The Tooke Report: Aspiring to Excellence
By Mary Avanis, SpR, North Central London School of Anaesthesia
The Tooke Report represents the findings of an inquiry led by Professor Sir John Tooke into Modernising Medical Careers (MMC) training for UK doctors. The former Secretary of State for Health Patricia Hewitt commissioned the report as a result of the concerns raised about MMC following the abandonment of the online Medical Training Application Service (MTAS) for selection into specialist training in Spring 2007.
The report strongly criticised the MMC and its implementation and proposed a new training system based on extensive consultation with medical professional bodies and practitioners. This would involve the creation of a new body, NHS:Medical Education England (NHS:MEE) which would act as the professional interface between policy development and implementation of matters relating to Postgraduate Medical Education and Training (PGMET).1 The interim report published 45 recommendations in October 2007 and was welcomed by the medical establishment. Out of the 39850 responses to the recommendations, 87% agreed or strongly agreed, 9% were neutral and only 4% disagreed or strongly disagreed. The final report of the Inquiry was published on 8 January 2008.
The Department of Health immediately agreed to half of the final 47 recommendations to reform postgraduate training, however remained vague regarding the timescale for implementation of these reforms. This response was deemed inadequate by many UK medical professions.
The areas of concern arising from MMC included:
- Professional engagement
- Workforce analysis
- Education and selection
- Training commissioning and management
- Service implications.
Key Issues identified and recommendations made (1)
Unclear policy objective of postgraduate medical training. No consensus on the educational principles guiding postgraduate medical training. No robust mechanisms for creating such consensus.
The underlying principles of PGMET should be clear and redefined based on available evidence with an emphasis on ‘broad based beginnings’, flexibility and aspiration to excellence
No consensus on the role of doctors at various career stages
Medical education at every stage of doctors’ careers should be focused on outcome and their role clearly defined
Weak DH policy development, implementation, and governance and poor inter- and
intra-departmental links adversely affected the planned reform of postgraduate training
The DH policy development and guidance needs to be enhanced including clear medical education leadership, better relations between departments as well as between health and education sectors
Medical workforce planning does not align with other aspects of health policy. There is no strategy regarding the potential massive increase in trainee numbers. Planning capacity is limited and training commissioning budgets are vulnerable.
Workforce policy objectives should be integrated with training and service objectives. Medical workforce advisory machinery should be revised and enhanced. Workforce planning and medical education commissioning should be subject to external scrutiny. Policies with respect to the current bulge in trainees should be urgently resolved.
The medical profession’s effective involvement in training policy-making has been weak.
The profession must develop strategies to provide coherent advice on issues of major importance to medicine and people’s health
Postgraduate training management is hindered by unclear principles, a weak contractual base, lack of cohesion, a fragmented structure and deficient relationships with academia and service.
The postgraduate training structure and funding means need to be reviewed.
Medical education regulation involves both the General Medical Council (GMC) and Postgraduate Medical Education and Training Board (PMETB), creating diseconomies in terms of both finance and expertise.
PMETB should be merged within GMC to facilitate the continuum of medical education
The postgraduate training structure proposed by MMC is unlikely to encourage or reward striving for excellence, offer appropriate flexibility, or meet needs of particular groups (eg academics). It risks creating another ‘lost tribe’.
The structure of postgraduate training should become broad-based for further specialist education, promoting felximility and excellence and valuing experience.