Why I don't like 'trainees'

2014 10 21 11 55 58 179 Girl With Pimple 200

Professional identity is a matter of pride for most doctors. Medical training is long, hard, and demanding. Many are therefore keen on their medical status being clearly identified. Some are unutterably tedious about it; some couldn't care less. But most will quickly correct you if you get their title wrong.

Dr. Paul McCoubrie is a consultant radiologist at Southmead Hospital in Bristol, U.K.Dr. Paul McCoubrie is a consultant radiologist at Southmead Hospital in Bristol, U.K.
Dr. Paul McCoubrie is a consultant radiologist at Southmead Hospital in Bristol, U.K.

The details of medical career structure are largely opaque to those outside the profession. To be honest, patients don't stand a chance. We're lucky if they even vaguely acknowledge that radiologists are doctors.

For this reason, it should be clear who does what from the name alone. The best professional names are the shortest, preferably one word: nurse, porter, and so on. The worst have four or more words and verge on being "nonjobs." Does anyone really know what a "senior imaging support worker" does?

You should also be able to distinguish the degree of seniority of the individual from their title. That is, it should be clear if you are speaking to the monkey or the organ grinder.

Evolution of U.K. job titles

For decades, the hierarchy of U.K. medical training was reasonably straightforward. After graduation you became a house officer, then senior house officer (SHO), registrar, senior registrar, and consultant in that order. If you became a general practitioner (GP), you turned left after SHO and became a GP registrar, then finally a GP. This was the model in many English-speaking countries. Not the simplest, but it was embedded in medical culture and healthcare folk knew who was who.

Once upon a time, you were a house officer as you practically (if not literally) lived in the hospital. But with the European Working Time Directive and removal of cheap hospital accommodation, this isn't the case anymore. Similarly, registrars are no longer responsible for recording hospital admissions, but the term has stuck.

Nowadays, we don't have house officers we have foundation year one (FY1) doctors. We don't have SHOs, we have foundation year two doctors, core medical trainees, basic surgical trainees, clinical fellows, and a whole mishmash of intermediate grades. We do have registrars, but in 1996 they became specialist registrars (SpRs) before morphing in 2007 to speciality registrars (oddly abbreviated to "StR" or just "ST").

U.K. radiologists are uncomplicated folk, and their career structure is simple. It is a model that has worked well for the last 18 years and we've got no desire to change it. You apply after a few years as a junior doctor, do five years as a radiology registrar, pass the FRCR (Fellow of the Royal College of Radiologists) diploma, and then become a consultant. Nice and simple.

However, for the rest of the hospital, there is an unholy maelstrom of medical monikers. Endless reforms of U.K. medical postgraduate education in the last 18 years have resulted in utter confusion.

Why the naming system is broken

I should say outright that I'm not afraid of change. If something is broken, by all means fix it. If something is outdated, please do update it. Just try not to make things worse whilst attempting to fix it. And for goodness sake, please don't uproot the trees you've just planted.

So what is my evidence that the naming system is broken? Well, seven years after the grade was officially abolished, why do junior doctors routinely introduce themselves as SHOs? And have SHO on their name badge?

This isn't the worst bit at all. It is the nefarious practice of using the word "trainee" to describe a postgraduate doctor. I don't think it is a deliberately malicious trend. Things like this are generally cock-ups rather than conspiracies. But I contend trainee is a rubbish word to describe our registrars.

Firstly, trainee is confusing to staff and patients. It doesn't give the right impression. When I summon a mental image of a trainee, I think of a pimply teenager, just out of secondary education, wearing a temporary badge and an ill-fitting uniform. To me, trainee is below student in the pecking order. At least student implies scholastic effort, rather than some mickey mouse vocational apprenticeship.

Secondly, trainee belittles the individual's status and doesn't do justice to him or her. These are experienced doctors who are often working with large degrees of autonomy. When I became a consultant, I had 15 years of medical experience and more letters after my name than in it. Seriously. I'm not unusual in that respect.

Lastly, education differs from training. Training is a technical task, preparation for a specific job. Education is much more than that; education broadly prepares individuals for future complexity. We train horses and dogs; we educate doctors.

Having stated the above, I'll no doubt get people tut-tutting and alleging pedantry over semantics. However, I feel passionately about treating our registrars well. They deserve respect and the best education we can give them. And who knows? As future consultant colleagues, they just could well be looking after you and your loved ones in the future.

Dr. Paul McCoubrie is a consultant radiologist at Southmead Hospital in Bristol, U.K.

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