Developing a charter for doctors in training: a personal perspective

My first days as a fellow at the Academy of Medical Royal Colleges were bewildering.  It was a world away from the familiar clinical environment; I had my own desk, my computer booted up almost immediately and limitless tea drinking opportunities were at my disposal. On the down side, I didn’t have a clue what I was supposed to be doing.  I had talked to friends who did office jobs, but usually ended up nodding attentively to cover up the fact that I was still unable to grasp what their day consisted of. Suddenly here I was in the black box of the ‘office’. Whereas previously I had been content to think of people entering this box on one side and work emerging magically from the other end, I was now obliged to decode the actual mechanics of the office experience.  To cover my bemusement I limited myself initially to moving icons around my desktop, hoping the answer would come to me once I had organised them in to a neatly regimented grid. It didn’t.

As time passed I became more familiar with this alien environment and my diary began to fill up with innumerable meetings with strange entities called stakeholders.  Who were these exotic creatures?  What did they want and how was I supposed to interact with them? First I needed to learn the lingua franca of this brave new world; to know my burning platform from my disruptive innovation.

Once I had started to settle in and acquire the necessary vocabulary, I was offered a really exciting project: To lead on a Health Education England workstream as part of the Better Training, Better Care Programme entitled ‘The Role of the Trainee’.  This sounded like something to get my teeth in to.  Not a fully defined project as such, but a series of recommendations from two major reports into postgraduate training; Temple’s consideration of the impact of the 48 hour working week and Collins’ inquiry in to the effectiveness of the nascent Foundation Programme.  The emphasis was on me to help shape the response. It was exciting to be given such freedom and responsibility, but daunting too.

Modernising Medical Careers turned the old order on its head, replacing familiar terms such as house officer and registrar with a befuddling jumble of letters and numbers.  More fundamentally it also signalled a shift to greater structure in the early years of the medical career following qualification, with more emphasis on training alongside service provision. Collins called for a consensus statement from all organisations involved in postgraduate medical education to define the role of these new ‘FY docs’.

I was fortunate to be supported in my new role by the excellent team at the Academy, as well as benefitting from the forum provided by the Academy’s Trainee Doctors’ Group, which brings together representatives from trainee groups across the specialty spectrum.   On reflection we thought, why just limit this to the Foundation Programme? The Royal College of Physicians of Edinburgh trainee group highlighted an excellent piece of work that they had done to create a Charter for Postgraduate Medical Training.  This was perfect.  Why reinvent the wheel?  We decided to use this as a basis for an Academy Charter that would speak to all specialties and grades.

Cat Stevens sang that ‘The first cut is the deepest’, but if he had been involved in writing policy he may have modified that to ‘The first draft is the hardest’.  The tyranny of the blank page requires considerable effort to formulate some initial ideas.  Once the sacrificial ‘straw man’ had been assembled, it was time to send him forth to meet those stakeholders. We consulted as widely as possible, aiming to involve everyone with a role to play in postgraduate medical education, across the four nations of the United Kingdom.

Incrementally incorporating the various comments and insights from the consultation immeasurably strengthened the Charter.  It brought balance and a multitude of perspectives to the manuscript, to ensure that the document that finally emerged had the endorsement of all relevant organisations.

Looking back on my year at the Academy from those uncertain early days to more confident later months, I count the Charter as something that I am most proud of.  It was a privilege to be involved in creating something that defines what it is to be a trainee.  The challenge now is to get it out there, for it to be used to improve training and patient care.

To read the charter please follow this link: www.aomrc.org.uk/doc_details/9750-a-charter-for-doctors-in-training-value-of-the-doctor-in-training.