Features: New doctors, new guidance
28 September 2009
Read about changes to the GMC's core undergraduate education guidance, Tomorrow's Doctors.
‘Medical students are tomorrow’s doctors. In accordance with Good Medical Practice, graduates will make the care of patients their first concern, applying their knowledge and skills in a competent and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations.’ Tomorrow’s Doctors, 2009.
Six years is a long time in medicine. The GMC last updated Tomorrow’s Doctors in 2003. This core guidance sets the ‘outcomes for graduates’ on the knowledge, skills and behaviour they must acquire in order to graduate and also specifies standards for the delivery of their teaching, learning and assessment.
Since 2003, there have been dramatic changes to the medical education environment including: the creation of the Foundation Programme; the restructure of postgraduate training; and the publication of a new edition of Good Medical Practice. And, as ever, medicine itself has continued its relentless march to the future with technological advances; raising patient expectations; changing societal attitudes and demography (notably an ageing population); and an increased emphasis on prevention.
Over the last two years the GMC has conducted a comprehensive review of Tomorrow’s Doctors led by Professor Michael Farthing who is Vice Chancellor of Sussex University, formerly Principal of St George’s Medical School and a team leader for the GMC’s Quality Assurance of Basic Medical Education.
Key changes
With the formal consultation having concluded in March, the new guidance was launched this September. Among the key changes from the 2003 edition, the outcomes for students are contextualised as relating to ‘the doctor as a scholar and a scientist’, ‘the doctor as a practitioner’ and ‘the doctor as a professional’.
There are new requirements about teaching, learning and assessment. A major theme is the importance of hands-on experience on clinical placements. Too often clinical placements have been a wasted opportunity. The new Tomorrow’s Doctors calls for clear agreements between medical schools and the organisations providing placements.
The guidance also introduces ‘Student Assistantships’, whereby students will act as assistants to junior doctors, with defined duties under appropriate supervision. There are also new, more detailed requirements relating to patient safety, assessment and support for students, including those with disabilities.
Balance
GMC Council Member and Chair of the Undergraduate Board Jim McKillop said: ‘New medical graduates must be scholars and scientists, practitioners and professionals.
'Tomorrow’s Doctors 2009 ensures medical schools will achieve the balance between teaching students the building blocks of medical science while ensuring they know how to communicate with patients and master basic clinical procedures.
'Publishing the requirements is one thing, getting them put into practice is something else entirely. So the GMC will be supporting and advising medical schools and the NHS as they prepare for implementation of the new requirements from 2011/12.’
Highlights
Highlights include:
After the ‘Overarching outcome for graduates’, outcomes are set out for:
- the doctor as a scholar and a scientist
- the doctor as a practitioner
- the doctor as a professional.
The nine sets of standards for delivery cover:
- patient safety
- quality assurance, review and evaluation
- equality, diversity and opportunity
- student selection
- design and delivery of the curriculum, including assessment
- support and development of students, teachers and the local faculty
- management of teaching, learning and assessment
- educational resources and capacity
- outcomes.
The new guidance also provides:
- a list of the basic sciences such as pharmacology that must be covered in curricula
- detailed requirements on prescribing skills
- advice on how to contribute to team-working and how to improve healthcare services for patients
- an appendix requiring new graduates to be competent in 15 diagnostic procedures and 12 therapeutic procedures.
You can view the new guidance online at www.gmc-uk.org/tomorrowsdoctors
Prescribing tomorrow
Professor Allan Cumming, a leading member of the Tomorrow’s Doctors Review Group, looks at the standards set in the new guidance on prescribing.
One of the most powerful responsibilities given to new doctors is the right to prescribe drugs. Figures for the incidence, severity, and impact on patients of prescribing errors vary enormously, but are always cause for concern.
While these errors are not confined to recently qualified doctors, surveys have shown that many new graduates feel poorly prepared for this area of practice.
It is not clear to what extent this is a new phenomenon, or whether, as has been claimed, it is linked to the introduction of integrated curricula in medical schools, with less apparent emphasis on specialist teaching by disciplines such as clinical pharmacology. Increased numbers of drugs and complexity of treatment regimens may also be relevant. Whatever the basis, it is clearly an issue which must be addressed in the interests of patient safety.
The new Tomorrow’s Doctors guidance includes an explicit set of curriculum outcomes related to the ability to prescribe safely and effectively (paragraph 17). They are based on the recommendations of the Medical Schools Council Safe Prescribing Working Group (2008).
Medical schools will therefore be required to demonstrate that their graduates have been adequately taught and assessed in relation to these outcomes and are competent in this area of practice. Many schools have already taken action.
The Prescribe project, a national initiative, aims to develop a comprehensive set of new e-learning materials for general use. Recent GMC-commissioned research suggested that more direct involvement of senior medical students in patient care, under appropriate supervision, will also help to enhance preparedness for safe prescribing. This is also an element in the new guidance.
It will be important to ascertain how these initiatives, together with developments such as computer-based prescribing and the separate research into prescribing commissioned by the GMC, translate into a reduced incidence of prescribing errors and improved patient safety.
Completing the picture
We have also reissued our guidance, The New Doctor, last issued in 2007, which sets out the training standards for the Foundation Programme and the outcomes that F1 doctors must demonstrate before applying for full registration. This completes our suite of medical education guidance which also includes the revised Medical Students: professional values and fitness to practise.