Acronyms soup
Can't tell your SSC from the
GMC? Deborah Cohen explains some acronyms
commonly used in the UK
health system
Medics seem to like acronyms. The use of
abbreviations and shorthand extends
beyond the clinical setting and enters into
the working lives of doctors too. The
studentBMJ has published lots of articles
about the UK system in the past, and if you don't know
your SSC from your GMC hopefully this short-and by
no means comprehensive-guide to acronyms will clarify
things a little. Beware though, the UK postgraduate
medical training setup is changing rapidly and no doubt
in a few years time, there will be another array of
acronyms to get to know.
NHS-The National Health Service was created in
1948 to provide a comprehensive health service to all
citizens of the UK based on need and not the ability to
pay. The NHS is mainly funded by the taxpayer and is
managed by the government's Department of Health
(DoH). The structure and financing of the NHS are currently
undergoing large scale changes.1
MBChB and MBBS-Bachelor of medicine and bachelor
of surgery is the qualification awarded to people who
successfully graduate from medical school. Medical
degrees differ in length depending on previous undergraduate
and postgraduate qualifications. Some medical
schools offer an additional qualification as part of the
course. They may also allow students to study a different
subject for a year resulting in a BSc (bachelor of science)
or a BA (bachelor of arts) and at some medical schools,
this is compulsory. For links to the faculties to find out
more about the different qualifications visit
www.chms.ac.uk/fschlweb.html.
SSM or SSC-Special study modules or student
selected components were introduced by the GMC in
their document Tomorrow's Doctors. When they were first
introduced these compulsory components were called
special study modules, but a later draft of Tomorrow's Doctors
stipulated that they change their name to student
selected component. These components allow students
to study in depth areas that they are particularly interested
in and go beyond the "core curriculum"-or the subjects
that medical schools must teach. Although the core
curriculum must take up most time, SSCs should take up
between 25% and 33% in a five year course.2
Medical schools are allowed to decide the number and
duration of student selected components and what's
available varies greatly. In some medical schools, the
options for SSCs are open to negotiation and some may
allow overseas experience. Whilst some medical schools
may allow students to study foreign languages, art or
journalism, to name just three, the GMC does stipulate
that "at least two thirds of each student's SSCs must be in
subjects related to medicine, whether laboratory-based or
clinical, biological or behavioural, research-orientated or
in humanities related to medicine."
PRHO-Preregistration house officer (or house officer)
was the name given to newly qualified doctors who have
obtained the primary medical qualification (MBChB or
MBBS) and only have provisional registration with the
GMC. By law, new UK medical graduates must be provisionally
registered with the GMC before they can begin
general clinical training. The purpose of the PRHO year
was to allow newly qualified doctors to practice the
key skills that they have learnt, and apply knowledge gained, during the medical degree. The PRHO year
has now given way to the foundation programme,
although the same principles exist (see below). The year
enables young doctors to demonstrate that, on
completing general clinical training, they are ready to
accept the duties and responsibilities of a fully registered
doctor and to begin training for specialist medical
practice. The year of training has to be approved by
the university and it has to include at least three
months of a medical specialty such as
rheumatology, and at least three months of surgical
specialty, such as orthopaedics. The remaining
six months must be spent in a recognised
clinical specialty, including general practice.3
SHO-Senior house officer posts were the
next phase of postgraduate medical education,
after the PRHO year. These posts were either
linked to a planned rotation
of two to three years of basic specialist training
for a career in hospitals; part of the three year
vocational
training programme for general practice; or they were
stand alone posts that were either training posts or
non-training posts. Doctors spend varying lengths of time
as an SHO for lots of different reasons including the
specialty chosen, their success in obtaining specialty
exams, and the availability of SpR posts. This current
system is set to give way to what has been dubbed "run
through training" or specialist and GP training
programmes by August 2007. But this is still work in
progress. See
http://careerfocus.bmjjournals.com/cgi/content/
full/332/7532/3-a for a good guide of the current
proposals.
SpR-Specialist registrar is the period
of specialist training after the SHO years.
This period typically lasts for four to five
years, but can vary.4 Before an SHO can
become an SpR, they need to have completed
their membership exams for the
royal college that represents their specialty.
