Clinical Oncology (1994) 6:144 © 1994 The Royal College of Radiologists Clinical

Oncology

Editorial

Post-FRCR Training: Will the Ideal Ever be the Norm?

J. M. Russell Beatson Oncology Centre, Western Infirmary, Glasgow, UK

In the past (and maybe in the present?) the training of junior medical staff in clinical oncology has been inadequate, often haphazard, and rarely well orga- nized and thorough. The requirement to cover all the syllabus for the FRCR has helped to focus the training of those in the registrar grades, but the continuing training of those who have passed their fellowship examinations has not been seen as a priority, particularly in a specialty with a heavy and increasing service commitment.

In 1989, the Royal College of Radiologists first published its report on post-fellowship training in clinical oncology, updated with minor changes in 1992. This followed the recognition that deficiencies in the service manpower requirements were often filled by the inappropriate and excessive use of junior staff to the detriment of their training in oncology. While all levels of junior staff have suffered in this regard, those who have passed the fellowship have most often been seen effectively as sub-consultants who have completed their training, rather than senior registrars whose deficiencies in their training should be corrected as far as possible before their appoint- ment to full consultant posts.

A graphic account of the deficiencies in senior registrar/post FRCR training is provided by Barrett et al. [1], who showed that, in 1990, of those who had passed their FRCR, 60% received less than one hour's training per week, there were low levels of attendance at national or local meetings, 44% attended three or more general outpatient clinics per week, 71% had no tumour site specialization train- ing, only 50% had received any form of management training, and only 11% of senior registrars were deputy audit co-ordinators (despite this being a specific recommendation of the first College report).

In what ways could the situation be improved? The overwhelming need is the recognition that the train- ing requirements of post-FRCR trainees must take precedence over clinical commitments, and that any deficiencies in the clinical service must be corrected in other ways. The one day a week available for research must be 'protected' time, and trainees must be given the opportunities to attend management courses and participate in audit on a regular basis.

Further general clinical experience must be chan- nelled towards deficiencies in previous experience, often in areas of rarer tumours and the smaller sub-specialties, and in the more technical aspects of radiation treatment.

The College reports have always recommended a period of a year of tumour site specialization experi- ence, including clinical trials, the development of departmental protocols, audit, and clinical research. It is difficult to envisage such training occurring in any but the larger centres, where the appropriate multidisciplinary teams have already been estab- lished. However, experience during training in the smaller centres, where many trainees will eventually be appointed as consultants, is recognized as valuable but very difficult to arrange in practice. Second centre experience is highly desirable.

The conflict between service requirements and post-FRCR training will continue to tax most depart- ments, but the Calman report [2] is likely to make this 'ideal' training even more difficult to achieve. If it is likely that most trainees will take more than 3 years to attain the FRCR, then, within an overall training time of only 5 years, this will leave 18 months for the whole of the post-Fellowship training programme. The Calman report recognizes that this can only be achieved with a further increase in consultant or staff grade appointments, the latter being generally regarded as inappropriate for much of the work of our specialty. The report also recognizes that the additional finance required for expansion of the consultant levels may not be forthcoming. Neverthe- less, we owe it to our senior registrars to ensure that their training requirements are given the highest priority, and to seek other solutions to deficiencies in the clinical service.

References

1. Barrett J, Benstead K, Bulman A, et al. Training in clinical oncology: Results of a Junior Radiologists' Forum question- naire. Clin Oncol 1992;4:205-8.

2. Department of Health. Hospital doctors: Training for the future. Report of the Working Group on Specialist Medical Training. London: Doll, 1993.