- Email: [email protected]
Training the Oncologists of the Future
Clinical Oncology 23 (2011) 565e568 Contents lists available at ScienceDirect
Clinical Oncology journal homepage: www.elsevier.com/locate/clon
Editorial
Training the Oncologists of the Future L. Hughes-Davies *, J. Barrett y * Cambridge y
University Hospitals NHS Trust, Cambridge, UK Royal College of Radiologists, London, UK
Received 12 July 2011; accepted 18 July 2011
The Early Years: From Sixth Formers to Oncology Trainees This pair of editorials considers the early years of training. These years begin at medical school, where students are exposed to a large number of specialties, each of which has to compete for talent. Specialities that have helicopters landing on the hospital roof have an obvious initial advantage, but the best recruitment tool is excellent teaching; if we can deliver this, we will attract the best students. First, Luke HughesDavies discusses medical school teaching and then Jane Barrett considers the next step: recruitment into our training programmes.
Undergraduate Education in Oncology It has become routine to lament the state of oncology teaching [1e7] and there have been calls for national or even European harmonisation, with mandatory rotations and a centrally planned syllabus. However, as the song goes, be careful what you wish for, you might just get it [8]. In an era of increasing centralisation and micromanagement, there is much to celebrate about undergraduate education. We have remarkable freedom and autonomy in how we organise our teaching, a freedom that has been eroded in other areas of our professional lives. It is, of course, the General Medical Council (GMC) that sets the standards required for a medical education. This is the oldest and best known of all the GMC’s duties. Considering that the GMC has had 153 years to draft as many regulations as it likes, its requirements for an undergraduate medical education are firmly rooted in common sense. It even Author for correspondence: L. Hughes-Davies, Cambridge University Hospitals NHS Trust, Cambridge, UK. E-mail addresses: [email protected], [email protected] (L. Hughes-Davies).
managed to digest the inevitable European Union directive 2005/36/EC without any noticeable increase in red tape. The GMC’s requirements are laid out in Tomorrow’s doctors [9], an all-you-need-to-know guide for medical student teaching. This is unexpectedly clear and well written. It starts by assuming that senior doctors can be trusted to work out their own teaching programmes, ‘it is for each medical school to design its own curriculum to suit its own circumstances’. However, it also lays out outcomes that must be achieved: the curriculum must be designed ‘to ensure that graduates demonstrate all these outcomes’. A summary of these mandatory outcomes is presented in Table 1. There is brief guidance within each of the outcome statements, again written in sensible terms. For instance, the outcome ‘Communicate effectively with patients and colleagues’ includes the advice that ‘the graduate should appreciate the importance of non-verbal communication’. So, the next time a student yawns cavernously during one of your consultations, they can be told that they are failing mandatory GMC outcome 2c. This explains why oncology is not taught as a separate rotation in a third of medical schools. Far from being deplorable, it shows how medical schools still have the freedom to integrate the subject in other ways. We may disagree with this approach, but we are free to organise things differently at our own institution. Now we have seen how the system works, how should we go about designing oncology teaching in a UK hospital? First, the GMC recommends that we must ‘take into account modern educational theory and research’ [9]. This is not a particularly rewarding exercise. Papers are often written in the impenetrable prose of the social scientist. Fortunately, the literature has been recently reviewed [2,3]. In brief, there has not been much research and little is of high quality. Most studies are uncontrolled, there is usually no randomisation and student feedback is often the only end point, usually reported as overwhelmingly positive. Some of the interventions, such as supervised student-led clinics, would be
0936-6555/$36.00 Ó 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.clon.2011.08.002
566
L. Hughes-Davies, J. Barrett / Clinical Oncology 23 (2011) 565e568
Table 1 Tomorrow’s doctors: summary of educational outcomes [9] Domain
Outcome
(1) The doctor as a scholar and a scientist
(a) Apply scientific method to clinical practice (b) Apply psychological principles to clinical practice (c) Apply social science principles to clinical practice (d) Apply principles of population health to clinical practice (e) Apply scientific method and approach to medical research (a) Be able to undertake a consultation with a patient (b) Diagnose and manage clinical presentations (c) Communicate effectively with colleagues (d) Provide immediate care in medical emergencies (e) Prescribe drugs safely, effectively and economically (f) Carry out practical procedures safely and effectively* (g) Use information effectively in a medical context (a) Behave according to ethical and legal principles (b) Reflect, learn and teach others (c) Learn and work effectively within a multiprofessional team (d) Protect patients and improve care
(2) The doctor as a practitioner
(3) The doctor as a professional
* In its latest version, the document includes a list of 32 practical procedures that every medical course should teach, from taking blood to performing and interpreting a 12 lead ECG. None of these is oncology specific.
