Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London
Editor – we read with interest the article Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London’ from Gowland et al.1
Most specialties are facing recruitment issues, with acute specialties the hardest hit. Therefore, in intensive care medicine (ICM) and anaesthetics we greatly sympathise with acute internal medicine's (AIM) difficulties of both recruitment and retention. When the Faculty of Intensive Care Medicine designed the ICM CCT programme, we recognised the importance to patient management of AIM and made sure that 12 months were set aside for hands-on medical experience.
We would fully support the wish to include more ICM exposure in the core programmes of medical trainees. However, the optimal time and structure required for trainees to gain something beneficial from that exposure would be specific objectives achieved over a (minimum) 3-month period.
Such training opportunities have been strengthened by the acute care common stem (ACCS) programme, which has given trainees a truly broad experience. Preparing doctors to manage a wide range of clinical situations has significantly improved the effectiveness of the acute pathway in hospitals. We see this as an immense benefit to all of our patients’ journeys, and it is their needs and the needs of our services that should be at the heart of training programmes. ACCS has shown itself as fit for purpose by producing doctors who are multiskilled and able to manage patients, door to discharge.
It would, therefore, be a shame for doctors and patients if AIM opted out of ACCS based upon concerns that trainees may see that the grass is greener elsewhere. There is a growing move, both through national initiatives like Shape of Training and through the local tenacity of doctors themselves taking advantage of standalone fellowships, to ensure that training careers have flexibility. The challenge for all acute specialties is to counter any demoralisation with improvements in training and support. If the elements of pastoral support and mentorship found in ICM and anaesthetics are attractive to trainees, it would be invaluable to see how similar initiatives could enhance AIM training. We would hope that there is merit seen in reviewing how the medical components of ACCS acute medicine could be uplifted in this way before, to use the trending phrase, a ‘conscious uncoupling’ happens.
Conflict of interest
The authors have no conflicts of interest to declare.
- © Royal College of Physicians 2017. All rights reserved.
References
- Gowland E
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