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    Foundation programme is changing - interesting read for medical students.

    http://www.stfs.org.uk/sites/stfs/fi...0-%20Draft.pdf
    http://hee.nhs.uk/wp-content/uploads..._V15-Final.pdf

    Brief overview:

    1) Cut numbers of surgical and some medical FY1/FY2 posts !

    "In terms of the redistribution of posts from specific specialties, it is likely that posts will move from surgery and, to a lesser extent, from medicine."

    "retaining trainees, particularly in surgery, by converting some of their placements into integrated and community-facing placements"

    2) target of 45% target for foundation doctors to do 4 month psychiatry post (22.5% FY1, 22.5% FY2)

    3) target of 100% for everyone to do an 'intergrated placements' or 'community placements' by 2017

    4) Other 'professionals' to take over the roles of junior doctors so they can do community placements

    This is the most interesting part:

    If posts are going to move away from acute trusts, how will the workload be covered?

    "It is unlikely that new training posts will be available, so other types of staff will be needed, both to cover the workload and prevent impact on other doctors in training. The skill mix of the staff needed will obviously depend on the workload to be covered. Activities such as prescribing or discharging patients would need senior nurses (band 7 or above) or physician associates. Foundation doctors often spend considerable amount of time on inappropriate duties such as routine phlebotomy and clerical work, much of which can be supported by staff in bands 1-4."

    Thoughts ?

    From experience the major problem is that juniors and SHO rotas are understaffed in surgery and medicine, throughout the country, so cutting these posts seem short sighted the jobs will only get worse for juniors. The hospital is bankrupt and in a recession and band 7 nurses and physician associates (which cant prescribe!) are very expensive. There is no money to get even basic assistants for cannula/bloods in most places so I think it will be a bad time to be a FY1/FY2, especially in surgery. Yet another reason not to do core surgical training if you havent already changed your mind !!
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    (Original post by Revenged)
    Foundation programme is changing - interesting read for medical students.

    http://www.stfs.org.uk/sites/stfs/fi...0-%20Draft.pdf
    http://hee.nhs.uk/wp-content/uploads..._V15-Final.pdf

    Brief overview:

    1) Cut numbers of surgical and some medical FY1/FY2 posts !

    "In terms of the redistribution of posts from specific specialties, it is likely that posts will move from surgery and, to a lesser extent, from medicine."

    "retaining trainees, particularly in surgery, by converting some of their placements into integrated and community-facing placements"

    2) target of 45% target for foundation doctors to do 4 month psychiatry post (22.5% FY1, 22.5% FY2)

    3) target of 100% for everyone to do an 'intergrated placements' or 'community placements' by 2017

    4) Other 'professionals' to take over the roles of junior doctors so they can do community placements

    This is the most interesting part:

    If posts are going to move away from acute trusts, how will the workload be covered?

    "It is unlikely that new training posts will be available, so other types of staff will be needed, both to cover the workload and prevent impact on other doctors in training. The skill mix of the staff needed will obviously depend on the workload to be covered. Activities such as prescribing or discharging patients would need senior nurses (band 7 or above) or physician associates. Foundation doctors often spend considerable amount of time on inappropriate duties such as routine phlebotomy and clerical work, much of which can be supported by staff in bands 1-4."

    Thoughts ?

    From experience the major problem is that juniors and SHO rotas are understaffed in surgery and medicine, throughout the country, so cutting these posts seem short sighted the jobs will only get worse for juniors. The hospital is bankrupt and in a recession and band 7 nurses and physician associates (which cant prescribe!) are very expensive. There is no money to get even basic assistants for cannula/bloods in most places so I think it will be a bad time to be a FY1/FY2, especially in surgery. Yet another reason not to do core surgical training if you havent already changed your mind !!
    That is interesting. I didn't do a psych job although I guess public health counts as community.

    I agree that its going to get harder for juniors as its pretty clear that just because there are less doctors doesn't mean there will be enough people to do the work. I can see it being even worse for juniors trying to get surgical experience. I know it varies but my surgical F1 job was really busy. I rarely went anywhere near theatre unless it was to tell the boss that one of his patients was really unwell.

    I can't see this affecting O&G as much as other areas but I'll eat my hat if it doesn't negatively impact on hospital training. I guess i'm biased because I always wanted to do a hospital specialty so wasn't particularly bothered about doing community based things.
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    There's certainly some proper pie in the sky stuff here, I especially like the bit where they magic up extra staff to cover the junior doctor workload so we can do whatever it is F1's on psych actually do.

    Nowt I can do about this, other than score highly and get my pick of the jobs, so as a 2015 graduate I'm just going to have to grin and bear it.
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    It might affect you in o&g, at my hospital the supernumerary o&g fy1 post became surgery fy1 as more were needed.

