Names are important. Patients, carers
and the general public should be able to understand the job titles
used by different health care practitioners in order that to help
them to gauge the competence, level of expertise and experience of
the professionals that they see. It is also undoubtedly
beneficial for a practitioner’s self-identity and self-confidence
to have a title that is meaningful and readily appreciated by
everyone.
The importance of considering the optimal
nomenclature for trainee psychiatrists has been highlighted and
discussed at recent College Psychiatric Trainees' Committee
(PTC) meetings and was also aired by the trainee
representative at the College’s Education, Training and Standards
Committee (ETSC). Here we bring some of the issues to the
attention of the wider College membership in the hope of receiving
opinion and feedback from psychiatrists at all stages of their
careers, in order to inform the debate.
Problems with the current terminology
A Junior doctor’s sense of self-identity and
self esteem is unlikely to be enhanced when he/she is not even
called a real name but, like some Star Wars character, is likened
to just a number or some letters that sounds like some dystopian
B-rated movie: “CT3/ST4/FTSTA”.
To an individual with knowledge of the medical
training system, a name like “Core Trainee 1 [CT1]” or “Senior
Trainee 6 [ST6]” conveys explicit information about the point in
the training path reached by the individual doctor. However,
it lacks familiarity or intuitive meaning for those lacking such
detailed technical knowledge. It is a rather obvious and
undesirable legacy of the MTAS fiasco to which recent trainees were
subjected.
It is useful to consider a few terms in
current usage and how they may be interpreted.
“Sub-consultant”, “Nurse consultant”, “SHO”, “Advanced
Practitioner”, “Foundation Doctor”, “Foundation Trainee”,
“Consultant”, “Student Doctor”, “Specialist Registrar”, “Specialty
Doctor”, “Associate Specialist”, “GPVTS”, “CT1” and “ST6”.
For a person with no clinical training and no technical knowledge
of what these terms might mean, it is unlikely that the level of
training and competence could be matched against the
name.
Does it make sense that a 34 year old final
year StR is called a junior doctor? Might there be fear and
confusion in patients’ and carers’ eyes when they are told they
will now see the “Trainee doctor”? (Is this person qualified
or a medical student?).
Possible alternative
It is useful to consider some of the
options:
1)
The terminology adopted by MTAS. This is
fine for the bureaucrats and officionados of the new training
machine but (as discussed above) lacks intuitive meaning and has a
distinctly impersonal, Orwellian feel that informs few and probably
makes no-one feel happy.
2)
Continuing to use the recent terms “Senior House Officer”
and “Specialist Registrar”. Some seniors and
managers have simply not assimilated and have resisted the changes
in nomenclature. The problem of course is that they don’t
exist anymore and as the new doctors progress, they will start
frowning at the slightly senile reminiscence of days gone by.
Of course it also does not make sense to call someone a Senior
House Officer when there is no House Officer to be senior to (and
Senior Foundation doctor makes no sense).
3)
Options that keep “Trainee” in the
title. It can be argued that
retaining the word “trainee” in the titles keeps training in the
mind of seniors, committees, DoH etc and that removing the term
could decrease the focus on training. Proposals include
Doctors in Training (DITs) and keeping the Core Medical Trainee
(CMT) and Higher Medical Trainee (HMT). This option ignores
the contribution of trainees to service provision and can be
confusing to patients (particularly now that medical students are
often called “Student Doctors”). There is also, perhaps,
something misleading in suggesting that only junior doctors are in
need of training. Of course, the reality is all practitioners
are required to keep up with lifelong learning.
4)
Adopt American terminology. The names used
in the United States are short, do not include the word “trainee”,
have been stable over many years and convey some meaning about the
clinical role and seniority of the practitioner: intern and
resident. A major disadvantage for the UK is that these terms
have not been in common usage here and they do not necessarily fit
well into the model of care used within NHS mental health
services.
5)
Adoption of “Junior and Senior
Registrars”. An option that
received substantial support at a recent Psychiatric Trainees'
Committee (PTC) meeting was that a simple distinction between
those in Core training and Higher training could be made by the
terms “Junior Registrar” (JR) and “Senior Registrar” (SR).
The concept of “Registrar” is already within the consciousness of
the health service and has been heard by many in the public.
This option has already been used in some mental health trusts so
it will be possible to obtain feedback.
Conclusion
Whatever terminology is used, it should be
simple, help to indicate with clarity the level of qualification of
the practitioner, minimise confusion and have a lifespan that can
outlive the inevitable technical changes to training
pathways.
We are keen for comments and
suggestions. In particular, we request that psychiatrists at
all stages of their career, complete an extremely brief
online questionnaire (3
questions taking less than one minute to complete) to indicate
their preferred terms and/or send comments to us by the end of
September 2010.
Professor Nick Craddock, Chair of the Academic
Faculty
Dr. Jon van Niekerk, Chair of the Psychiatric Trainees'
Committee (PTC)
Friday 6 August 2010