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The strength of postgraduate medical education in the United Kingdom lies in the recognition that it is a continuing process from the preregistration year through the training grades into the stage of independent practice. The continuity derives from the support given to postgraduate deans by the universities, regional health authorities and professional colleges whose various contributions and training activities can be coordinated under the umbrella of the dean's office. This contrasts with the Australian scene where the responsibility for medical postgraduate education is still largely divided between the Australian Medical Council, individual state medical boards and the various professional colleges and faculties. Australia, has, however, devised a shorter basic and higher specialist training structure that ensures an earlier and more productive entry to independent practice. Australia has also accepted the principle of recertification which would seem to be a logical sequel to the committed system of defining and maintaining high standards of delivery of health care in the United Kingdom.
This project examined the academic audit of postgraduate medical education, and went on to research, design and implement an educational audit system for use in Mersey Region, UK. Issues found to be significant included ownership of both standards and results, norming, and the levels of aggregation of data. The project has demonstrated that designing and implementing a system of feedback which is effective and sustainable is feasible, but requires the agreement and support of tutors as to its objectives and use. The resulting system has now been tested across a range of courses and programmes of meetings in Mersey Region, and has been accepted by the Postgraduate Office as the basis for future development.
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The postgraduate hospitals of London grew up in the nineteenth century and offered a unique national specialist service. Since then specialist services have developed in undergraduate hospitals throughout Britain as well as in London, but the postgraduate hospitals have nevertheless preserved their high levels of staffing. Although numbers of medical posts in the provinces have grown, this has not been by redistribution of London posts but merely differential growth. The fact identified by Tomlinson--that Londoners are not receiving the most appropriate clinical care--is in fact the strongest argument for changing postgraduate medical education. Such education needs to be rooted first in clinical care, though Tomlinson underestimates the importance to education of such care being sited in a shared environment with strong scientific activity.
The Postgraduate Medical Education and Training Board (PMETB) is an independent regulatory body which sets standards, approves, quality assures and evaluates postgraduate medical education and training. The PMETB is currently preparing to take over as the single competent authority for postgraduate medical education and training in September 2005.
Information technology in postgraduate medical education has developed rapidly over the last 5 years. This report describes the experience of setting up a computer-based information system in postgraduate centres in the West of Scotland. It includes a viewdata service, library facilities, computer-assisted learning, word processing, and statistics. An electronic mail system provides rapid communication between users. The costing and some of the problems in setting up such systems are discussed.
The Postgraduate Medical Education and Training Board (PMETB) is a new organisation set up to develop, establish, and maintain standards and requirements for postgraduate medical education (PGME) and training. First trailed in the NHS Plan, its remit covers the UK. As such it aims to be a single, unifying framework for doctors in training.
The Permanent Working Group of European Junior Hospital Doctors' Policy Statement on Postgraduate Medical Education reviewed the regulations governing postgraduate training in the European Communities and set out educational principles which the Group believed were applicable in all medical disciplines. Recognizing that the training of general practitioners poses some specific problems, the PWG has adopted this further statement on training in general practice. It reaffirms the need for trainees to have a model of good practice, extensive experience, theoretical teaching, critical scrutiny and regular, unambiguous feedback regarding progress. In addition, it argues for the availability of an appropriate number of posts for GP trainees both in hospitals and in practices and an awareness among hospital-based trainers of the educational needs of trainees who intend a career in general practice.
The Permanent Working Group of European Junior Hospital Doctors (PWG), representing junior doctors of 18 European countries, has amongst its foremost interests the quality of postgraduate medical training. Building upon the work of other groups, and notably that of the Advisory Committee on Medical Training (EC), it has developed its own policy statement on postgraduate training. The statement defines the aims of training and the needs of the trainee and proposes that these can only be met through a close relationship between the trainee and a clearly identified trainer. The duties of the trainer are set out, with emphasis on the need for both practical and theoretical teaching and on the importance of regular, unambiguous feedback regarding progress. Trainers themselves require remunerated time for carrying out these duties and training in educational methods. An appropriate balance between clinical and research experience may require an upper limit on the proportion of the training period which may be spent in research. Training programmes should be inspected and approved by appropriate professional bodies working to published criteria of sufficiency. The PWG believes that high levels of skill and knowledge amongst fully trained specialists can only be guaranteed when the training system identifies trainees' shortcomings at every stage and corrects them through unambiguous feedback.