impossible to deliver cost-effectively. There is a general motherhood-and-apple-pie agreement that oncology teaching should be made relevant to real life as a junior doctor. Surveys emphasise the importance of teaching symptom control and show that going into too much detail about chemotherapy or radiotherapy is unhelpful and should be avoided. Unsurprisingly, young doctors wish they had received more training in how to communicate with very sick patients and their families. As we have seen, the GMC’s educational regulations are intended to let a thousand flowers bloom. Therefore, this editorial does not presume to make any recommendations for any particular course design or content. Instead, in keeping with the GMC’s philosophy, it will end with a ‘How I do it’ discussion. In my institution, oncology is taught as a stand-alone 2 week rotation. Each day is framed with a morning seminar and ends with a written case of the day, usually based on a lightly edited recent review. Clinic and ward attachments are scheduled between these commitments. All of the daily seminars are given by the same person, as we believe that continuity is as important for teaching as it is for patient care. We decided that teaching devoted to ‘real life as
a junior doctor’ would be utilitarian and quite dull. We have included some sessions on oncology emergencies, practical prescribing, communication skills and physical diagnosis. But ‘real life as a junior doctor’ is short. Junior doctors turn into more senior doctors with remarkable speed, and they need to take something from their training that is more sustaining. This is also recognised by the GMC, which strongly emphasises the domain of the doctor as scholar and scientist. Therefore, we designed content by spreading our bets across each of the GMC outcomes listed in Table 1. For example, an introductory seminar starts by emphasising three professional attributes (punctuality, appearance and non-verbal communication), which are strictly enforced during the 2 week rotation (GMC outcome 2c) and then moves on to discuss the ‘hallmarks of cancer’ [10] (GMC outcomes 1a, 1e), whereas the next seminar discusses KaplaneMeier calculations and clinical decision making (GMC outcomes 1a, 1b, 1e, 2a, 3c), followed by a session on error in oncology (GMC outcomes 3a, 3b, 3c, 3d) and so on for a series of 10 seminars. But this is just one medical school’s approach.The GMC still encourages everyone to cultivate their garden in their own way, which is why we can still get job satisfaction from educating medical students.
Recruitment Strategy for Clinical Oncology A well-designed recruitment strategy is essential for recruiting high-calibre candidates in clinical oncology. The second part of this editorial describes the first two rounds of the new central recruitment process. It also outlines the results of the 2010 Royal College of Radiologists (RCR) workforce census, which have a direct effect on recruitment strategy.
