Memorandum from the Postgraduate Medical
Education and Training Board (PMETB)
1. INTRODUCTION
PMETB welcomes the opportunity to provide
evidence to the Defence Committee's Inquiry.
1.1. Background to PMETB's role
To set this in context PMETB:
— Took up its statutory responsibilities
on 30 September 2005.
— Subsumed the functions of
two Competent Authorities: The Specialist Training Authority of
the medical Royal Colleges (STA) and the Joint Committee on Postgraduate
Training for General Practice (JCPTGP).
— Has a remit which extends
across all four nations of the UK.
— Has responsibility for postgraduate
medical education and training. Undergraduate medical education
is the responsibility of the GMC.
1.2. PMETB's legal responsibilities
The principal functions of PMETB, as
set out in the Statutory Instrument made on 8th May 2003—The
General and Specialist Medical Practice (Education, Training and
Qualifications) Order 2003 are to:
— Establish standards of postgraduate
medical education and training.
— Secure those standards and
requirements.
— Develop and promote postgraduate
medical education and training in the UK.
— Accredit training in hospital
and general practice to meet PMETB standards.
— Issue (or refuse) Certificates
of Completion of Training or eligibility for specialist registration.
1.3. PMETB's statutory objectives
are to:
— Safeguard service users.
— Ensure the needs of those
undertaking training are met.
— Ensure the needs of employers
are met.
1.4. PMETB also has a statutory duty
to cooperate with:
— The General Medical Council.
— Any other body that appears
to it to be representative of the medical Royal Colleges in the
UK.
— Any other body that may be
specified by the Secretary of State.
2. GENERIC
STANDARDS COVERING
ALL POSTGRADUATE
MEDICAL TRAINING
2.1. In April 2006, PMETB
published the Generic Standards for Training. The standards:
— Apply across the health sector
in all places where postgraduate medical training is provided
ie NHS, independent environments and military establishments.
— Cover all postgraduate training
programmes after the end of the 2 year Foundation programme (which
happens after undergraduate training) for all specialties, including
general practice.
— Are relevant to all medical
specialties and sub specialties.
— Are designed to run alongside
PMETB's Standards for Curricula and the Principles for an Assessment
System for Postgraduate Medical Training.
— Form the basis of the quality
assurance process with postgraduate deans.
2.2. The standards are built
around eight domains:
— Quality Assurance Review and
Evaluation.
— Equality, Diversity and Opportunity.
— Recruitment, selection and
appointment.
— Delivery of curriculum including
assessment.
— Support and development of
trainees, trainers and local faculty.
— Management of Education and
Training.
— Educational resources and
capacity.
3. TRAINING
IN WAR
ZONES
The legal framework governing postgraduate training
and certification
3.1. Doctors who have undertaken
and satisfactorily completed specialist or GP postgraduate training,
in programmes approved by PMETB, may be awarded a Certificate
of Completion of Specialist Training (CCT) by PMETB. Doctors who
do not have a CCT may not legally work in general practice or
take up consultant posts in any medical specialty in the NHS.
Other doctors who have not completed UK training programmes but
who demonstrate that their specialist training, qualifications
and experience are equivalent to CCT standards may be approved
for entry to the Specialist Register. CCT holders and those approved
for specialist registration have equal status.
3.2. The legislation governing
certification and postgraduate medical training—the General
and Specialist Medical Practice (Education, Training and Qualifications)
Order 2003—requires that all UK training undertaken for
the award of a CCT is supervised and carried out in units and
posts specifically approved and recognized for training purposes
by PMETB. The legislation states that training may be interrupted
in specific circumstances including military service. This, we
understand, was primarily meant to cater for the one-year national
service which is still compulsory in certain EU countries and
often comes at the beginning of a doctor's training. Inevitably,
however, the continuity of planned CCT training for those in postgraduate
training can be affected, particularly for reservists called up
at short notice eg Afghanistan, Iraq. PMETB are clear that, as
far as possible, individuals should not be unnecessarily disadvantaged
as a result of their contribution to the military effort. Therefore,
arrangements first introduced by PMETB's predecessor—the
Specialist Training Authority—in liaison with the Defence
Postgraduate Medical Dean, were adopted to ensure that as much
relevant training time as possible, whilst on deployment, could
be counted towards trainees' CCT training programmes.
So what steps were taken to safeguard UK postgraduate
trainees deployed as a result of military action?
3.3. It was agreed that that
those called up should have their overseas placements prospectively
approved as a matter of course but that their actual time on deployment
should be reviewed retrospectively, on the trainee's return, so
that any relevant training could be counted towards CCT requirements
and any training gaps identified. In practical terms PMETB provides
the following advice to trainees affected:
— individuals should maintain
activity reports or College training logs whilst away;
— military consultant supervisors
must assume the role of trainer and assist in the continuity of
training;
— in-house training, lectures
and other related activity should available;
— military consultant supervisors
must complete assessments at the end of the trainees' deployment—preferably
on College or Joint Committee forms—to cover the whole deployment
period; and
— Postgraduate trainees must
return to approved NHS training posts for a minimum of six months
before the award of their CCT. This will enable an assessment
of their progress, or otherwise, against CCT training programme
standards to be made for the periods on deployment and the necessary
sign- off processes completed.
3.4. Subject to the effective
operation of these safeguards, trainees should be able to provide
their next assessment panel with seamless evidence of their involvement
in relevant training whilst deployed. On return to a training
programme in the UK, following any periods of military deployment,
trainees' records would need to be reviewed on an individual basis
and any gaps in the training identified and covered during the
next training rotation or, if this is not possible, by extending
the expected date for CCT certification.
How can others who have not completed a full UK
training programme but have gained relevant experience as a result
of military deployment, have that experience taken into account?
3.5. As mentioned earlier
in this submission, doctors who have not undertaken or completed
a programme of postgraduate training in the UK may be considered
for specialist registration. Under the Certificate Confirming
Eligibility for Specialist Registration, PMETB assesses applications
for Specialist Registration from those doctors who have not followed
a UK specialist training programme that leads to a CCT but who
may have gained the same level of skills and knowledge as CCT
holders. A similar route applies to those in general practice—the
Certificate confirming Eligibility for GP Registration. These
are sometimes referred to as the "equivalence routes".
3.6. It is therefore open
to a doctor, who wished to apply through one of these routes,
to provide evidence to show that their specialist qualifications,
specialist training and experience—which could include time
spent on military deployment—were equivalent to a CCT.
15 June 2007
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