The Royal Free Hospital, London, UK
Correspondence to J.R. Buscombe, The Royal Free Hospital, London NW3 2QG, UK
Tel: +44 20 7830 2470; e-mail: email@example.com
Received 28 August 2009 Accepted 3 September 2009
‘Education, education, education’, A Blair BBC News 14 May 1997.
The above-named quote was an answer to a question to Mr Blair, then the leader of the opposition before the 1997 UK general election, asking for the three main priorities for his new government. What are the three main priorities for UK nuclear medicine as we approach the second decade of the second millennium? It would appear that these do not necessarily include education. In a specialty dealing with the issues of waiting lists, payment by results and who gets access to PET-computed tomography (CT), the role of education seems to have become belittled.
The Post Graduate Medical Education and Training Board (PMETB) has the present UK remit for postgraduate education. Though it is soon to be merged with the UK General Medical Council, it will be responsible for the delivery of the new curriculum for 2010.
There have been many changes in the way medical education is delivered in the UK. The traditional method of teaching has been by apprenticeship but this has been rendered no longer feasible by the European Working Time Directive. Who can imagine the registrars sitting late into the night listening to the pearls of wisdom from the great teacher? If the trainees are not out of the building at 17:00 h sharp, sanctions including removal of trainees beckon.
As from January those who are responsible for the education supervision will need to demonstrate that they have undergone sufficient training for their post and have kept up to date with this expertise [1,2]. Trainee's competence cannot be assumed because they have seen 100 scans and it must now be formally assessed.
Many of these changes were occurring with the 2007 curriculum revision but will be further expanded in the latest revision. It will be necessary to show a progressive increase in competence and knowledge base throughout the training. There will be various tools for doing this with enigmatic names such as DOPS, miniIPX, MSF and CBD [Directly Observed Practical Session, Mini Interpretation Exercise, Multi-Source Feedback and Case Based Discussion] . By the 2010 entry of trainees, these will be available as an e-portfolio similar to the ones used for foundation trainees.
How will this impact on us in nuclear medicine? All training centres will need to provide sufficient time to not only train registrars but also perform the required assessments of which we would expect over 20 a year and each taking 10–30 min . This will mean the educational supervisor will have to have sufficient time to deliver training and will need a minimum of one programmatic activity of supporting professional activity per week and maybe more, especially if there is more than one trainee in nuclear medicine or trainees from other specialties passing through nuclear medicine. There is also some evidence emerging that these assessment techniques can result in stress between the trainer and the trainee .
I suspect most trusts have not identified that these changes are coming and certainly most will be unhappy to provide additional funding to cover these programmatic activities as only the trainees are paid for by the deaneries and not the trainers.
Education has had a very low priority in both the Health Service and universities despite fine words to the opposite from ministers and senior managers at the Department of Health and PMETB. The reality in most hospitals shows that it is often very different, and university departments fare no better, with an emphasis on obtaining research monies above all else.
There remain areas which are controversial for some centres. How will nuclear medicine physicians gain experience in cross-sectional imaging and to what standard? At what point in training should teaching in PET-CT and therapy be introduced? The present plan of leaving all this till the final year (ST6) is not sustainable with the expansion of different PET-CT techniques beyond F-18 fluorodeoxyglucose and the expansion in radionuclide therapy. This will clearly not be so much of an issue for those trainees taking the 4-year course but may be more of an issue for those applying after a Certificate of Completion of Training (CCT) in radiology for what used to be known as year 6 training as there may not be enough time to gain competency in all aspects of PET-CT and radionuclide therapies in 12 months. On top of that, for each CCT there must be an appropriate knowledge-based assessment, and at present the only one recognized by PMETB for nuclear medicine is the Post-Graduate Diploma in Nuclear Medicine offered by King's College in London.
In addition, how can we expand the role of the nuclear medicine physicians in the UK when those with double CCTs in radiology and nuclear medicine have an obvious skill mix that a hospital may need? An option would be to follow the Scottish model and offer the possibility of a double CCT in general (internal) medicine and nuclear medicine. This may suit and attract to nuclear medicine those with an interest in cardiology, nephrology etc. who wish to retain clinical medical skills.
Where there is no doubt is that education of the next generation of nuclear medicine specialists will require a new group of trainers who are able to dedicate a significant proportion of their week to the training and assessment of our next generation and trainees who will need to be prepared to work much more flexibly.