Competition Ratios for Specialty Training
Dear Friend,
Greetings this week from Poland. I hope you all are having a lovely weekend and making the most of the last few days of brightness. In a couple of weeks, the clocks will change once again and it will get darker even earlier. Remember to top up on your Vitamin D, as it can drop to really low levels over the winter.
It is again coming up to that point in the year where many junior (now resident doctors) doctors, including myself, will be applying for higher training. This means entering a training pathway to become a specialist after FY2. As medical students in the UK, you are guaranteed to get a job for FY1 and FY2 – however, after that you must apply for the specialty that you want to join. I had to do this 2 years ago when I was applying for internal medicine training.
Some specialties allow you to apply to them directly. This includes GP, psychiatry, radiology, paediatrics – we call these run-through specialties. Others, including cardiology, oncology, plastic surgery, require an intermediate step via applying for internal medicine or core surgical training first (and then re-applying for these specialities after).
The application statistics for specialty training last year have just come out, and I was shocked to see how competitive higher training has become. Have a look at the competition ratios below.
More competitive every year
As you can see, higher training is becoming increasingly competitive every year. The main reason for this is that the number of medical school places has increased a lot (with 8 new medical schools). In addition, there are lots of internal medicine graduates joining the NHS. However, the number of training posts has barely increased at all. This has created a bottleneck after FY2, and sadly means that many doctors may not get the specialty of their choice – or even worse, may not get a training job at all.
This means that they effectively cannot progress in their medical careers. They will have to try again the following year, against even more competition.
With these stats being released, a lot of you may have been thinking about doing FY3 years out. Whilst this has traditionally been a great way of taking a break and getting some more experience, I’d advise you to throw in an application and see what happens – you can always say no. You don’t want to come back from your FY3 year and then get stuck in the bottleneck.
I hope health education England takes a look at these stats and realises that simply increasing medical school places is not enough, unless you also increase the training posts. It seems so strange that everywhere we read that there are not enough GPs or consultants, yet we are limiting so many doctors from getting into the training programmes.
Whether you are at medical school or a foundation doctor, it’s definitely something to keep you eye on over the subsequent months/years.
Hope you found that interesting. Have a lovely week!
Drug of the week
Dalbavancin
This is a second-generation lipoglycopeptide antibiotic medication.
It belongs to the same class as vancomycin, the most widely used and one of the treatments available to people infected with methicillin-resistant Staphylococcus aureus (MRSA)
Similar to other glycopeptides, dalbavancin exerts its bactericidal effect by disrupting cell wall biosynthesis.
It binds to the D-alanyl-D-alanyl residue on growing peptidoglycan chains and prevents transpeptidation from occurring, preventing peptidoglycan elongation and cell wall formation.
A Brain Teaser
A 64-year-old woman, whose husband had a TIA one month ago brings you a newspaper article with the headline ‘new super drug prevents stroke’. Reading through the article with her, it states that a recent clinical trial has shown that a new lipid-lowering therapy for stroke had a number needed to treat (NNT) of 20 for the prevention of the primary end-point.
How do you best describe these results to her?
A: 20 extra patients in the placebo group had a stroke
B: For 1000 patients treated with active therapy, there would be 50 fewer strokes
C: For 1000 patients treated with active therapy, there would be 20 fewer strokes
D: For 1000 patients treated with active therapy, there would be 100 fewer strokes
E: 20 patients in the treatment group were protected from stroke
Answers
The answer is B.
This prevention study for stroke reveals that 20 patients need to be treated to prevent one event.
Thus if you treat 1000 patients then you will expect to have 50 fewer strokes.
NNT is a time-specific epidemiological measure of the number of patients who need to be treated in order to prevent one adverse outcome. A perfect NNT would be 1, where everyone improves with treatment, thus the higher the NNT, the less effective the treatment.
Subdural haematoma is correct. The patient has a typical history of slow onset symptoms with fluctuating consciousness and confusion. She also has risk factors of old age and previous alcoholism to make this diagnosis most likely.
Delirium is incorrect. Although delirium is a key differential to consider, fluctuating confusion/consciousness following head trauma puts subdural haematoma as the most likely diagnosis.
Extradural haematoma is incorrect. It is less likely given the mechanism of trauma and subacute onset of symptoms. The question does not state whether there was a noted lucid interval after the fall, just that she currently has fluctuating consciousness and GCS has dropped since the ambulance crew met the patient.
Intracerebral haematoma is incorrect. Although this patient has hypertension which is a risk factor for intracerebral haematoma, the history is more suggestive of a subdural haematoma given the fluctuating consciousness/confusion.
Subarachnoid haemorrhage is incorrect. The typical presentation for a subarachnoid haemorrhage is sudden onset occipital headache, which doesn’t quite fit with this patient’s presentation.
