Higher specialist training--teething problems. Working Minds Research Project.

An interview survey was conducted to ascertain the views of the first cohort of doctors in Scotland completing Higher Specialist Training under the new Calman arrangements. It was intended that this information would influence plans for the future training of Specialists in Scotland, building on strengths and addressing weaknesses. A team of interviewers saw 140 out of the 168 Senior/Specialist Registrars who were due to receive their Certificate of Completion of Specialist Training (CCST) in the year leading to August 1999. The response rate was 83 per cent. The median age of respondents was 34 years (range of 29-51 years), with a third of the cohort being female. Overall the doctors had spent between nine and 13 years in training after graduation with a median of 10 years by the time they entered their final year of higher specialist training. On average, eighteen months had been spent in another specialty. Psychiatry and Surgery stand out as specialties that trainees enter immediately after gaining full registration. Most of the doctors (84 per cent) wish to remain in Scotland for their career posts. Although the majority (69 per cent) plan to work full-time, two thirds of the women said they might or would work part-time in the future. When asked whether they perceived gaps in their clinical training, 39 per cent said they did. No consistent pattern emerged according to the specialty and dual certification did not appear to create difficulties. On balance, the doctors felt as prepared for the role of Consultant as those appointed to Consultant posts five years ago. However, they had experienced both old and new style training and were concerned that the next generation of Specialist Registrars would not be so well prepared and might find the transition from Specialist Registrar to Consultant difficult. The benefits of an explicit and detailed curriculum were recognised but there were doubts expressed as to whether such a structure could be implemented. In craft specialties, doctors felt that it was impossible to acquire the skills and experience to become a competent Consultant within five or six years of higher specialist training. A second major concern is a perceived lack of flexibility under the new training arrangements both in geographical location and in catering to the training needs of individuals. Responses to questions exploring the nature of clinical supervision, appraisal, assessment and mentoring emphasised the fundamental importance of the relationship between supervising Consultant and the trainee. Good supervision, regular appraisal and mentoring are seen as highly desirable and extremely valuable when carried out well. This high standard was not perceived to be the norm. Only one third of the sample felt that they had had a continuing mentor or supervisor throughout the training programme. Trainees have reservations about their annual formal RITA assessments with some feeling that they lack objectivity as far as assessment of their own performance is concerned. They were more positive about the impact of Specialty Committees on the quality of training posts.