Important Update: The role of Medical Oncology in Shape of Training
Over the past three years the ACP has been working closely with the GMC’s Curriculum Oversight Group to develop a curriculum that meets the requirements set out by ‘Shape of Training’, while continuing to provide the best care for cancer patients. Two of the central pillars of the ‘Shape of Training’ recommendations were to build greater flexibility in training and to enhance generalism to equip the future medical workforce with the skills and experience to manage an aging population with multiple co-morbidities.
Acute oncology has played an important role in demonstrating to the GMC that our trainees are equipped with the necessary skills and experience to manage the cancer patient with multiple co-morbidities and to contribute significantly to the acute unscheduled care burden. However, during negotiations with the GMC, it was agreed that coverage of AOS is not universal and access not equitable. Although there have been significant improvements in the care provided since the first inception of AOS, it needs to continue its development and expansion. While there is not a ‘one-size fits all’ model of AOS care, we need to ensure that our patients receive the highest quality of care irrespective of location.
The GMC were also looking to build greater flexibility into the curriculum so that trainees could, should they wish, transfer more easily between medical and clinical oncology. We had heard, both at our AGM, and in surveys to our membership, that in the first year of training there are shared areas of learning and practice between medical and clinical oncology. This includes acute oncology (especially on-call rotas), common cancers that have treatment paradigms incorporating both radiotherapy and systemic therapies, and the scientific background of cancer.
The choices were difficult as it was clear that the GMC would not view the status quo as compliant with the principles of Shape of Training. A separate curriculum working group, with representatives from both medical and clinical oncology, including trainees, was established to provide a single unified voice to work through how best the specialties could work together to fulfil the requirements of ‘Shape of Training’. Throughout these discussions it was very evident that, without a proactive approach, medical oncology would be designated a dual accrediting specialty with internal (general) medicine, which would have a detriment on the high-quality training we provide to our trainees, an inability to fully deliver on the acute oncology agenda and a negative impact on cancer patient care. At the direction of the ACP membership, we have worked with the Royal Colleges of Physicians and Radiologists to formulate a proposal that meets the requirements of flexibility while maintaining the quality of training and emphasising each specialty’s unique contributions to cancer care.
The GMC has now approved in principle a curriculum proposal that maintains the two unique but complementary specialties of medical and clinical oncology, but in the first year of training will see trainees meeting core capabilities that are reflected in both the medical and clinical oncology curricula. Aligning of these core elements of the curriculum, together with assessments and decision aids, will allow greater flexibility and transferability between specialities and provide the best opportunities for future trainees.
A formal curriculum proposal application has been made to the GMC in line with this, and the outcome of that application expected in mid-April. The proposal is that medical oncology will recruit after two years of internal medicine training into a four-year higher specialty training in medical oncology as a group 2 specialty. This means that medical oncology will not dual accredit with internal medicine or be part of the unselected take, but instead will care for cancer patients through acute oncology services. Recruitment and appraisal processes for the two specialties will remain separate, but will reflect the proposed changes and alignment of curricula for the first year.
The details and process of aligning the curriculum elements for the first year are currently being formulated by a joint working group which includes trainees, and will seek the input of TPDs in the near future.
We hope that as a specialty we can seize upon the opportunities that working more closely with clinical oncology will bring. For centres where there is already integrated on-call and learning, the changes will recognise this close working. For other centres it may require more significant changes. We hope that you can understand and see this as a good opportunity that maintains the specialty care that we can deliver to our patients.
We will keep you updated with progress.
David Cunningham, Chair of Association of Cancer Physicians
Jackie Newby, Chair of the Specialty Advisory Committee of the Royal College of Physicians
Peter Selby, President of the Association of Cancer Physicians
Adam Januszewski, Trainee Representative of the Association of Cancer Physicians