Central Recruitment in Clinical Oncology Clinical oncology specialty training begins after the completion of core medical training, i.e. in ST3. Applicants are advised to obtain some experience in clinical or medical oncology or palliative medicine before applying to the specialty, but this is not mandatory. In the past, the 18 clinical oncology training schemes in the UK recruited to training posts independently, but in 2010 national recruitment was introduced. National recruitment is not a new concept, and general practice has a well-established process that has been developed over several years. This is robust, has high reliability and predictive validity, is perceived to be fair by candidates and allocates applicants equitably across the country. The key success factors have been identified as corporate commitment to the goal of a national process, with gradual convergence rather than the imposition of the change. The general practitioners have also shown that their selection process correlates with success in the MRCGP examination. Following the successful experience of general practice, the RCR, supported by Kent, Surrey & Sussex Deanery undertook the first round of clinical oncology national
L. Hughes-Davies, J. Barrett / Clinical Oncology 23 (2011) 565e568
recruitment in 2010. This allowed candidates to make one application, preferencing their deanery/ies of choice with one point of contact for all enquiries during the recruitment process. In 2010, there were 119 applicants for entry to the specialty of clinical oncology. All 115 eligible candidates were invited for interview, and 100 people were interviewed over 2 days in a single location. The interview was comprised of three stations covering clinical scenarios, management and ethics, and portfolio/CV each with two consultants interviewing and scoring the candidates. Sixty candidates were deemed appointable, and were ranked according to score and geographical preference. All 46 substantive and one Locum Appointment for Training (LAT) posts were filled. Thirty consultants, two lay chairs and five members of deanery staff ran the process. They felt that recruitment was fair, with wide agreement of the standard required for applicants to be successful. The RCR Oncology Registrars’ Forum survey in 2011 asked questions about the national recruitment process. Twenty per cent of respondents had been through it and for 98% of the trainees, clinical oncology had been their first choice specialty. Seventy-two per cent obtained their preferred post, with 87.5% obtaining their first, second or third choice post. Trainees also felt that overall the process had been fair and well run, although some felt it was overly reliant on a point scoring process rather than interview. Clearly this only reflects the views of successful candidates. In 2011, medical oncology joined clinical oncology in central recruitment. Applications were considered together and 46 applicants applied to both specialties. There were 95 applicants for 41 clinical oncology posts, 82 candidates were interviewed and 51 were deemed appointable. This year an optional online upgrading mechanism was in place for candidates who did not receive a post in their choice deanery. Candidates were offered an ‘upgrade’ in the event that a higher ranked preference became available. Thirty-nine clinical oncology posts were filled, with 19 upgrades occurring. 73% of medical oncology training posts were filled by LAT or substantive posts. Almost all the highest ranking candidates were offered posts in both specialties, indicating a similar standard in ranking by assessors in medical and clinical oncology. In 2012, academic trainee recruitment may join the process, thus strengthening links with medical oncology and academic training. Scotland and Northern Ireland may also participate.
567
RCR to identify opportunities and challenges facing the workforce in the future. The 2010 workforce census shows that the overall clinical oncology workforce in UK cancer services (including unfilled posts) has increased by 60 posts to 1110 in 2010. This equates to a 6% increase over the period. The number of consultant posts increased by 9% in both 2009 and 2010, to 702 consultant posts in 2010. The number of specialist registrar posts also increased in 2009 and 2010 to 315 posts in 2010. In the last 12 months, there have been 72 new appointments to consultant grade posts, compared with 20 leaving the workforce, mainly through retirement. Almost 20% of consultants now work part-time. This is a 4% increase since 2009. This trend will probably continue in future years. In 2010, just over one in 10 male consultant clinical oncologists worked part-time, compared with three in 10 female. The gender split of clinical oncologists appointed to their first consultant post between January 2006 and December 2009 was 59% male, 41% female compared with 41% males and 59% females appointed in 2010. This mirrors the gender profile of trainees (62% women versus 38% men). The observed feminisation of the work force and the greater propensity towards working part-time will need to be addressed through future training numbers ensuring the workforce can sustain delivery of services.
Conclusion The RCR experience over the last 2 years is that national recruitment has been successful, although it remains to be seen if those taken in to the specialty in this way complete their training in a satisfactory and timely manner. The increased feminisation of the workforce and the large number of retirements predicted over the next few years will require changes to training programmes. Consideration will need to be given to more flexible working patterns. One concern is that recruitment occurs so early in the core medical training programme that many trainees will not have experienced oncology by the time they apply for higher training and the overall calibre of applicants will be affected. This does not seem to be the case so far and if the undergraduate oncology training is successful, oncology will continue to attract high achieving trainees.
