Dr Clive Weston is Deputy Head of College at Swansea University Medical School. He discusses what the GMC’s new medical education standards will mean for medical schools and some of the opportunities and challenges they may present.
It is a truth universally acknowledged that it is the nature of regulators to regulate. It is also in the nature of the regulated to feel… conflicted. As a ‘seasoned’ practising clinician/educator – a sub-Dean for professional development in a graduate-entry medical school – I welcome anything that makes explicit what I and my colleagues are expected to do or achieve.
I welcome anything that makes explicit what I and my colleagues are expected to do or achieve.
Yet, I am wary. I am fearful that new pronouncements will simply add to bureaucratic burden without noticeable benefit – more hoops through which to jump, not with which to work.
So, it was with trepidation that I read the GMC publication. Despite my ‘glass-half-empty’ predisposition, I have to admit to some relief.
Reasons to be cheerful
First, the new standards replace those contained within two previous publications that considered, separately, undergraduate medical education and postgraduate training. So, no additional hoops! Just, new hoops for old.
Second, the document is well structured and succinct. It even contains a glossary for those who struggle with LEPs and LETBs, or who don’t know their ‘Education Organiser’ from their ‘Named Educational Supervisor’. It is understandable.
Through drawing together both undergraduate and postgraduate educational standards, the guidelines acknowledge the continuum of medical education, the commonality of the clinical learning space, and the roles of the various organisations involved in educational provision. It should therefore act as a common reference for these organisations and encourage them to work more closely together to streamline quality assurance.
The emphasis has shifted to ensuring that our learners’ educations take place in safe environments where learning and teaching is valued and where the care and experience of patients is good.
Last, it is refreshing to read that the focus has moved away from the protection of patients from medical students and doctors ‘in training’. This concept has been a pet hate of mine. While the safety of patients is at the core of the standards, the emphasis has shifted to ensuring that our learners’ educations take place in safe environments where learning and teaching is valued and where the care and experience of patients is good. So for medical schools, at least we can move from, ‘Above all things do no harm’ to, ‘Above all things educate, safely’. Bravo!
Still waiting for the bad news?
Well there isn’t any really. It’s difficult to argue against standards that seek to further support educators and learners through implementing systems of educational governance at the highest organisational level, and shape curricula to meet required outcomes. And while in the standards I would have liked to have seen a little more emphasis on the responsibility of the individual learner to their own education, it is the importance placed on the learning environment and organisational culture – the subject of the first theme – that has set me thinking.
An ‘environment’ (including space, IT access, time for learning, etc.) can be described in details that lend themselves to assessment, even to measurement. But can a culture be regulated or ‘provided’, as the document suggests, or can it merely be encouraged – particularly a culture that is caring and compassionate?
The requirements associated with this theme include a need to ‘demonstrate a culture’ that values and promotes: learning from mistakes, raising concerns about poor care and unsafe practice, exercising candour, and seeking and responding to feedback. There will be Trust/Health Board Policies that cover precisely these issues, and will be offered as (indirect) evidence of such a culture.
Yet there is no requirement that speaks of the need to exhibit the kind of intuitive awareness of the suffering of individual patients, coupled with the disposition overtly to mitigate that suffering, which would characterise a truly caring and compassionate culture.
The trick I think is to open students’ eyes to the many examples of respect and compassion that already exist out there – celebrate the good stuff wherever possible.
Perhaps this is beyond the remit of the GMC. Certainly, medical schools struggle to promote such an approach to students, who look on the Universities as one step removed from real clinical practice, and who cast about among many clinical role models, yet may choose the wrong heroes.
Students returning from clinical placements frequently report witnessing relatively innocuous behaviours that could be described as undervaluing or undermining education – e.g. the acute physician who casually but repetitively is disparaging of general practitioners – or even adverse clinical outcomes and (perceived) medical errors.
What are medical schools to do under these circumstances? The trick I think is to open students’ eyes to the many examples of respect and compassion that already exist out there – celebrate the good stuff wherever possible. Change is possible, but will (as the GMC document makes clear) require close collaboration with education providers, postgraduate deaneries and LETBs. Medical schools cannot do it alone.
To finish, I return to Promoting Excellence and a sentence that points to the wisdom and experience of the unknown author(s): ‘medical schools [should] make sure that medical education and training takes place in an environment and culture that meets these standards, within their own organisation [my italics] and through effective quality management.’
In our rush to evaluate the culture that exists in local hospitals and surgeries, medical schools must look internally. Do we extend to our students the same care and compassion in an educational setting that we wish to see extended to them and to patients in a clinical setting? This is a timely reminder.
To help organisations implement Promoting excellence: standards for medical education and training we will publish our Quality improvement framework in early 2016.
You can read more about the new standards for undergraduate and postgraduate medical education here.
Dr Clive Weston is Deputy Head of College at Swansea University Medical School.
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