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What every medical SHO should know

The Royal College of Physicians is not the most radical of medical organizations, and has only lately dropped the use of Latin for summoning Fellows to meetings. A new document, however, marks a striking change of direction1: for the first time, the College has published a curriculum for senior house officers (SHOs) in medicine and its subspecialties. In his foreword the President says that previous moves towards producing a curriculum had been resisted on the grounds that it would have had to include the whole of medicine. SHOs will be relieved to observe that the 1996 document is less ambitious. The curriculum itself is divided into two principal components-a core for all medical SHOs, and the additional knowledge and skills expected of SHOs working in each of the medical specialties. The requirements for specialties are subdivided into topics and practical skills. Most of the individual specialty curricula are easy to understand though some are probably too extensive. The main weakness is that the balance between core and specialty knowledge and the degree of detail described differ from specialty to specialty. For example, gastroenterology and neurology do not distinguish at all between the knowledge required by all SHOs and those working within the specialty. Neurology requires SHOs to know the costs of investigations such as magnetic resonance angiography whereas information of this sort is not required by, say, cardiology. The inconsistency of approach is also evident in what is included under the term practical skills. In some specialties this is confined to clinical procedures such as lumbar puncture and paracentesis. For others the content is much broader. Renal medicine includes assessment of hydration status. Rehabilitation medicine wishes its SHOs to know when and who to ask for help; apparently this skill is not required for other specialties! The section on psychiatry is too brief and failsf the strong association between psychol( physical medicine that the College has recognized elsewhere2. I am sure that these issues of cross-specialty consistency and degree of detail will be ironed out when the document is revised. All SHO posts in the UK must now have educational approval from the relevant Royal College. It seems logical that, if there is a curriculum in place, then educational approval should in some way be related to the organizing hospital's ability to deliver the curriculum. That this is so is by no means clear. Large hospitals such as North Staffordshire Hospital, where I work, are able to organize a year-round core curriculum course that includes lectures, tutorials and bedside teaching; smaller units will find this difficult if not impossible without inter-hospital cooperation. A final point. Those who aspire to be specialist physicians will have to pass through both general professional training (SHO grade) and higher training (specialist registrar grade). For the latter, satisfactory completion (without an examination) will yield a certificate of specialist training and eventually a consultant appointment. For the former, satisfactory completion does not automatically lead to anything. To become a specialist registrar one must pass the MRCP examination, for which the Colleges still decline to issue a curriculum and which has a low pass rate; until something is done about this, most SHOs will spend their time trying to pass the examination rather than gaining the experience and skills outlined in the core curriculum.