Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UK
Introduction: In 2022, the UK introduced a major restructure to higher specialty training (HST) in all Group 1 medical specialties, compressing most specialities from 5 to 4 years and embedding a year of internal medicine (IM) training within the programme. The IM Stage 2 curriculum recommended an i...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
|
| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664525002231 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849417874248040448 |
|---|---|
| author | Hasaan Rafique Sadaf Hasaan Neil Fisher |
| author_facet | Hasaan Rafique Sadaf Hasaan Neil Fisher |
| author_sort | Hasaan Rafique |
| collection | DOAJ |
| description | Introduction: In 2022, the UK introduced a major restructure to higher specialty training (HST) in all Group 1 medical specialties, compressing most specialities from 5 to 4 years and embedding a year of internal medicine (IM) training within the programme. The IM Stage 2 curriculum recommended an indicative 75% specialty and 25% IM time split, aiming to strike a balance between generalist breadth and specialist depth. Yet, early frontline experience suggests this balance has not been realised. Instead, specialty training time is being consumed by IM service delivery, leaving many trainees underexposed, underprepared and unable to meet curriculum requirements. We undertook a deanery-wide audit to objectively assess whether this training model is being delivered as intended. Methods: We tracked and audited specialty trainee rotas across all 14 hospitals delivering Group 1 training in the West Midlands Deanery, including 11 district general hospitals (DGHs) and 3 university hospitals, over a 3-year period from 2022 to 2024. IM time was defined as all acute unselected take, general medicine on-calls and mandatory IM clinics and teaching. Specialty time was defined as all remaining in-hours non-on-call gastroenterology activity. Annualised adjustments were made for leave, and all data were validated with Trust staffing teams. Results: No DGH met the 75:25 training time split in any year, while only one university hospital achieved this benchmark. In 2024, trainees spent a mean of just 55.35% of their time in specialty training, equating to a deficit of 9.5 weeks per year. The situation was worse in DGHs, where specialty time dropped to 53.2%, with a mean annual deficit of 10.5 weeks. Over 4 years, this translates to just over 2 years of effective specialty training, far below curriculum expectations. Discussion: Compared with international models, where trainees receive 3–5+ years of full-time specialty training without parallel IM duties, the UK now compares unfavourably. Specialty education is being diluted by rota-driven IM commitments, and curriculum delivery is being sacrificed to sustain under-resourced services.This collapse in specialty time has critical implications. In gastroenterology, certification standards for colonoscopy and gastroscopy have become more demanding, and only 22% of trainees achieved accreditation by Completion of Training (CCT) in 2022. Similar problems are seen in cardiology, where 87% of trainees expect to need post-CCT fellowships. In surveys, 84% of Group 1 trainees do not feel ready for consultancy after 4 years. These are not isolated sentiments; they signal a systemic failure. This shift of skill acquisition into the post-CCT phase is neither sustainable nor equitable and risks lowering the standard of specialty expertise at the point of independent practice. Conclusion: Our audit confirms that Group 1 training across one of the UK’s largest deaneries is not being delivered as intended. Without urgent structural reform, including enforcement of the 75:25 split, protection of specialty immersion time and reduced dependency on trainees to fill IM rotas, the UK risks producing a generation of consultants who are underprepared, undertrained and internationally uncompetitive. The current model is not just unsustainable, it is undeliverable by design. |
| format | Article |
| id | doaj-art-27cf1f08e8e2452a8673af8e3a2a335a |
| institution | Kabale University |
| issn | 2514-6645 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Future Healthcare Journal |
