Significant delays have occurred in delivering end-point assessments in the military medicine specialist training scheme, which are crucial assessments for trainee progression and sign-off, the Medical Independent (MI) has learned.
This newspaper has also been informed of shortfalls in the provision of some formative assessments and advanced clinical placements. Furthermore, it is understood trainees are owed out-of-hours payments for work undertaken in the health service and military settings.
The end-point assessments for years four and five are due to be held on 25-26 July. A trainee in year five will undertake the assessments for both years on these dates, according to the Defence Forces.
“The delay until the end of year five has been due to other Defence Forces operational taskings and personnel resource availability impacting on the ability to deliver the assessments,” said a Defence Forces spokesperson. No comment was provided in regard to formative assessments and clinical placements. “The Defence Forces have no further comment to add at this time,” said a spokesperson.
It is understood the general practice elements of the programme have proceeded as planned via the ICGP.
The five-year military medicine training scheme facilitates dual qualification in military medicine and general practice. The programme was launched in 2017 with the intention of recruiting two trainees per year and ensure a consistent supply of specialist-trained medical officers available to the Defence Forces. No doctors have completed the scheme to date.
As of early 2023, three doctors had left the scheme prior to completion of the full training programme and three doctors were enrolled in the scheme. However, MI understands one of these doctors, who was at an advanced stage of training, is seeking to exit the Defence Forces on several grounds, including non-delivery of promised assessments.
The terms for trainee appointments state that after “successful completion of training” they shall be required to serve an undertaking of three years as a medical officer in the Defence Forces. Failure to successfully complete training at any stage may result in withdrawal of commission and discharge from the Defence Forces.
According to the Department of Defence: “As with many other academic courses provided to Defence Forces’ personnel free of charge by the organisation, an undertaking to the organisation is associated with the scheme.”
Currently, no service undertakings apply in other postgraduate medical training programmes in regard to doctors who have attained their certificate of satisfactory completion of specialist training.
Last year, the Department of Defence stated that discussions were ongoing on a framework agreement between the Department, HSE and ICGP pertaining to the military medicine programme. The agreement will cover a range of issues including out of hours payments.
This week the HSE informed MI: “A framework agreement underpinning the HSE commitments to paying out of hours payments to military medicine trainees has been drafted and signed by the HSE and ICGP. Signature is currently awaited from the Department of Defence in order to activate the agreement and put the required funding arrangements in place.”
Subsequently, a Department of Defence spokesperson stated: “We can confirm a framework agreement has been agreed and is now pending signature by the relevant parties. This is currently being progressed.”
To date, the Department of Defence has not required medical officers to have specialist registration with the Medical Council and the salary scale is considered unattractive compared to other medical posts. This has negatively impacted on recruitment of military medicine trainees and direct-entry medical officers.
As of May there were five vacancies for medical officers. The effective medical officer strength was 20.5, as well as one civilian psychiatrist. There were ten medical officers eligible for overseas deployment.
There have been gaps in the Defence Forces’ deployment of medical officers with contingents participating in the United Nations Disengagement Observer Force (UNDOF) in Golan Heights, Syria. Medical officers have been deployed for shorter periods in an effort to cover these gaps.
Last October, a 130-strong contingent from the 66th Infantry Group were deployed to the Golan Heights without a medical officer, MI previously reported. At the time, the Defence Forces noted that personnel had access to a UN medical facility.
“Due to resourcing issues, the deployment of the 66th Infantry Group, UNDOF, required mitigating measures to be put in place which included the deployment of a number of medical officers for shorter periods to provide medical officer cover,” according to the Defence Forces.
“There is a senior medical officer (Lt Col rank) currently deployed with the 67th Infantry Group, Golan Heights, Syria. They will be deployed for the entirety of the current mission.”
Two medical officers are part of the Defence Forces’ contingent (122nd Infantry Battalion) with the United Nations Interim Force in Lebanon (UNIFIL), according to a response on 18 May.
The Defence Forces’ largest overseas missions are with UNDOF and UNIFIL.
In March, the Government announced its intention to withdraw from UNDOF effective from April 2024.
In a parliamentary response that month, Tánaiste and Minister for Defence Micheál Martin said: “The withdrawal of troops from UNDOF will allow the Defence Forces an opportunity to undertake a process of consolidation with regard to their overseas commitments and to prepare for future peace-keeping missions. It will also relieve ongoing challenges in respect of the filling of specialist roles in overseas deployments.”