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Medical graduates 'not fit to take up foundation programme posts', say employers

Employers believe that medical graduates ‘lack professionalism’ and are ‘not fit’ to take up their foundation programme training posts, an influential review body has found.

The latest findings from the Shape of Training Review of postgraduate medical education and training warn that NHS employers are concerned that medical graduates lack the ‘essential skills’ necessary for their jobs and they had to teach graduates basic skills as part of their postgraduate training.

The review - which has been sponsored by the General Medical Council and the Academy of Medical Royal Colleges among others – also found that medical trainers were worried that medical graduates were losing learning opportunities as treatments were being removed from the NHS.

The panel interviewed hospital and GP trainers to gather evidence for its final report due out in the autumn.

Its evidence document said:  ‘We heard from almost all employers that they were concerned that many doctors when leaving medical school are not fit to take up their foundation programme posts. They suggested medical graduates often lack professionalism and do not have essential skills necessary for their job. Many employers suggested they had to teach graduates basic skills as part of their postgraduate training.’

However, Dr Krishna Kasaraneni chair of the BMA’s GP trainees subcommittee, told Pulse that this was not his experience.

He said: ‘Since my graduation eight years ago, the number of assessments newly qualified doctors have to do has increased significantly. It is no secret that workload in primary and secondary care has now reached record levels. Junior doctors now have to treat patients with more complex health needs due to an ageing population as well. I would suggest they are more competent than they have ever been before. A junior doctor’s work has been more intense and more focused than ever before.

‘I am very surprised at these suggestions from some employers that most junior doctors lack professionalism. If they do have some evidence to back it up, I would suggest they share it with medical schools to improve undergraduate training. This is nothing but anecdote and I wouldn’t want statements like this to form the basis of shaping the training of the future medical workforce.’

Elsewhere the review evidence showed that medical trainers were worried that many learning opportunities were being lost to the private sector as some treatments were being removed entirely from the NHS. They also raised concerns that doctors have a lack of exposure to outpatient clinics, which could give them another way of developing their decision-making skills.

Dr Kamal Sidhu, a GP trainer in Country Durham said: ‘NHS care becomes more fragmented by the day, there are and clearly will be lost opportunities for trainees. 

‘We already have been restricted in choice of out of hours providers who agree to take on GP trainees for the experience they need. Even when training requirements are a part of the contract, the ethos of providing a learning environment are very different from when expectation is purely of an additional pair of hands.   A lot of goodwill to make it work has been lost.’

He said that the next generation of GP trainees faced a challenge in learning to work in and with a ‘very fragmented environment’.

Dr Chand Nagpaul a GPC negotiator,  agreed and said that the BMA had always warned that the consequences of the Government’s insistence on the introduction of private providers would undermine and fragment NHS hospitals, which provide the bulk of junior doctor training.

‘This was always a concern about the reforms and one of the reasons the BMA believe it is important to recognise that the NHS does not just provide a service to patients.’

A spokeswoman for the review said the final report will be used to help assess the future of medical training and education and set future standards.

Pulse today revealed that deaneries are failing to produce enough medical graduates to meet Health Education England’s target of 3,250 GP trainees by 2015.

Readers' comments (9)

  • 'Junior Doctors nowadays don't have the skills for the job' said NHS employers.
    'They are particularly lowly skilled in: pretending not to notice poor performance in hospitals; not lying about their hours; keeping their mouth shut when asked what could be improved at their place of work.'
    'As an employer we just can't find quiet, conforming graduates who do what we say, regardless of patient outcomes or their learning needs, and who collude with us to fudge admission and discharge targets.'
    'Oh well I'm leaving this trust anyway with a big pay package as I f***ed up again - oops shouldn't have disclosed that - onwards and upward!'

    - NHS Trust Spokesperson

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  • This comment has been edited by the moderator.

  • Somethings never change when the old speak of the young.Here's what Socrates had to say about the youth of his time:
    “Our youth now love luxury. They have bad manners, contempt for authority; they show disrespect for their elders and love chatter in place of exercise; they no longer rise when elders enter the room; they contradict their parents, chatter before company; gobble up their food and tyrannize their teachers. "

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  • " the number of assessments newly qualified doctors have to do has increased significantly"..sounds as if the boxes have been ticked. To ask for evidence is to miss the point. None of these changes which have had an impact on medical students and junior doctors ( ie, foundation training, EWTD and MTAS) were set up to measure or compare improvement.
    I would suggest we respond to these 'soft' critiques because they have been said by too many senior clinicians to be ignored or dismissed.
    I see far too many young doctors with a sense of entitlement, too focused on the boundaries of their work, so of course this will impact on their professionalism.

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  • Actually, compared to when I graduated over 10 years ago, newly qualified junior doctors have far better skills and ward knowledge. I remember not being able o cannula the, only painkillers we knew were paracetamol and morphine, had no idea what we do after the 1st ever ward round. So I wouldn't knock them on the day to day practical skills and knowledge.

    On the other hand, the professionalism have gone with EWTD. I don't mean keeping quiet when things are wrong but a sense of pride and responsibility even a HO had. But then back then, we were respected by our patients and in return we put in hours and hard work to repay such respect.

    I'm not romatacizing the past. It is wrong to work for over 48 hours with hardly any rest. It is wrong to have 1st proper meal of the day at 11pm. But it did prepare me to cope with hard work. As one of my senior colleague once said "You can always ask for my help, but do feel free to cope".

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  • A tad harsh on our junior colleagues. I feel professionalism is an attitude to patient care that I do teach medical students and junior doctors. Unfortunately, many medical students do feel that they are not given time by their trainers. The report should also be looked on by what are we offering the students in terms of training.
    - anonymous salaried!

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  • Vinci Ho

    Political beacon is flashing!!
    (1) GPs are lazy and causing the trouble in A/E
    (2) Women doctors are burden to NHS
    (3) Consultants need to be managed better ( on BBC news)
    (4) Junior doctors are lacking professionalism
    Of course , Staffordshire scandal was the fault of doctor and nurses instead of the management led by 'people' from higher up.
    As I said , the most cunning and poisonous political tactic is introducing division amongst factions of your enemies . It starts by smearing them one by one . Wake up , comrates and stop fighting against ourselves.......

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  • I think modern graduates are far ahead of where I was when I became a houseman. I had actually done the job a little as I had been a 5th year student on the ward but I relied heavily on more senior doctors to help me learn. I was fortunate in having splendid consultants from whom I learned skills in managing patients that are only possible to learn from practice and watching others at work. The increased patient contact in most courses seems to be designed to improve that.

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  • I m a GP partner, can't see clearly despite the 2 cataract surgeries, had bilateral hip and knee transplants. i also take treatment for Alzeimer's.i am not going to retire till i m 85 and then book myself as locum for next 5 yrs in my own pension will be 60,000 plus locum pay everyday. so what .i deserve it for working from scratch. i m looking for a slave sorry salaried gp, who shud have good eyesight, all real joints, no ambition or greed, ready to work for peanuts, bring his own tea and biscuits. sorry we don't have parking space for them, they can park any where.should do all paper work. leave to be applied one year in advance, not during school holidays, xmas or any other holiday season.

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  • This is political spin yet again. By saying that medical graduates are less well trained and less professional than before, they are paving the way to pay cuts for all doctors.

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