    It seems quite a savage attack on surgical trainees, I am not sure as to why. given surgical core trainees posts are being cut and now foundation are as well - what is going to happen is anyone guess as there is a big loss of doctors.

    In my hospital the 'solution' was to fill theses unfilled posts with gp vts trainees. In my hospital they made many gp vts do 4 months general surgical posts which adds nothing to their training when many never did psychiatry. This is what will happen to fill the unfilled surgical posts - no way will there be band 7 nurses or other noctors being employed - I am sure they will just get gp vts to fill the gap.
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    Foundation doctors often spend considerable amount of time on inappropriate duties such as routine phlebotomy and clerical work, much of which can be supported by staff in bands 1-4
    Insert every 'that's obvious' meme ever here.

    Perhaps finally acknowledging that is encouraging though. I mean, how much does a phleb get paid? Surely not much. Employ one, take away 90% of bloods duties and that could indeed free up time for FY1s to do actual medicine (read: TTOs).
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    (Original post by nexttime)
    Insert every 'that's obvious' meme ever here.

    Perhaps finally acknowledging that is encouraging though. I mean, how much does a phleb get paid? Surely not much. Employ one, take away 90% of bloods duties and that could indeed free up time for FY1s to do actual medicine (read: TTOs).
    Most trusts have routine phlebotomy services who already do >90% of blood tests. Junior doctors generally should only be doing urgent ones out of hours, or difficult ones the phlebs couldn't do. I have worked in one or two places where they had 24 hour cover with more advanced phlebotomists who could also cannulate, so junior docs had to do even less of that. But it is still a core skill which anyone in hospital medicine should maintain to some degree.

    Streamlining requests/referrals/discharge letters would save a whole lot more time.
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    I personally did not mind bloods, cannulas - it is not an 'inappropriate job' at all.

    Most of house officer work is just admin. Copying blood results into a blood folders for 40 patients, took an hour a day, and it was a pointless as they were on the computer already.
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    (Original post by Helenia)
    Most trusts have routine phlebotomy services who already do >90% of blood tests.
    The frequency to which they mysteriously disappear and the juniors have to to 16+ bloods in Oxford is pretty amazing. Plus the restrictions placed on phlebs are absurd (only allowed one attempt, not allowed to go even an inch away from the ACF).

    But it is still a core skill which anyone in hospital medicine should maintain to some degree.
    Not in most countries.

    (Original post by Revenged)
    I personally did not mind bloods, cannulas - it is not an 'inappropriate job' at all.
    I disagree. You don't need 6 years of med school training to take blood.

    Of course admin is going to be the bigger workload... it just seems like e.g. TTOs are written by doctors for a reason. Bloods on the other hand can be easily exported, as virtually every other country in the world does. I'm sure there is plenty of redundant admin out there too though.
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    I personally did not mind bloods, cannulas - it is not an 'inappropriate job' at all.
    But it is still a core skill which anyone in hospital medicine should maintain to some degree.
    Not in most countries... You don't need 6 years of med school training to take blood.
    Interesting. On placement earlier this year with some students from the American University of the Caribbean:
    BT: How do we compare with doctors in the US?
    AUC student: Well you guys are very hands on here. Bloods, cannulas... in the US the nurses do all of that".
    BT: No bloods or cannulas?!

    I said that was crazy. In hindsight that's probably quite a British skew on what constitutes playing doctor.

    Anyway, as has already been said, we could go down the US route with extra phlebs, PAs and the like, but with what money?

    Finally, this tidbit in the background report to the actual report caught my eye:

    The educational policy context: the recommendations
    of Professor John Collins
    • The Foundation Programme “should remain at two years for the present and be
    reviewed in 2015”

    As if 'training' in this country wasn't long enough :lolwut:
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    (Original post by Blatant Troll)
    Interesting. On placement earlier this year with some students from the American University of the Caribbean:
    BT: How do we compare with doctors in the US?
    AUC student: Well you guys are very hands on here. Bloods, cannulas... in the US the nurses do all of that".
    BT: No bloods or cannulas?!

    I said that was crazy. In hindsight that's probably quite a British skew on what constitutes playing doctor.

    Anyway, as has already been said, we could go down the US route with extra phlebs, PAs and the like, but with what money?
    Its not just the US - its pretty much everywhere apart from the UK that taking blood is a nurses thing to do. And they're much better at it - some of them have 20 years experience as opposed to every single year making new bungling med students/FY1s make a mess of patients as they learn only for them to stop doing them entirely two years later.