Acknowledgements
The Royal College of Radiologists Workforce Census The RCR has undertaken a census of the UK clinical oncology workforce in 2009, 2010 and 2011 to obtain accurate data on the composition of the workforce. It provides information on clinical oncologists in training (specialist registrars) and the probable future supply for National Health Service consultant appointments. The intention is to establish trend data, for example, gender patterns and the extent of part-time working to enable the
With grateful thanks to Dr D. Gilson, Warden Clinical Oncology RCR, for advice and Anna Campbell, Executive Education Officer and Karen Darley, Professional Services Manager for collection and analysis of data.
References [1] Cave J, Woolf K, Dacre J, Potts HW, Jones A. Medical student teaching in the UK: how well are newly qualified doctors prepared for their role caring for patients with cancer in hospital? Br J Cancer 2007;97(4):472e478.
568
L. Hughes-Davies, J. Barrett / Clinical Oncology 23 (2011) 565e568
[2] Gaffan J, Dacre J, Jones A. Educating undergraduate medical students about oncology: a literature review. J Clin Oncol 2006;24(12):1932e1939. [3] Dennis KE, Duncan G. Radiation oncology in undergraduate medical education: a literature review. Int J Radiat Oncol Biol Phys 2010;76(3):649e655. [4] Barton MB, Bell P, Sabesan S, Koczwara B. What should doctors know about cancer? Undergraduate medical education from a societal perspective. Lancet Oncol 2006;7(7):596e601. [5] Pavlidis N, Vermorken JB, Stahel R, et al. Undergraduate training in oncology: an ESO continuing challenge for medical students. Surg Oncol 2010. http://www.sciencedirect.com/ science/article/pii/S0960740410000642.
[6] Pavlidis N, Vermorken JB, Costa A. Oncology for medical students: a new ESO educational avenue. Ann Oncol 2005;16(5): 840e841. [7] Oncology Education Committee. Ideal oncology curriculum for medical schools. Sydney: The Cancer Council Australia; 2007. Available at: http://www.cancer.org.au//Healthprofessionals/ OncologyEducation/IdealOncology.htm. [8] Eminem (Marshall Bruce Mathers III) Careful What You Wish For. Interscope Records, 2009. [9] http://www.gmc-uk.org/education/undergraduate/tomorrows_ doctors_2009.asp. [10] Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011;144(5):646e674.
Clinical Oncology journal homepage: www.elsevier.com/locate/clon
Editorial
Training the Oncologists of the Future L. Hughes-Davies *, J. Barrett y * Cambridge y
University Hospitals NHS Trust, Cambridge, UK Royal College of Radiologists, London, UK
Received 12 July 2011; accepted 18 July 2011
The Early Years: From Sixth Formers to Oncology Trainees This pair of editorials considers the early years of training. These years begin at medical school, where students are exposed to a large number of specialties, each of which has to compete for talent. Specialities that have helicopters landing on the hospital roof have an obvious initial advantage, but the best recruitment tool is excellent teaching; if we can deliver this, we will attract the best students. First, Luke HughesDavies discusses medical school teaching and then Jane Barrett considers the next step: recruitment into our training programmes.
Undergraduate Education in Oncology It has become routine to lament the state of oncology teaching [1e7] and there have been calls for national or even European harmonisation, with mandatory rotations and a centrally planned syllabus. However, as the song goes, be careful what you wish for, you might just get it [8]. In an era of increasing centralisation and micromanagement, there is much to celebrate about undergraduate education. We have remarkable freedom and autonomy in how we organise our teaching, a freedom that has been eroded in other areas of our professional lives. It is, of course, the General Medical Council (GMC) that sets the standards required for a medical education. This is the oldest and best known of all the GMC’s duties. Considering that the GMC has had 153 years to draft as many regulations as it likes, its requirements for an undergraduate medical education are firmly rooted in common sense. It even Author for correspondence: L. Hughes-Davies, Cambridge University Hospitals NHS Trust, Cambridge, UK. E-mail addresses: [email protected], [email protected] (L. Hughes-Davies).
