Medical Director and Director of Education and Standards, Professor Colin Melville, introduces our new Practical skills and procedures list. In this blog, he explains how we’ve worked with medical students, doctors, educators and employers across the UK to update the list and make sure all foundation doctors will be prepared for practice.
The world of medicine and medical education is rapidly changing. New technologies, evolving expectations and different ways of working are regularly introduced, but the practical skills and procedures that students must be able to perform by the time they graduate, was last updated ten years ago. Over the past few years we’ve worked with educators, employers, doctors, medical students and patients to scrutinise the Outcomes for gradates and accompanying Practical skills and procedures to make sure they reflect what is needed from a foundation doctor.
We published the updated Outcomes for graduates last summer but due to consultation feedback, we uncoupled the practical skills list from this publication. While educators supported having a core set of practical skills, we needed additional time to work with experts and test the content and structure in more detail, to make sure it met the needs of modern practice.
How was the list developed?
In summer 2018 we formed an expert working group made up of clinical skills teachers, Foundation Programme representatives, student representatives and educators to carefully consider the issues raised in the public consultation which closed last year.
The previous list said nothing about the level of competency students needed to demonstrate, and educators told us this meant it wasn’t clear how they should sign off the procedures. For example, some schools would sign off a skill based on performance in a simulated setting, and others for demonstration in practice on a single occasion. This led to a degree of confusion amongst students and schools, and a varying sense of preparedness for students entering foundation training.
So as well as taking into account the consultation responses, the group also considered information from research into the activities carried out by foundation doctors. We mapped the procedures against the equivalent list for newly qualified nurses, and also looked at 2018 induction survey data to identify procedures which new doctors felt unprepared for.
It was important for us to understand what newly qualified doctors need to be able to do, and how we could make the list as clear as possible, so medical schools can make sure all their new graduates are safely able to meet these standards, and postgraduate educators and students are clear on what’s expected of someone starting the Foundation Programme.
The core list remains very similar – for example, doctors still need to take blood samples, measure a patient’s blood pressure and complete a peak flow assessment. But the previous list focused only on the physical process of carrying out the procedure, and not how it fitted into the consultation and overall care of a patient.
The revised list covers the whole encounter between doctor and patient; from introductions to arranging appropriate aftercare or monitoring. We have defined clearly the level of competence that students should safely reach by graduation, whether conducting the procedure in simulation, or while directly, or indirectly being supervised. This will mean students, medical schools and foundation placement providers are clear about what’s expected of a newly qualified doctor as they go into the workplace.
There are a few additions to the list, including ophthalmoscopy (an eye examination) and otoscopy (an ear examination), but, after careful consideration, several other proposed new procedures were not included. We worked closely with the groups who suggested these procedures to better understand their requests, and concluded that while they did not fit within the practical skills list, they were important and were already incorporated in the Outcomes for graduates. We also agreed to work with those involved in the current review of the Foundation Programme curriculum to look at emphasising these aspects of care.
From 2020 we will remove the list of core clinical and procedural skills from the Foundation Programme curriculum so that there is a common list for both undergraduate and foundation training. This will avoid unnecessary duplication of assessment and encourage greater competence development.
Like the updated Outcomes, medical schools have until the summer of 2020 to implement the new requirements. Students joining from the 2020/21 academic year will be taught and assessed using the new list. We are confident many schools are already meeting the new standards, as they’ve continued to develop their curricula and assessments in line with developments in medical practice and education.
With the list now separated from the main Outcomes, we will also be able to respond more rapidly to changes, updating the list without needing to review the Outcomes at the same time. We will continue to work with the Academy of Medical Royal Colleges and Medical Schools Council, to explore how to better reflect the changing patterns of health and disease in the undergraduate curriculum.
We hope the added clarity in the revised Practical skills and procedures helps medical schools to make sure their students feel prepared to safely practise when they graduate, and gives foundation providers a clearer guide of what to expect from newly qualified doctors. This in turn should give students and doctors a better experience of medical education and training, and help them to have fulfilling and sustained careers in medicine.