    Paying doctors to take blood is the expensive waste of money, not the other way around. If training is made more like actual training rather than being an expensive secretary/phleb then you could make it shorter and save money.

    Finally, this tidbit in the background report to the actual report caught my eye:

    The educational policy context: the recommendations
    of Professor John Collins
    • The Foundation Programme “should remain at two years for the present and be
    reviewed in 2015”

    As if 'training' in this country wasn't long enough :lolwut:
    Are you sure he wasn't implying it should be shorter? Given the other recommendations that would seem more logical to me. Or if it is made longer, it would surely be compensated by shorter CT/ST training (in line with the more generalist less specialist mantra).

    Making it longer would be pretty crazy. Again, look at other countries with their 4 years post-med school consultants...
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    Completely agree with the first part. The second part, I don't see how training could be made shorter. Someone's still got to do the scut work, and junior doctors are still easy rota fodder. Meanwhile GPs are already looking at 4 years training, and on the hospitalist side of things, this Broad Based Training malarky before more traditional CT/ST also makes training longer. Unless they subsequently integrate and lop time off a more generalist top end as you say, which might be a reasonable assumption given the spirit (if not the letter) of SoT.

    It would be crazy in comparison to other countries, but then service comes before training here, which is definitely the letter of SoT. And on the subject of consultants, whether you could call the end result of all this a consultant is debatable in itself.
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    I am literally gobsmacked by this document lol, I cant think of a more out of touch list of suggestions....when I am getting 10 locum emails a day to cover staffing issues at my hospital alone, the answer is to employ lots of band 7 nurses to do prescribing! Brilliant idea

    45% of docs to do psychiatry...just lol

    when MAUs around the country often have 12 hour waiting times to see a junior doctors the answer is so put all medics on some out of hospital placement for a while....

    Keep training numbers the same? Good luck training your surgeons when they are on the wards instead of theatre to do that tricky cannula cos phleb can only try once and not in the same arm as a drip. ..or to correctly prescribe in a multi organ system patient when the surgical nurse practitioner doesn't know how to deal with something non surgical..

    SO glad I've finished F2 as of next week...you poor *******s in 2015 should really consider moving abroad
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    (Original post by Fission_Mailed)
    There's certainly some proper pie in the sky stuff here, I especially like the bit where they magic up extra staff to cover the junior doctor workload so we can do whatever it is F1's on psych actually do.

    Nowt I can do about this, other than score highly and get my pick of the jobs, so as a 2015 graduate I'm just going to have to grin and bear it.
    You're worried about not getting those surgical/medical posts?

    Having done surgery and medicine as an F1, I could have spent those 8 months working in a fish and chip shop and I probably would have learnt more medicine.

    The main objective of FY1, particularly in these jobs, is to somehow try and retain the knowledge you learnt at medical school whilst spending a year writing discharge summaries, signing drug charts and taking notes on ward rounds. You won't be missing much.
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    (Original post by Ciaran88)
    You're worried about not getting those surgical/medical posts?

    Having done surgery and medicine as an F1, I could have spent those 8 months working in a fish and chip shop and I probably would have learnt more medicine.

    The main objective of FY1, particularly in these jobs, is to somehow try and retain the knowledge you learnt at medical school whilst spending a year writing discharge summaries, signing drug charts and taking notes on ward rounds. You won't be missing much.
    I don't doubt that it's going to suck, the best I can do is put myself in the position to get my choice of the suck.
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    (Original post by Ciaran88)
    You're worried about not getting those surgical/medical posts?

    Having done surgery and medicine as an F1, I could have spent those 8 months working in a fish and chip shop and I probably would have learnt more medicine.

    The main objective of FY1, particularly in these jobs, is to somehow try and retain the knowledge you learnt at medical school whilst spending a year writing discharge summaries, signing drug charts and taking notes on ward rounds. You won't be missing much.
    Mate, not to be rude but why are you still here if you hate medicine so much?
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    (Original post by Carpediemxx)
    I am literally gobsmacked by this document lol, I cant think of a more out of touch list of suggestions....when I am getting 10 locum emails a day to cover staffing issues at my hospital alone, the answer is to employ lots of band 7 nurses to do prescribing! Brilliant idea

    45% of docs to do psychiatry...just lol

    when MAUs around the country often have 12 hour waiting times to see a junior doctors the answer is so put all medics on some out of hospital placement for a while....

    Keep training numbers the same? Good luck training your surgeons when they are on the wards instead of theatre to do that tricky cannula cos phleb can only try once and not in the same arm as a drip. ..or to correctly prescribe in a multi organ system patient when the surgical nurse practitioner doesn't know how to deal with something non surgical..