managed to digest the inevitable European Union directive 2005/36/EC without any noticeable increase in red tape. The GMC’s requirements are laid out in Tomorrow’s doctors [9], an all-you-need-to-know guide for medical student teaching. This is unexpectedly clear and well written. It starts by assuming that senior doctors can be trusted to work out their own teaching programmes, ‘it is for each medical school to design its own curriculum to suit its own circumstances’. However, it also lays out outcomes that must be achieved: the curriculum must be designed ‘to ensure that graduates demonstrate all these outcomes’. A summary of these mandatory outcomes is presented in Table 1. There is brief guidance within each of the outcome statements, again written in sensible terms. For instance, the outcome ‘Communicate effectively with patients and colleagues’ includes the advice that ‘the graduate should appreciate the importance of non-verbal communication’. So, the next time a student yawns cavernously during one of your consultations, they can be told that they are failing mandatory GMC outcome 2c. This explains why oncology is not taught as a separate rotation in a third of medical schools. Far from being deplorable, it shows how medical schools still have the freedom to integrate the subject in other ways. We may disagree with this approach, but we are free to organise things differently at our own institution. Now we have seen how the system works, how should we go about designing oncology teaching in a UK hospital? First, the GMC recommends that we must ‘take into account modern educational theory and research’ [9]. This is not a particularly rewarding exercise. Papers are often written in the impenetrable prose of the social scientist. Fortunately, the literature has been recently reviewed [2,3]. In brief, there has not been much research and little is of high quality. Most studies are uncontrolled, there is usually no randomisation and student feedback is often the only end point, usually reported as overwhelmingly positive. Some of the interventions, such as supervised student-led clinics, would be
0936-6555/$36.00 Ó 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.clon.2011.08.002
566
L. Hughes-Davies, J. Barrett / Clinical Oncology 23 (2011) 565e568
Table 1 Tomorrow’s doctors: summary of educational outcomes [9] Domain
Outcome
(1) The doctor as a scholar and a scientist
(a) Apply scientific method to clinical practice (b) Apply psychological principles to clinical practice (c) Apply social science principles to clinical practice (d) Apply principles of population health to clinical practice (e) Apply scientific method and approach to medical research (a) Be able to undertake a consultation with a patient (b) Diagnose and manage clinical presentations (c) Communicate effectively with colleagues (d) Provide immediate care in medical emergencies (e) Prescribe drugs safely, effectively and economically (f) Carry out practical procedures safely and effectively* (g) Use information effectively in a medical context (a) Behave according to ethical and legal principles (b) Reflect, learn and teach others (c) Learn and work effectively within a multiprofessional team (d) Protect patients and improve care
(2) The doctor as a practitioner
(3) The doctor as a professional
* In its latest version, the document includes a list of 32 practical procedures that every medical course should teach, from taking blood to performing and interpreting a 12 lead ECG. None of these is oncology specific.
impossible to deliver cost-effectively. There is a general motherhood-and-apple-pie agreement that oncology teaching should be made relevant to real life as a junior doctor. Surveys emphasise the importance of teaching symptom control and show that going into too much detail about chemotherapy or radiotherapy is unhelpful and should be avoided. Unsurprisingly, young doctors wish they had received more training in how to communicate with very sick patients and their families. As we have seen, the GMC’s educational regulations are intended to let a thousand flowers bloom. Therefore, this editorial does not presume to make any recommendations for any particular course design or content. Instead, in keeping with the GMC’s philosophy, it will end with a ‘How I do it’ discussion. In my institution, oncology is taught as a stand-alone 2 week rotation. Each day is framed with a morning seminar and ends with a written case of the day, usually based on a lightly edited recent review. Clinic and ward attachments are scheduled between these commitments. All of the daily seminars are given by the same person, as we believe that continuity is as important for teaching as it is for patient care. We decided that teaching devoted to ‘real life as
a junior doctor’ would be utilitarian and quite dull. We have included some sessions on oncology emergencies, practical prescribing, communication skills and physical diagnosis. But ‘real life as a junior doctor’ is short. Junior doctors turn into more senior doctors with remarkable speed, and they need to take something from their training that is more sustaining. This is also recognised by the GMC, which strongly emphasises the domain of the doctor as scholar and scientist. Therefore, we designed content by spreading our bets across each of the GMC outcomes listed in Table 1. For example, an introductory seminar starts by emphasising three professional attributes (punctuality, appearance and non-verbal communication), which are strictly enforced during the 2 week rotation (GMC outcome 2c) and then moves on to discuss the ‘hallmarks of cancer’ [10] (GMC outcomes 1a, 1e), whereas the next seminar discusses KaplaneMeier calculations and clinical decision making (GMC outcomes 1a, 1b, 1e, 2a, 3c), followed by a session on error in oncology (GMC outcomes 3a, 3b, 3c, 3d) and so on for a series of 10 seminars. But this is just one medical school’s approach.The GMC still encourages everyone to cultivate their garden in their own way, which is why we can still get job satisfaction from educating medical students.
