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Establishing a contract for bench training of specialist registrars in medical microbiology
  1. H Ludlam,
  2. N Bentley
  1. Clinical Microbiology and Public Health Laboratory, Health Protection Agency, Box 236, Addenbrooke’s Hospital, Cambridge CB2 2QW, UK;

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    In common with other medical microbiology laboratories in the UK, the biomedical scientist staff (BMS) at Cambridge have faced an increasing burden of specialist registrar (SpR) training from our own, and other specialties, in the face of falling BMS numbers as a result of efficiency savings and an increasing diagnostic workload. This has led to periods of several months in each year in which SpR training by the BMS has had to be abandoned locally in favour of services with formal laboratory contracts.

    Developing a longterm strategy to deal with this problem necessitated the preparation of a business case for SpR training by the BMS, which required an estimation of the local BMS SpR training load. In the first two years, SpRs receive the same basic training in diagnostic methodologies provided for trainee BMS. SpRs spend four months annually in full time bench training, apprenticed to qualified BMS, who spend approximately half their working time on direct supervision of the trainee, equivalent to four months BMS time for each SpR over the first two years. In our own laboratory, we have nine trainees in bacteriology and virology, representing 36 months of BMS time over a notional five year period of SpR training. This calculation assumes that all trainees achieve their annual milestones without delay. In practice, half the trainees sitting the practical component of the examination for membership of the Royal College of Pathologists have required a further six or 12 months of bench training in preparation for a re-sit of the examination. Assuming that half of all the trainees require a nine month extension, this represents an increase in training load at this stage of 27 months, equivalent to an additional 13.5 months of dedicated BMS time, resulting in a total BMS training time of 42.75 months. From their third year of training, SpRs receive three months of advanced training annually, in focused preparation for the RCPath practical examination. The BMS provide and supervise the processing of simulated clinical samples, to be processed independently by the trainee, on a programme that runs continuously throughout the year. The BMS time required for this programme amounts to one day each week. This is equivalent to 2.4 months of BMS time, annually, in years 3, 4, and 5—that is, 7.2 months over the five year period, in both bacteriology and virology, amounting to 14.4 months in total. Therefore, the total of BMS time required for SpR training is 57.15 months—11.43 months of working time each year. Allowing for six weeks of leave entitlement, this is equivalent to one full time BMS. The experience and skills are of those at grade 2 of the BMS pay spine, for which the salary, with on costs, is £26 663 to £33 737 per annum.

    Having established a business case for a full time training BMS (grade 2), we sought a source of funding from those with an interest in training. None was prepared to fund this comparatively large recurrent sum, but three local stakeholders were prepared to fund one third each: the deanery, with its responsibility for the delivery of SpR training; the workforce development directorate (the training and development arm of the Strategic Health Authority), with its overarching responsibilities to training laboratory staff: and the local primary care trust, which has an interest in preserving and developing the laboratory’s services.

    The core duty of the training BMS (grade 2) is to preserve SpR training. Whenever BMS numbers are inadequate to allow SpR training, this function is assumed in full by the training BMS. At other times, the training of SpRs continues to be shared between all the BMS, and the training BMS engages in related educational activities, which have been tailored to the sources of funding. These duties are, first, supporting and developing the education, training, and research of SpRs in medical microbiology, as directed by the deanery’s programme director in medical microbiology. Second, duties supporting the laboratory training manager in the provision of training of SpRs, BMS, medical laboratory assistants, and visitors to the laboratory. Third, maintaining the training BMS’s own professional status and microbiological skills by participating in the rota for provision of the laboratory’s routine diagnostic service, under the direction of the laboratory manager. Because the job description contains three major components with different line managers, a clear division of the working week is necessary to ensure realistic expectations and harmonious working relations. The time allocated to the first, second, and third duties are three, one, and one day each week, respectively.

    We resolved our local crisis in the provision of SpR technical training by negotiating a training contract, analogous to the laboratory’s service contract, with local parties with a training interest. We recommend this model, which we believe to be unique in the UK, to laboratories experiencing difficulties similar to our own.