    SO glad I've finished F2 as of next week...you poor *******s in 2015 should really consider moving abroad
    I found your post interesting because I read it thinking you were very lucky. You actually worked in a hospital where phlebotomists do cannulas, in my hospital it was mostly only doctors and I would be amazed to see this. Also I am amazed they do employ band 7 practitioner nurses, which is very interesting to see patients on wards. What actually did a 'surgical nurse practitioner' do on the ward ?

    I think the push for more doctors to do psychiatry is a reaction to the low numbers of UK doctors picking it. As we see the numbers picking jobs is variable and psychiatry has improved its numbers even without the push to push foundation doctors from surgery to psychiatry so I am not sure it is needed now in such numbers. GP and surgery figures have dropped again. I think the poor training experience (surgery) and media attention of crisis (A&E and GP) has influenced training preferences.

    As for surgery, I dont think any one with intelligence will pick surgery now knowing how much of a mess the training is in. It is a toxic combination of post-CCT unable to get consultant posts and having to do fellowship abroad, current trainees not being able to operate even simple procedures - shortened time in operating time with limited theatre experience, rotas where they are more service provision and now the current changes (shape of training review - 'broadening surgical training') and changes to foundation programme axing all their house officers with no replacement, it will no doubt get worse. I do not think it is all EWTD, I hate surgery with a passion and some of the fault must rest with the consultant surgeons especially some of the old school ones that make little to no effort to help their trainees, which is very common. I am however a bit more sympathetic now to their plite since they have to pick up the pieces of a broken system and have to carry out all the operating work which used to be done by more juniors in their era so I understand a bit now why the consultants were so frustrated there especially when having to come in to help SpR for a night shift then having to struggle through the next day. It is toxic combination in surgical world atm and somewhere I would advise everyone to avoid unless you are prepared for a hard hard life, the dream job in plastics / ENT will likely be unattainable !!

    As I understand it the current role is for all medicine will be much less affected by the change and employment chances is still very good. As I understand in broadening training everyone will be medics having to do the acute medicine role. There will no more be a neurology / histology / dermatology registrar / palliative care / rheumatology register being able to 'opt out' of there medical registar rota as an ST3 they do now. Most places already have rheumatology doing acute on call so I think the others will follow. I think this is an interesting development for people who are picking core medical training and pick out jobs as it means they dont have to be a medical registrar. In future with the changes to broaden training this will likely be possible so it is an interesting area if you are considering doing CMT and are not prepared to spend some time in a acute general medical registrar role. Will be very interesting to see how it all develops.
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    (Original post by Revenged)
    I found your post interesting because I read it thinking you were very lucky. You actually worked in a hospital where phlebotomists do cannulas, in my hospital it was mostly only doctors and I would be amazed to see this. Also I am amazed they do employ band 7 practitioner nurses, which is very interesting to see patients on wards. What actually did a 'surgical nurse practitioner' do on the ward ?

    .
    You misunderstood, phleb do bloods only where I am
    There are nurse practitioners in various specialties, most are very useful and appropriate like asthma nurses or diabetic nurses
    Surgical nurse practitioners depend on the specialty but cardiothoracic surgery for example they will pre op and harvest leg veins in theatre
    They do nothing on the ward and also do not do anything like the junior doctor role

    This plan will never ever work
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    (Original post by shiggydiggy)
    Mate, not to be rude but why are you still here if you hate medicine so much?


    etc. etc.

    (Original post by Fission_Mailed)
    I don't doubt that it's going to suck, the best I can do is put myself in the position to get my choice of the suck.
    God speed bro.
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    (Original post by Ciaran88)
    You're worried about not getting those surgical/medical posts?

    Having done surgery and medicine as an F1, I could have spent those 8 months working in a fish and chip shop and I probably would have learnt more medicine.

    The main objective of FY1, particularly in these jobs, is to somehow try and retain the knowledge you learnt at medical school whilst spending a year writing discharge summaries, signing drug charts and taking notes on ward rounds. You won't be missing much.
    I can't comment on your personal experience, but I honestly found F1 to be the steepest learning curve of my medical career to date - I felt I learnt more in the first month (albeit on an A&E rotation) than I did in my entire final year.
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    (Original post by Captain Crash)
    I can't comment on your personal experience, but I honestly found F1 to be the steepest learning curve of my medical career to date - I felt I learnt more in the first month (albeit on an A&E rotation) than I did in my entire final year.
    I didn't do A&E but I've heard it's a lot more hands on and requires you to learn a lot more.

    Medicine & surgery are usually just scut-fests. Even on calls, you're just filling in a clerking proforma, no time to think about the patient just fill it in ASAP then move on to the next one.
 
 
 
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