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The outcome of specialist registrars in the southwest region
  1. MARY McGRAW, Regional advisor in paediatrics and chairman of the southwest regional paediatric training committee

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Editor,—The UK national directive is to increase consultant paediatric numbers substantially over the next 5–10 years which requires the delivery of suitably trained doctors. Higher specialist training in paediatrics is five years and there is a concern that the current number of trainees will produce more consultants than there are posts, so trainee numbers will still have to be reduced. The southwest regional training committee has expressed concern that trainees are not completing training within five years for a variety of reasons. We therefore reviewed the training times and outcome of the 90 specialist registrars (SpRs) who have trained in our region since the introduction of the Calman training scheme.

The impact of the high proportion of women entering paediatrics needs to be addressed. Our review confirms that 29% of trainees are training flexibly, which will increase their training time for anything up to 10 years. All these are in the flexible training scheme that requires at least five sessions per week. In regions where trainees have access to the retainer scheme and train for only two sessions per week, training times will be even further extended. Also our training committee is concerned that five SpRs have resigned before completing training. Four of these are women who resigned because, despite working part time, they felt that the career process was incompatible with family life.

Of the trainees who trained flexibly and who have obtained consultant posts, four have chosen to work as part time consultants. The other two would have done so had the opportunity been available. Female trainees will take longer to train, both because of flexible training and also time out for maternity leave. Moreover, every trainee will not necessarily translate into one whole time equivalent consultant.

In our region 47% of trainees are having their Certificate of Completion of Specialist Training (CCST) date reviewed; the average time for them to complete a five year CCST programme based on current calculations is 6.3 years. Reasons include sickness, maternity leave, time out to undertake essential training in specialties other than paediatrics (for example, anaesthetics for those training in paediatric intensive care), and flexible training. We do not operate a lenient policy for out of programme experience (OOPE) or leave of absence. We allow OOPE only for experience that will count towards training. No more than one year is allowed except for those entering an MD or PhD programme, and only four trainees have taken more than one year for research prior to CCST. Moreover, we insist that training in locum appointment for training (LAT) posts in our own region in core paediatrics does count towards CCST. Therefore, in other regions where more liberal policies are operated, or there are more trainees in research posts, training times may be even longer.

Having obtained their CCST, only half of our trainees have currently obtained consultant posts; 75% of the remainder have sought training elsewhere as post-CCST PhD training, lecturer posts, fellowships abroad, or training in another specialty. Therefore the total average training time is further extended. The remaining 25% are locum consultants awaiting a suitable post becoming available. All are geographically restricted and some are also specialty restricted.

Our review would therefore suggest that there is a considerable discrepancy between the number of national training numbers issued and the numbers of doctors wishing, or eligible, to take up consultant posts five years later. These issues need to be taken into consideration in manpower planning and in designing the national service framework for the future.