People who have completed these
exams might have MRCS (membership
of the Royal College of Surgeons) or MRCP (membership of the Royal College
of Physicians) after their name. There are
colleges for other specialties too, such as
psychiatry, paediatrics, obstetrics and gynaecology,
pathology, and general practice. During
the SpR period, doctors will continue to
sit royal college exams. Upon completion of
this period and exams, SpRs can apply for consultant
posts. However, this system is set to
change in August 2007.
F1 and F2-Foundation year 1 and foundation year 2
are the training years you have to complete upon finishing
medical school. The foundation programme is a two
year general training programme, which follows a curriculum.
All medical graduates enter the programme immediately
following graduation by applying to a competitive
selection process.5 The idea is that the programme will
form a bridge between medical school and specialist or
general practice training. It comprises a series of placements
in a variety of specialties and healthcare settings.
The learning objectives are set by the GMC. Foundation
year 1 is the first year of the programme and is like the old PRHO year. Doctors graduating from UK medical
schools will be eligible for full registration at the end of
the F1 year, although the requirements for full registration
have shifted from being based on the amount of time
spent training to one based on the achievement of specific
competencies. Foundation year 2 is intended to build
upon the knowledge, skills, and attributes developed in
the first year. For further information visit
www.mmc.nhs.uk/pages/foundation/FAQ.
GMC-The General Medical Council registers doctors
to practise medicine in the United Kingdom. The 1858
law that set up the GMC described its four main functions.
These included keeping up to date registers of qualified
doctors; fostering good medical practice; promoting high
standards of medical education; and dealing firmly and
fairly with doctors whose fitness to practise is in doubt.6
Entry on the register shows that the doctor holds a recognised
primary qualification and is committed to upholding
the profession's values.7 There are different types of
registration depending on the country of qualification and
the stage of medical training. The GMC is currently
reforming doctor's registration procedures.
BMA-The British Medical Association is a voluntary
professional association of doctors that represents
medical students and doctors from all branches of
medicine all over the UK. The main functions of the
BMA are to speak for doctors at home and abroad-it
is an independent trade union. It also provides additional
services for its members and is a scientific and
educational body. It is funded largely by its members.8
PLAB-The Professional and Linguistic Assessments
Board examination is designed to assess overseas doctors'
ability to work safely as an SHO in a UK hospital and is a
prerequisite for overseas doctors GMC registration. There
are two parts: a written exam and an OSCE (objective
structured clinical examination), which tests clinical and
communication skills.4
Although the above list might go some way in helping
you understand how the UK system has worked up until
now, it's essential to bear in mind this will change over the
coming years. Still confused? Guaranteed you won't be
the only one.
Deborah Cohen, assistant editor, BMJ
Email: dcohen@bmj.com
studentBMJ 2006;14:265-308 July ISSN 0966-6494
- NHS. History of the NHS.
www.nhs.uk/england/aboutTheNHS/history/default.cmsx (accessed 30
May 2006).
- General Medical Council. Tomorrow's doctors: recommendations on
undergraduate medical education. London: GMC, 2003.
www.gmcuk.
org/education/undergraduate/tomorrows_doctors.asp (accessed 30
May 2006).
- General Medical Council. General provisional training for UK qualified
doctors. London, GMC.
www.gmcuk.org/doctors/how_to_register/
registration/guidance_for_provisional_registration.asp (accessed
30 May 2006).
- Dosani S, Cross P. Making it in British medicine: essential guidance for
international doctors. Oxford: Radcliffe Publishing, 2004.
- Modernising Medical Careers. The foundation programme. London,
MMC. www.mmc.nhs.uk/pages/foundation/about (accessed 30 May
2006).
- General Medical Council. The role of the GMC. London, GMC.
www.gmc-uk.org/about/role/index.asp Accessed 30 May 2006
- Marcovitch H, ed. Black's medical dictionary. 41st ed. London: Scarecrow,
2005.
- BMA. About the BMA. London: BMA, 2005.
www.bma.org.uk/ap.nsf/Content/Hubaboutthebma (accessed 30 May
2006).
careers
