A Quick Overview of the ‘Gold Guide’
This document is designed to give a brief overview of the ‘Gold Guide’ for those involved in organising specialty training. I have tried to use the exact wording from the ‘Gold Guide’ in answer to my posed questions in order to reduce confusion. Any quote from the ‘Gold Guide’ is followed by the paragraph number in square brackets in order to assist cross referencing. The ‘Gold Guide’ can be downloaded from http://www.mmc.nhs.uk/pages/news/article?227E16A3-42B1-4FCB-BF6B-CEF787F9743C
Kirstin Barnett
Specialty Manager, JRCPTB
1 Introduction to the ‘Gold Guide’ and Specialty Registrar Training
1.1 Who are bound by the ‘Gold Guide’?
The ‘Gold Guide’ supports all those appointed after 1 August 2007 and any trainee who chooses to switch from a SpR training programme to the new curriculum. The Orange Book will continue to be applicable to those that remain on the old curriculum except where legal requirements prevent this e.g. prospective approval of posts.
1.2 How are trainees in the two different systems distinguished?
Trainees appointed before 1 August 2007 will continue to be called Senior House Officers (SHO) and Specialist Registrars (SpRs) and “all doctors recruited into the new Postgraduate Medical Education and Training Board (PMETB) approved specialty and general practice training programmes will be known as Specialty Registrars (StR)”.
SpRs and StRs will also be distinguishable by the suffix of their National Training Number (NTN):
1.2.1 SpR
N current NTN holders who remain on current SpR or GP training curricula
F: some trainees may still retain part of a fixed term, FTNs will not be awarded from 01/08/07
1.2.2 StR
“C: for all trainees who are entering into specialty training on new approved PMETB curriculum and who will apply to enter the Specialist Register through holding a Certificate of Completion of Training
E: for trainees who have not undertaken a full programme of prospectively approved training, as defined by PMETB, and who will therefore apply for a Certificate confirming Eligibility for Specialist Registration (CESR) … through Article 14
S for trainees who Switch from the current SpR (specialist training) curriculum to the new specialty training PMETB approved curriculum in a specialty” [6.45]
1.2.3 Both SpR and StR
A denotes a trainee undertaking combined academic and clinical training. NTNAs will exist for both those on the SpR and StR training programmes and therefore, their files will need to be clearly identified to prevent confusion
2 Why would a trainee chose to switch to the new curricula and how would they go about it?
All “SpRs, GPRs appointed prior to August 2007 may continue to training using the curriculum to which they were appointed or may choose to switch to the new curriculum after obtaining advice from the Postgraduate Deanery” [paragraph 1.45]. “They are under no obligation to switch to the new curriculum, but if they choose to do so it must be by 31 December 2008”.
The main difference between the two curricula is that those for SpRs are time-based and those for StRs are competency-based and has a set assessment system for measuring competence. European Law sets the minimum amount of training that can be undertaken in a specialty in order to be eligible to apply for consultant positions in that specialty. These European minima must still be completed for those on the new competence-based curricula, and in some cases this could lead to the training being completed in a shorter time period than was possible with the time-based curricula. All the new curricula “quote either absolute minimum training durations … or an indicative ‘range’ of time that the training programme is expected to take, the bottom end of the range reflecting the minimum European requirement” [7.3]
“Doctors holding employment contracts in the SHO grade will be entitled to complete their contracts in the grade if they wish to do so but would be advised to apply for specialty training at their earliest opportunity. It is expected that there will be few doctors in this grade after July 2007.” [5.9] “The Guide to Specialist Training (the “Orange Book”) should be used as the guidance for SpRs, including arrangements for the review of in-training assessments (RITA), although workplace based assessments (WPBAs) may be used to provide evidence to support it. SpRs should continue to use RITA documentation” [5.52]
Full details of the switching process can be found in paragraph 5.54
3 How will trainees be informed of any important information?
Trainees must ensure that the deanery have has an up-to-date e-mail address at all times and is one which the trainee regularly checks [7.94]
4 Appointment Process and Training Positions
4.1 What is the appointment process for StR training?
How the recruitment process for the next round of posts is to be carried out is not yet clear. However, it is clear that the process will still contain the following elements:
§ “Entry into specialty training can only be achieved competitively” [5.6]
§ “Applicants must demonstrate they have achieved the foundation competences as set out in the revised edition of the Foundation Curriculum which will be available later in 2007”. [5.7]
§ “Doctors who have not undertaken a foundation programme will have to provide evidence that they have achieved the foundation competences.” [5.7]
§ “All doctors in training should enrol/register with the relevant Royal College/Faculty” [paragraph 2.15 and 5.12]
4.2 How will trainees progress from Core Medical Training or the Acute Care Common Stem?
“Trainees will …be allocated (possibly competitively) into one of the designated follow-on specialties that share the core curriculum,” [6.19] “where trainees wish to change into a specialty which is not one of the designated outcome specialties, they will need to compete for entry into a different specialty (e.g. a trainee holding a CMT NTN who wishes to compete to enter radiology, or microbiology, etc). If successful, a NTN in that specialty will be allocated and the previously held NTN will be relinquished.” [6.20]
“Trainees appointed into the Acute Care Common Stem (Emergency Medicine, Anaesthetics/Intensive Care Medicine and General/Acute Medicine) broad programme will be recruited to one of the three outcome specialties from the outset and will be awarded a NTN in the appropriate specialty. Those allocated a CMT NTN because they are appointed to the medical stream will be eligible for allocation (possibly competitively) for all of the available medical specialty outcomes, although it is anticipated that they will prefer to apply for entry into one of the more acute medical specialties.” [6.21]