Recruitment Strategy for Clinical Oncology A well-designed recruitment strategy is essential for recruiting high-calibre candidates in clinical oncology. The second part of this editorial describes the first two rounds of the new central recruitment process. It also outlines the results of the 2010 Royal College of Radiologists (RCR) workforce census, which have a direct effect on recruitment strategy.
Central Recruitment in Clinical Oncology Clinical oncology specialty training begins after the completion of core medical training, i.e. in ST3. Applicants are advised to obtain some experience in clinical or medical oncology or palliative medicine before applying to the specialty, but this is not mandatory. In the past, the 18 clinical oncology training schemes in the UK recruited to training posts independently, but in 2010 national recruitment was introduced. National recruitment is not a new concept, and general practice has a well-established process that has been developed over several years. This is robust, has high reliability and predictive validity, is perceived to be fair by candidates and allocates applicants equitably across the country. The key success factors have been identified as corporate commitment to the goal of a national process, with gradual convergence rather than the imposition of the change. The general practitioners have also shown that their selection process correlates with success in the MRCGP examination. Following the successful experience of general practice, the RCR, supported by Kent, Surrey & Sussex Deanery undertook the first round of clinical oncology national
L. Hughes-Davies, J. Barrett / Clinical Oncology 23 (2011) 565e568
recruitment in 2010. This allowed candidates to make one application, preferencing their deanery/ies of choice with one point of contact for all enquiries during the recruitment process. In 2010, there were 119 applicants for entry to the specialty of clinical oncology. All 115 eligible candidates were invited for interview, and 100 people were interviewed over 2 days in a single location. The interview was comprised of three stations covering clinical scenarios, management and ethics, and portfolio/CV each with two consultants interviewing and scoring the candidates. Sixty candidates were deemed appointable, and were ranked according to score and geographical preference. All 46 substantive and one Locum Appointment for Training (LAT) posts were filled. Thirty consultants, two lay chairs and five members of deanery staff ran the process. They felt that recruitment was fair, with wide agreement of the standard required for applicants to be successful. The RCR Oncology Registrars’ Forum survey in 2011 asked questions about the national recruitment process. Twenty per cent of respondents had been through it and for 98% of the trainees, clinical oncology had been their first choice specialty. Seventy-two per cent obtained their preferred post, with 87.5% obtaining their first, second or third choice post. Trainees also felt that overall the process had been fair and well run, although some felt it was overly reliant on a point scoring process rather than interview. Clearly this only reflects the views of successful candidates. In 2011, medical oncology joined clinical oncology in central recruitment. Applications were considered together and 46 applicants applied to both specialties. There were 95 applicants for 41 clinical oncology posts, 82 candidates were interviewed and 51 were deemed appointable. This year an optional online upgrading mechanism was in place for candidates who did not receive a post in their choice deanery. Candidates were offered an ‘upgrade’ in the event that a higher ranked preference became available. Thirty-nine clinical oncology posts were filled, with 19 upgrades occurring. 73% of medical oncology training posts were filled by LAT or substantive posts. Almost all the highest ranking candidates were offered posts in both specialties, indicating a similar standard in ranking by assessors in medical and clinical oncology. In 2012, academic trainee recruitment may join the process, thus strengthening links with medical oncology and academic training. Scotland and Northern Ireland may also participate.
