Features: Fit for tomorrow
26 January 2009
We ask doctors, medical students and others what our new guidance for tomorrow's doctors should look like.
The GMC is reviewing its standards for undergraduate medical education as published in
Tomorrow’s Doctors. From medical students through to NHS employers, GMCtoday asked representatives of key interest groups what the new guidance for tomorrow’s doctors should look like.
Medical education and training has changed fundamentally since the GMC’s guidance, Tomorrow’s Doctors, was last published in 2003: a Foundation Programme for newly qualified doctors has been established along with a national curriculum for which medical students must be prepared; PMETB was launched in 2005, now to be merged with the GMC; and summer 2008 saw the publication of Lord Darzi’s Next Stage Review.
To reflect the developments in medical education, the Tomorrow’s Doctors Review Group is reviewing a new version of the guidance to ensure undergraduate medical education continues to provide graduates with a strong foundation for future learning and practice; vital for doctors but even more vital for tomorrow’s patients.
The GMC is seeking input from the medical profession, medical schools, patients and the public, and experts including postgraduate deaneries, Royal Colleges and doctors’ employers for views on the draft guidance.
Professor Michael Farthing, Chair of the Tomorrow’s Doctors Review Group, said: ‘The consultation takes into account several important areas for review, such as prescribing and patient exposure, professionalism and leadership, assessment, quality management, student selected components and disability. Your views on these subjects, and others, are very welcome. They will help us to set the appropriate standards for a new generation of tomorrow’s doctors.’
What they said
Hannah Donnelly
Medical student at the University of Sheffield
'What is good about the current student experience in medicine? A difficult question to answer, not because there are no positives but because everyone’s experience is different, and I believe this is an important part of studying.
Variety is important both within medical schools and between them. Students should be given a choice in ways of learning and flexibility to explore areas of interest. However, with variety comes the difficulty of comparison.
Standards should be consistent across medical education yet these standards should also allow for variety in the student experience. There needs to be assurance that on completion of any medical course in the UK you possess the necessary skills and knowledge to be a competent doctor. What that competence is should be agreed between doctors, medical schools, students and, most importantly, the public.
The guidance set by the GMC needs to be a complete guide to the necessary skills an F1 doctor requires to be competent at their job, and there should be procedures in place that ensure these are the minimum standards every student meets. People need to be aware of these standards, and it needs to be known what an F1 doctor is capable of and therefore what is acceptable to ask of them.
A robust process of monitoring progress throughout the course is important – there is so much time, money and effort invested in the studying of medicine, it should be recognised early on if a student is struggling. Every student wants to be a good doctor, but it is up to the educational system to ensure that we are all competent ones.'
Johann Malawana
Junior doctor at the Royal London Hospital
'When I qualified from medical school in 2005, it was from a new-look course based on ‘problem-based learning’ at an established medical school that had a long and illustrious history, Barts and The London. Despite that, I was convinced on leaving that I was completely unprepared for the real world of being a doctor.
My particular feelings of dread came at the idea of not being technically competent at doing basic practical tasks such as cannulas. I started my first job feeling that I had been given the ability to communicate anything I wanted, yet lacked sufficient knowledge to actually communicate anything of note. However, I’m pleased to say I learnt very quickly that medical school had actually prepared me very well for the parts I envisioned as being difficult, and that actually nothing is better than on-the-job training for very basic practical skills.
Perhaps the most important lesson I learned in the very early part of my clinical experience was the reason why we focus on communication so much. I saw that patients and fellow health professionals value good communication skills and benefited from the rewards of a good medical education, including communications skills. I hope that the new guidance will continue to encourage the incredible innovation in medical education we have in the UK, whilst promoting those areas that are key to our most important partners as doctors – our patients.'
David Grantham
Head of Programmes, NHS Employers
'NHS Employers recently set out the employers’ vision of the medical workforce of the future (Medical training and careers – the employers’ vision). Employers in the NHS firstly want doctors who are competent and safe, with proper accreditation of their capabilities, but also who have the potential to develop with a clear commitment to creating patient services that deliver excellence and who embrace the values of the NHS.
It is possible that this involves further development of the undergraduate (and postgraduate) curricula covering the structure, funding and development of the NHS as well as leadership skills, multidisciplinary working, business and management. There is a clear commitment to having clinicians in leadership and management roles in the future NHS and in achieving this it is important that all doctors have a good grounding in the skills required. It is from this knowledge base that future talent can be developed.
Employer organisations would also like to see accreditation (or credentialing) providing a more robust basis on which to assure employers and patients of doctors’ capabilities, and the level at which they should be working.
We also need to review whether medical schools continue to attract individuals with the right attributes to be the NHS's doctors of tomorrow. At the same time, the NHS needs to be clear about career structures and opportunities to ensure future expectations are both informed and realistic.'
Jill Morrison
Head of the Undergraduate Medical School, University of Glasgow
'Tomorrow’s Doctors has been hugely influential in determining the structure and content of undergraduate medical education since 1993. It has achieved a level of consistency across undergraduate programmes in UK medical schools, without being overly prescriptive and still managing to facilitate innovative approaches within individual schools.
The clear message from the recent research1, that was carried out to assess how prepared our graduates are to enter Foundation Programme training, is that medical students need more opportunities for gaining hands-on practical experience of the broad skills they will require, in authentic clinical settings. These skills include, for example, managing the acutely ill patient and prioritising their workload, as well as practising more complex practical procedures.
This finding is true regardless of the type of undergraduate curriculum followed. It would be very helpful if the GMC could provide further guidance on the timing and appropriate types of clinical experience that would help our graduates to be better prepared for the Foundation Programme while still allowing the flexibility of approach that is such a strength of UK medical education. This guidance would enable curriculum planners to consider how best to achieve any necessary curriculum change and to assist in negotiations with universities and the NHS.'
1. Illing J. et al. How prepared are medical graduates to begin practice? A comparison of three diverse UK medical schools. A report for the GMC Education Committee. September 2008.
The consultation closes on 27 March and a conference to discuss the issues will be held in London on 2 March. To take part in the consultation visit www.gmc-uk.org/tomorrowsdoctors. To attend the conference, email: events@gmc-uk.org. The final revised guidance will be published in summer 2009.