition that the demographics and values of our resident doctors are changing. We’re increasingly female, increasingly ethnically diverse, and increasingly less-than-full-time, whether female or male.

These are sentiments not just seen and experienced in anaesthetics, but across all specialties. The consequence of these increasingly heated frustrations was the announcement of the postgraduate medical training review in 2024, headed by Professor Steve Powis and Sir Chris Whitty.

Phase one

During phase one – dubbed a ‘listening exercise’ – the anaesthetist in training representatives and senior members of the training team attended a joint meeting with the Association of Anaesthetists and Powis and Whitty. This meeting, led by resident anaesthetists from both organisations, allowed us the opportunity to present our thoughts and suggestions for reform. We also collated previously published research and College reports, and provided our own formal response to be included in the evidence submission. The results of phase one, published last summer, concluded that reform was required as a matter of urgency. The need for flexibility in training is a clear priority, including recognising the training that occurs outside formal training posts. The report also highlighted the need to address recruitment bottlenecks. Many contributors lamented the decline of the ‘firm’, which has been compromised by short and frequent rotations. Therefore, the need to protect and value trainer time is crucial to ensure training is promoted and resident anaesthetists feel valued within their roles.

The conclusions of phase one are welcome but, I would argue, are not groundbreaking. It’s already evident that the needs of each specialty are too diverse to summarise in a single revamp. Thus, reform is likely to be broad and look different for different specialties.

Phase two

We’re now in phase two, which has begun with multiple focus groups (on which we have ensured anaesthetic representation) and a large amount of ‘blue-sky thinking’ to imagine what training could look like in an unrestricted world. What could we learn from international approaches to training? For example, could Trusts be judged on the exam pass-rates of their residents? Could we develop a training ‘passport’, collecting evidence in an order that suits the resident doctor flexibly over several years?

There is, however, an elephant in the room; this is an attempt to produce major reform in training without any more money. It’s difficult to see how its aims can be fulfilled – aims such as freeing up educators’ time at under-pressure Trusts – without at least some investment to do so. There has also been inevitable discussion about the role of AI, industry, and private healthcare in the future of medical training (read as: ‘how can we get others to pay for this’). Additionally, many are still burnt by the unintended consequences of previous reform programmes such as Modernising Medical Careers and The Shape of Training, which perhaps may water down the strength or the implementation of the review’s recommendations, whatever they may be.

In the meantime...

Many of us at the College feel that we had already begun trying to address some of phase one’s recommendations before they were announced. We’re already publishing guidance on reducing the number of rotations and increasing the flexibility of crediting experience outside of training. We won’t wait for this review to keep working on this, nor will we ever stop asking for more training places in the next workforce report to combat the 1,900 anaesthetists shortfall identified in our State of the Nation report. The sentiment of the review feels ambitious and hopeful; its implementation remains to be seen.

If you’ve been thinking about what you would like to see in the postgraduate medical training review, or if this article has prompted your own thoughts or concerns, please email us so we can incorporate your voices in the ongoing review.