A Pain Medicine view on Shape of Training and Credentialing

The Shape of Training project was begun in the spring of 2012 with the appointment of Professor David Greenaway, but has its background in various changes in training and workforce beginning with the Calman report on education in the early 1990s; the establishment of the Postgraduate Medical Education board (PMETB) in 2005, unifying medical education in an arm’s length governmental body; Professor Tooke’s report Aspiring to Excellence in 2008; and the re-organisation and re-focusing of the General Medical Council in the 2000s, which absorbed PMETB in 2010.

The review was essentially aimed at examining the fit between patient needs and the current training schemes and workforce, with focus on the areas of generalists/specialists, training flexibility and training/service issues. The review took evidence over a 4 month period from November 2012 to February 2013, and produced its report in the October 2013.

There are 19 key recommendations and 20 Key Messages (although some of the discussions often mix and match the two). The most notable are:

  • Full registration should occur on completing undergraduate studies.
  • Increasing emphasis on generic training and the management of the acutely ill.
  • Training to have increased consideration for local needs, but within the framework of UK wide training standards.
  • The development of 'credentials' to support specialty and subspecialty development.

Credentialing is an idea that has been in development from the GMC since 2010, and it is probably no coincidence that subspecialty recognition has been on hiatus since shortly after the project began to be piloted.  The rest are less specific in terms of the current situation, with emphasis on patient involvement in training and education and the development of generic skills in training. Having said that, the document goes on to describe its ideas of how these could be implemented in considerable detail, some of which are quite different from the current systems. A number of concerns were raised, both by some of the original stakeholders to the process, and a number of other bodies who provided evidence or who are involved with or closely involved with medical training and trainees.

In February 2015, a UK Steering Group for Shape of Training (UKSGST), with a larger representation, was established to “consider the proposals and make recommendations”.

In the Summer of 2015 two scoping papers were circulated. The UKSGST issued a mapping exercise that asked questions relating to the functioning of the training scheme and the place of generic and cross specialty issues. The College and Faculties provided a combined response, which broadly supported the current scheme, recognising ACCS as an example of cross specialty generic training already in action. Within Pain Medicine we emphasised the value of training within a pre-CCT environment linked to Anaesthesia, but recognised that training to deal with Pain is fundamental to all areas of medicine. In the undergraduate sphere we have been working with medical schools on dedicated undergraduate training. In the postgraduate arena generic and cross specialty activities would be easily accommodated. In regards to workforce, and particularly the push towards increased weekend activity, it was recognised that Acute and Chronic pain services are understaffed with consequent risks to discharge and return to work policies.

The GMC also put out a separate consultation on credentialing. There remain numerous issues of governance, finance, standards and revalidation, which affect both the individual doctor, the hospitals and the Credentialing bodies which were left unclear.  The Faculty submitted a response to this which, whilst noting the potential benefits of a robust credentialing system, delineated all the unanswered and problematic questions that credentialing would generate.

The report from the Academy of Royal Colleges feedback to the UKSGST covers similar ground, with an equally cautious approach to the credentialing issue.

The process continues.

Dr Barry Miller
Vice-Dean, Faculty of Pain Medicine


03 February 2016