4.3 What is a StR LAT?
A LAT is a Locum Appointment for Training and will be used to fill gaps in a training programme. All LATs “must be competitively appointed” [5.40]. “PMETB does not have limits on LATs except that they can only count towards a CCT if the doctor subsequently enters an approved run-through training programme. Deaneries should keep a careful record of these appointments on the trainee’s file. A doctor cannot obtain a CCT with only LAT appointments. They can, however, use LATs towards their CESR application”. [5.43]
4.4 What is an FTSTA?
An FTSTA is a Fixed Term Specialty Training Appointment, these “offer formal, approved specialty training, usually but not exclusively in the early years of a specialty curriculum” [5.15]. “FTSTAs are up to one year fixed-term appointments. Appointments to FTSTAs will usually be by the same UK recruitment process as for run-through training and will be managed by Postgraduate Deaneries.” [5.16] “Trainees appointed to FTSTAs will not be allocated a National Training Number (NTN) since these are only allocated to trainees” [5.27]
Doctors will generally be discouraged from undertaking more than two years in FTSTAs in a given specialty although they cannot be prevented from doing so”, [5.20] but “a doctor cannot obtain a CCT with only FTSTA appointments [5.32].
Like trainees in run-through training, trainees undertaking FTSTAs will need to register with the appropriate College/Faculty in order to access the learning/professional portfolio and assessment documentation for the specialty. [5.23] At the end of each FTSTA, the trainee should participate in the Annual Review of Competence Process (ARCP) (para 7.9) and receive the appropriate annual assessment outcome documentation. [5.25] It will be the responsibility of each individual undertaking an FTSTA to retain copies of their Annual Review of Competence Progression (ARCP) outcomes as evidence of the competences they have obtained.(5.28)
4.5 Can a LAS position count towards a CCT?
“LAS posts cannot count for CCT award but may be used as part of the evidence for a CESR/CEGPR application.” [5.46]
4.6 Is dual StR training possible?
Dual specialty is still possible in StR training as long as the trainees is “competitively appointed to a training programme leading to dual certification (e.g. neurology and clinical neurophysiology)” [6.37]. Once appointed to a dual scheme “trainees are expected to complete the programmes in full and obtain the competences set out in both curricula. Application to PMETB for a CCT should only take place when both programmes are complete. The two CCTs should be applied for and awarded on the same date.” [6.37]
“Where a trainee wishes to curtail the programme leading to dual certification and to apply to PMETB for a single CCT, the trainee must apply to the Postgraduate Dean for agreement to do so. If the Postgraduate Dean agrees, the dual certification programme will terminate and a single CCT will be pursued.” [6.38]
4.7 Is it possible to take some time out of training to ‘act up’ as a consultant?
“Trainees will also be able to take time out of programme and credit time towards training as an “acting up” consultant if this has been prospectively approved by PMETB” [6.96] Since the publication of the ‘Gold Guide’ PMETB have since qualified their statement on ‘acting up’ to:
“If the period of acting up as a consultant is intended to count towards the trainee's CCT, and it is deemed to be a normal part of the CCT-approved specialty training programme, then PMETB approval will not need to be sought as in effect this is an already approved element of the training programme. It is up to the College and Deanery to make the decision on whether this is a usual part of training within the programme.” The JRCPTB has agreed that up to 3 months of ‘acting up’ is to be considered a possible training setting in all curricula and as long as the trainee has prospective approval from the JRCPTB before taking up the post then it will count towards the CCT date.
5 Deferring entry to the training programme and time out of programme
5.1 Can entry to the training programme be deferred?
“The start of training may only be deferred on statutory grounds (e.g. maternity leave, ill health), or to enable the doctor to complete research for a registered higher degree which they have already commenced or for which they have already been accepted at the time of being offered their clinical placement.” [6.23] “A trainee may request deferral for up to three years before starting a run-through specialty training programme if they have been accepted to a higher degree programme (e.g. PhD, MD, MSc) at the time of being offered their clinical placement or if they are already undertaking research for a registered degree when their clinical placement is due to start.“ [6.89]
5.2 Is it possible to take time out of StR training?
“The request to take time out for such experience must be agreed by the Postgraduate Dean. The OOP document should be used to make the request and should be returned on an annual basis to the Deanery whilst the trainee is out of programme. OOPEs will normally be for one year in total, but can be extended for up to two years with the agreement of the Postgraduate Dean”. [6.101]
Three months is the minimum period of notice required so that employers can ensure that the needs of patients are appropriately addressed. [6.89]
Whilst out of programme (OOP) trainees will need to submit the OOP “document annually, ensuring that they keep in touch with the Deanery and renew their commitment and registration to the training programme. PMETB must prospectively approve the clinical training if it is to be used towards their CCT award”. [6.93]
PMETB splits time out of training into four types:
OOPT Out of programme training
OOPE Out of programme experience
OOPR Out of programme training for research
OOPC Out of programme for a career break
5.2.1 OOPT
“Trainees who undertake OOPT must submit the assessments required by the specialty curriculum to the home Deanery’s annual outcome panel, along with an annual OOPT document.” [6.99] OOPT posts must be prospectively approved by PMETB in order for them to count towards a CCT.
5.2.2 OOPE
“Trainees may seek agreement for out of programme time to undertake clinical experience which has not been approved by PMETB and which will not contribute to award of a CCT”. [6.100]
5.2.3 OOPR
“PMETB has made clear that:
time spent out of a specialty training programme for research purposes will be recognised towards the award of a CCT when the relevant curriculum includes such research as an optional element… Both the College/Faculty and Deanery must support the application for prospective approval” [6.103]