In order to evaluate postgraduate medical education (PGME) in Japan, residents and supervisors of all the postgraduate teaching hospitals (128 university hospitals and 216 non-university hospitals designated by the Ministry of Health and Welfare) were surveyed. The purposes of this study were, 1) to compare the goals of PGME set by residents and the achievements of PGME by residents in university hospitals and non-university hospitals, 2) to compare the goals of PGME between residents and supervisors, 3) to identify how clinical skills and knowledge related to the behavioral sciences and social medicine are stressed on PGME. Residents and supervisors received a newly developed questionnaire consisting of 41 items concerning clinical skills and knowledge. The items were divided into four categories: 17 basic areas, 9 allied areas, 12 areas related to the behavioral sciences and social medicine, and 3 areas related to clinical research. The response rate was 52.3% for university hospitals and 75.5% for non-university hospitals. The results are 1) residents in non-university hospitals scored at higher levels than residents in university hospitals for 14 items concerning goals and 11 items of achievements, mainly basic clinical skills and knowledge, 2) there was an incongruence between residents and supervisors for 23 items concerning goals, 3) clinical skills and knowledge related to the behavioral sciences and social medicine were not as highly stressed as other areas of clinical skills and knowledge. This study suggests that more effort is needed to create or improve the system of PGME, especially in university hospitals.
The history of postgraduate medical education in Singapore is chronicled. Four phases have been discerned; phase I from 1910--1936 when only one local doctor obtained a higher postgraduate qualification; phase 2 from 1946--1960 when 40 qualified; phase 3 from 1960--1970 when 86 qualified. The School of Postgraduate Medical Studies was established in 1970 and in phase 4 from 1970--1981, 391 postgraduates were trained and qualified. This last phase has enabled the National University of Singapore and the Academy of Medicine to provide sufficient expertise in both the private and public sectors. The problem of continuing medical education in Singapore is discussed.
From 1910 to 1945, doctors in Singapore received postgraduate training through apprenticeship. During the early post-war period, some doctors in the public service were given scholarships to study in Britain and to obtain higher professional qualifications from the British Royal Colleges. The events that most influenced subsequent development of postgraduate education in Singapore occurred between 1956 and 1969: the formation of the Academy of Medicine and the Singapore Medical Association (SMA); organisation of courses for candidates preparing for examinations of the Royal Australasian and British Colleges; competition between the Academy and the University over responsibility for postgraduate medical education; the inauguration of the School of Postgraduate Medical Studies (SPMS); and the introduction of Master of Medicine (M Med) degrees in various medical specialties. From 1970 to 1999, there was expansion in several aspects of postgraduate medical education: SPMS awarded more than 2000 M Med degrees; the Singapore Medical Council (SMC) established a Register of Specialists and formed a Specialist Accreditation Board; the Academy formed Chapters in 10 specialties and developed Advanced Specialty Training programmes leading to Fellowship of the Academy of Medicine Singapore (FAMS); the SMA formed Societies in some 20 specialties; and a College of Family Physicians was inaugurated. There have been more developments from 2000 to 2005: the University restructured SPMS as a Division of Graduate Medical Studies within the Faculty of Medicine; the SMC implemented compulsory Continuing Medical Education; and the Academy converted 6 of its 10 Chapters into Colleges.
Where is the present flurry of activity in medical education leading and what sort of future is envisaged? This paper looks at trends in postgraduate medical education. Four themes and two trends for each theme have been identified. The themes are: the postgraduate medical curriculum, the application of learning technologies, assessment of competence, and professionalism in medical education. The trends are: outcome based education and a unitary approach to medical education; the use of simulators and e-learning; competency and performance based assessment, and portfolios and self assessment; and training the trainer and best evidence medical education. Any limitations in implementing change will likely result from a lack of imagination in those planning postgraduate medical education and their ability to bring about the necessary changes. To avoid a growing gap developing between what is possible educationally and what is delivered, it is clear that we need a new paradigm for postgraduate medical education.
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