| spelling | doaj-art-27cf1f08e8e2452a8673af8e3a2a335a2025-08-20T03:32:37ZengElsevierFuture Healthcare Journal2514-66452025-06-0112210044410.1016/j.fhj.2025.100444Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UKHasaan Rafique0Sadaf Hasaan1Neil Fisher2University Hospital of North MidlandsThe Royal Wolverhampton NHS TrustThe Dudley Group NHS Foundation TrustIntroduction: In 2022, the UK introduced a major restructure to higher specialty training (HST) in all Group 1 medical specialties, compressing most specialities from 5 to 4 years and embedding a year of internal medicine (IM) training within the programme. The IM Stage 2 curriculum recommended an indicative 75% specialty and 25% IM time split, aiming to strike a balance between generalist breadth and specialist depth. Yet, early frontline experience suggests this balance has not been realised. Instead, specialty training time is being consumed by IM service delivery, leaving many trainees underexposed, underprepared and unable to meet curriculum requirements. We undertook a deanery-wide audit to objectively assess whether this training model is being delivered as intended. Methods: We tracked and audited specialty trainee rotas across all 14 hospitals delivering Group 1 training in the West Midlands Deanery, including 11 district general hospitals (DGHs) and 3 university hospitals, over a 3-year period from 2022 to 2024. IM time was defined as all acute unselected take, general medicine on-calls and mandatory IM clinics and teaching. Specialty time was defined as all remaining in-hours non-on-call gastroenterology activity. Annualised adjustments were made for leave, and all data were validated with Trust staffing teams. Results: No DGH met the 75:25 training time split in any year, while only one university hospital achieved this benchmark. In 2024, trainees spent a mean of just 55.35% of their time in specialty training, equating to a deficit of 9.5 weeks per year. The situation was worse in DGHs, where specialty time dropped to 53.2%, with a mean annual deficit of 10.5 weeks. Over 4 years, this translates to just over 2 years of effective specialty training, far below curriculum expectations. Discussion: Compared with international models, where trainees receive 3–5+ years of full-time specialty training without parallel IM duties, the UK now compares unfavourably. Specialty education is being diluted by rota-driven IM commitments, and curriculum delivery is being sacrificed to sustain under-resourced services.This collapse in specialty time has critical implications. In gastroenterology, certification standards for colonoscopy and gastroscopy have become more demanding, and only 22% of trainees achieved accreditation by Completion of Training (CCT) in 2022. Similar problems are seen in cardiology, where 87% of trainees expect to need post-CCT fellowships. In surveys, 84% of Group 1 trainees do not feel ready for consultancy after 4 years. These are not isolated sentiments; they signal a systemic failure. This shift of skill acquisition into the post-CCT phase is neither sustainable nor equitable and risks lowering the standard of specialty expertise at the point of independent practice. Conclusion: Our audit confirms that Group 1 training across one of the UK’s largest deaneries is not being delivered as intended. Without urgent structural reform, including enforcement of the 75:25 split, protection of specialty immersion time and reduced dependency on trainees to fill IM rotas, the UK risks producing a generation of consultants who are underprepared, undertrained and internationally uncompetitive. The current model is not just unsustainable, it is undeliverable by design.http://www.sciencedirect.com/science/article/pii/S2514664525002231 |
| spellingShingle | Hasaan Rafique Sadaf Hasaan Neil Fisher Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UK Future Healthcare Journal |
| title | Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UK |
| title_full | Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UK |
| title_fullStr | Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UK |
| title_full_unstemmed | Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UK |
| title_short | Undeliverable by design? How excessive internal medicine commitments are compromising Group 1 specialty training across the UK |
| title_sort | undeliverable by design how excessive internal medicine commitments are compromising group 1 specialty training across the uk |
| url | http://www.sciencedirect.com/science/article/pii/S2514664525002231 |
| work_keys_str_mv | AT hasaanrafique undeliverablebydesignhowexcessiveinternalmedicinecommitmentsarecompromisinggroup1specialtytrainingacrosstheuk AT sadafhasaan undeliverablebydesignhowexcessiveinternalmedicinecommitmentsarecompromisinggroup1specialtytrainingacrosstheuk AT neilfisher undeliverablebydesignhowexcessiveinternalmedicinecommitmentsarecompromisinggroup1specialtytrainingacrosstheuk |