What’s in a name?
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?).
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.
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.
Professor Nick Craddock, Chair of the Academic Faculty
Dr. Jon van Niekerk, Chair of the Psychiatric Trainees' Committee (PTC)
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