Chief medical adviser unveils overhaul of 'poorly planned' doctors' training

The Chief Medical Officer unveiled long-awaited reforms for the training of medical graduates yesterday, admitting the present system was often poorly planned, badly supervised and fragmented.

Sir Liam Donaldson saidstandards were frequently indifferent and declared that, under the proposed reforms, all junior doctors would receive three years of well structured training in hospitals.

He was referring to a Department of Health report on proposals aimed at modernising on-the-job training for about 19,000 senior house officers (SHOs) by making it more focused and relevant.

Sir Liam said: "This report offers the exciting prospect of a completely new approach to SHO training, bringing the benefits of structured training and professional development to a group of doctors whose needs have not been properly met in the past."

Most graduates spend a year as a pre-registration house officer before applying for an SHO post, which is supposed to provide broad-based hospital training. But Sir Liam's report acknowledged that "half of all SHO posts are short-term and do not form part of any training rotation or programme".

Training is often poorly planned and has no fixed ending date so that SHOs cannot plan their next career move. The workload is increasing and supervision, appraisal and career advice is inadequate, the report says

Under the new scheme, medical graduates will immediately start a two-year foundation course during which they will develop core clinical and people-management skills. They will then complete one of a series of eight specialist training schemes, each lasting about a year. The courses will include general practice and specialties including child medicine or general surgery. After these courses, doctors will be able to decide whether to become GPs or remain as hospital doctors, in which case they would enter higher specialist training.

Under the plans, this higher specialist training could be shortened to allow doctors to apply for consultant posts at an earlier stage. Critics said yesterday this amounted to a "junior consultant post" or sub-consultant grade, which could reduce the quality of care provided to patients. But the claim was denied by the Department of Health.

The Royal College of Physicians said the report addressed "the lost tribe" of SHOs, who because of the reduction in junior doctor hours were "increasingly inexperienced and less well trained".