Carrie MacEwen GMC Symposium remarks - November 2024

The future of education and career development

Introduction

Good morning everyone and welcome. It’s great to see so many people here and I’m looking forward to catching up with you all throughout the day.

A new landscape

We will shortly be publishing our annual report on the state of medical education and practice.

And the findings point to a workforce that is changing.

Non-UK graduates have been joining the register in record numbers. This means there are now a significant number of doctors in the workforce that are new to the UK – who are navigating a new life in a new country, as well as adjusting to UK practice.

We’re also seeing an evolution in the roles doctors undertake. Locally employed (LE) doctors are now the fastest growing group. Non-UK graduates are driving this shift, but the growth is also down to doctors stepping off the training pathway after their second foundation year.

And beyond the doctor population, we’re on the cusp of a milestone. The multidisciplinary team continues to develop and from next month, Physician Associates (PAs) and Anaesthesia Associates (AAs) will come under our regulation.

The wider landscape in which we work is also evolving.

The population is both growing and ageing, and increasingly living with multiple morbidities and chronic conditions. That’s driving demand at a daunting rate.

But we’re also living in an era of innovation, with new treatments and technologies being constantly developed. This is allowing us to improve patients’ quality of life and prognoses, as well as holding promise for future patient care.

Meanwhile, expectations continue to shift on all sides.

There is a desire, generally, for more flexibility – in how patients access care, and in how doctors gain the skills to deliver it. And both want more agency. The paternalistic approach that was still prevalent when I was coming up is long gone. Patients today, rightly, are not passive recipients of care. While doctors want more control over how they train and how they work.

Culture and leadership

In the face of this changing picture, we have to be proactive.

That’s crucial if we’re to meet the needs of the society we serve. But also if we’re to ensure that medicine moves with the times and remains an attractive career prospect for our brightest and best.

We know that retention is at least as big a challenge as recruitment – if not a bigger one… there’s no point bringing more people into the workforce if we can’t create the conditions that encourage them to stay.

Culture is absolutely central to this.

Compassion, courtesy and camaraderie are important regardless of where you work. But in medicine they are material to good outcomes. Doctors who feel supported and valued deliver better care than those who feel overlooked and undermined. And doctors who work in these environments are more likely to want to build their careers here.

Creating a healthy culture – where the things that doctors see, hear and experience everyday are conducive to their wellbeing – is an active endeavour. It requires leadership, and a recognition that we all have a role to play in setting the tone.

But, as Dame Clare, who we celebrated at the inaugural Marx Lecture yesterday, used to say: leaders are made, not born.

As we develop our clinical abilities throughout our careers, so, too, must we develop our leadership skills, by making them an integral aspect of education and training.

And we have to start early. Because the experiences we have at the start of our careers lay the foundations for what comes after.

Changing career paths

We also need to think more creatively about how those careers might unfold.

Our current system of training has been in evolution, particularly over the past 30 years.

Before this, medical training lacked formal structure, was flexible and was much driven by the individual doctor.

The 1996 Calman reforms introduced unified registrar training and a time limited, rigid pipeline and that, in turn, created unintended consequences. These were detailed in a 2002 report which coined the phrase ‘The lost tribe’ for SHOs who could not progress.

The Choice and Opportunity report the following year highlighted the lack of career progression opportunities for those outside formal training, specifically the SAS grade.

Further reports and changes in the forms of Modernising Medical Careers and then Shape of Training aimed to: “train effective doctors who are fit to practise in the UK, provide high quality care and meet the needs of patients and the public.”

So, the need to keep up is not new and change continues around us. 

As I mentioned, LE doctors now comprise a very substantial cohort in the workforce.

But, despite their numbers, they don’t get the recognition and training opportunities they deserve. This denies these doctors the chance to develop their skills, and patients the opportunity to benefit from them.

Providing greater flexibility in how doctors train has proved a real challenge. It is still the case that not all training opportunities are optimised or recognised. Training pathways remain rigid. And we have some way to go to make career progression work for doctors’ wider lives.

Some strides have been made here. When I was training, even up to the level of senior registrar, working anything less than full time was not entertained.

Having three children under four as a consultant made absolutely clear to me that ‘doing everything’ is simply not always possible – and seeking to keep infinite balls in the air is a recipe for burnout and stress.

Taking on the role as the first Associate Dean for Less than Full Time Training for East Scotland – initially as a ‘wee extra’ – was the opportunity I needed to facilitate change. And, now this is a totally normalised training option, I’ve seen how it’s helped keep people – both men and women – in medicine, who would otherwise have been lost.

This taught me many things, but mainly that change is possible and collaborating with others is crucial to making things work. That is one of the reasons we are here today.

Support for educators

Of course, as well as thinking about the needs of those in training, we also need to think about those who do the training.

Our data in this area are stark – half of trainers are at moderate or high risk of burnout . And over a quarter don’t think their job plan contains enough designated time for training.

It’s crucial we have enough doctors coming into the workforce – and plans to expand medical school places are welcome and necessary.

But there is no sense training more medical students if we can’t also support them to become capable, competent doctors.

We need a sufficient number of educators and trainers, who are motivated to take on these roles and who have adequate resources and protected time within busy clinical jobs to do it. Without that, the system will stall. Worse, we’ll risk creating an environment where it is impossible to deliver any form of professional development… far less the high-quality medical education and training which the UK is currently famed for, and which our profession and population deserve. That’s the road to failure.

Our shared endeavour

There is no silver bullet.

Re-imagining medical education and training for the modern age remains an ambitious undertaking. But it is an absolutely critical one.

This is a priority for us at the GMC. And through our Future of Education and Career Development programme we are already starting to explore these issues.

But we can’t do it alone.

Building a system that makes sense in today’s context means hearing every voice, and this Symposium gives us the chance to further this collective endeavour, by drawing on the insight and experience that everyone can bring to bear.

That, critically, includes those who are, or who might be, on the receiving end of care.

Patients, families and carers must be at the centre of this work – for all stages of learning, training and ongoing career development of doctors, PAs and AAs.

Their needs and experiences must be our north star, grounding us in our primary purpose of good patient care.

Conclusion

Medicine is changing, and it’s our collective duty to anticipate what this means for doctors and patients alike.

We share a vision of a system that allows all doctors to thrive, with the right support in place to develop the knowledge, skills and behaviours needed to deliver the highest standards of care.

We know it is in the interests of the profession, and, most importantly, in the interests of the public we’re here to serve.

Thank you.