567
RCR to identify opportunities and challenges facing the workforce in the future. The 2010 workforce census shows that the overall clinical oncology workforce in UK cancer services (including unfilled posts) has increased by 60 posts to 1110 in 2010. This equates to a 6% increase over the period. The number of consultant posts increased by 9% in both 2009 and 2010, to 702 consultant posts in 2010. The number of specialist registrar posts also increased in 2009 and 2010 to 315 posts in 2010. In the last 12 months, there have been 72 new appointments to consultant grade posts, compared with 20 leaving the workforce, mainly through retirement. Almost 20% of consultants now work part-time. This is a 4% increase since 2009. This trend will probably continue in future years. In 2010, just over one in 10 male consultant clinical oncologists worked part-time, compared with three in 10 female. The gender split of clinical oncologists appointed to their first consultant post between January 2006 and December 2009 was 59% male, 41% female compared with 41% males and 59% females appointed in 2010. This mirrors the gender profile of trainees (62% women versus 38% men). The observed feminisation of the work force and the greater propensity towards working part-time will need to be addressed through future training numbers ensuring the workforce can sustain delivery of services.
Conclusion The RCR experience over the last 2 years is that national recruitment has been successful, although it remains to be seen if those taken in to the specialty in this way complete their training in a satisfactory and timely manner. The increased feminisation of the workforce and the large number of retirements predicted over the next few years will require changes to training programmes. Consideration will need to be given to more flexible working patterns. One concern is that recruitment occurs so early in the core medical training programme that many trainees will not have experienced oncology by the time they apply for higher training and the overall calibre of applicants will be affected. This does not seem to be the case so far and if the undergraduate oncology training is successful, oncology will continue to attract high achieving trainees.
Acknowledgements
The Royal College of Radiologists Workforce Census The RCR has undertaken a census of the UK clinical oncology workforce in 2009, 2010 and 2011 to obtain accurate data on the composition of the workforce. It provides information on clinical oncologists in training (specialist registrars) and the probable future supply for National Health Service consultant appointments. The intention is to establish trend data, for example, gender patterns and the extent of part-time working to enable the
With grateful thanks to Dr D. Gilson, Warden Clinical Oncology RCR, for advice and Anna Campbell, Executive Education Officer and Karen Darley, Professional Services Manager for collection and analysis of data.
References [1] Cave J, Woolf K, Dacre J, Potts HW, Jones A. Medical student teaching in the UK: how well are newly qualified doctors prepared for their role caring for patients with cancer in hospital? Br J Cancer 2007;97(4):472e478.
568
L. Hughes-Davies, J. Barrett / Clinical Oncology 23 (2011) 565e568
[2] Gaffan J, Dacre J, Jones A. Educating undergraduate medical students about oncology: a literature review. J Clin Oncol 2006;24(12):1932e1939. [3] Dennis KE, Duncan G. Radiation oncology in undergraduate medical education: a literature review. Int J Radiat Oncol Biol Phys 2010;76(3):649e655. [4] Barton MB, Bell P, Sabesan S, Koczwara B. What should doctors know about cancer? Undergraduate medical education from a societal perspective. Lancet Oncol 2006;7(7):596e601. [5] Pavlidis N, Vermorken JB, Stahel R, et al. Undergraduate training in oncology: an ESO continuing challenge for medical students. Surg Oncol 2010. http://www.sciencedirect.com/ science/article/pii/S0960740410000642.
[6] Pavlidis N, Vermorken JB, Costa A. Oncology for medical students: a new ESO educational avenue. Ann Oncol 2005;16(5): 840e841. [7] Oncology Education Committee. Ideal oncology curriculum for medical schools. Sydney: The Cancer Council Australia; 2007. Available at: http://www.cancer.org.au//Healthprofessionals/ OncologyEducation/IdealOncology.htm. [8] Eminem (Marshall Bruce Mathers III) Careful What You Wish For. Interscope Records, 2009. [9] http://www.gmc-uk.org/education/undergraduate/tomorrows_ doctors_2009.asp. [10] Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011;144(5):646e674.