The GMC has published a statement setting out its vision for the future of medical education and training, including increased flexibility and innovation to better serve doctors and patients.
Professor Colin Melville, the GMC’s Medical Director and Director of Education and Standards, tells us more.
Healthcare is changing
Since I qualified as a doctor in 1983, the patients we treat today are very different. People are living longer, health needs are more complex including those with multiple illnesses, and the public have higher expectations of care. The way we look after them has altered, with doctors increasingly involved with the promotion of health and prevention of disease, not just treatment. Where we look after them has shifted too. There has been a blurring of the boundaries between primary and secondary care, for example outreach clinics conducted by hospital specialists within general practice, and virtual wards, where healthcare teams monitor patients remotely in their own homes. More treatment is being delivered in the independent sector. Healthcare is changing shape.
Medicine is still a prestigious, sought after profession signified by the high demand for medical school places, and it is exciting that those places are expanding. While it is hugely positive that we are training more doctors of the future, the question arises as to whether our current education system is fit for purpose, given this changing landscape.
Over the years, medical degree programmes have been updated and tweaked, such as making general practice more prominent. But, in my view, there is still much more to do to make them relevant to the 21st century. Medical education needs transformation.
Our statement
Our statement sets out how the UK can deliver increased flexibility and innovation in modern medical education to benefit doctors and serve patients better. Its publication signals the start of a significant programme of work, with some changes needing to be implemented more quickly.
The statement covers a lot of ground, but here I want to make three points.
First, if we’re going to embrace an expansion of medical students, and doctors, we need to expand the pool of educators who will support them through their careers and help provide the pipeline of senior clinicians we need.
I use the term educators because this is not a solely doctor-based solution. In a medical student’s formative stages, most of their supervisors and educators are not doctors – they are academics and scientists. The clinical skills elements are typically delivered by people from nursing backgrounds. Then there are technicians, lab scientists and others who are experts in their fields.
Second, we must re-examine what doctors need to know and what skills they require given the changing patient and healthcare system landscape. Every year scientific, technological and pharmaceutical advances changes what needs to be learned. The nature of learning is changing too. With up-to-date information at our fingertips via trusted sources on our smartphones we don’t need the huge repository in our heads from textbooks and lectures. Content in the curriculum can be streamlined.
And do our new graduates feel adequately prepared for when they begin work? The results of our annual national training survey suggest many do not.
Third, the way we describe doctors’ status should be more inclusive. The word ‘postgraduate’ does not accurately reflect their position as many medical students are now graduate entry. It may be better to use the terms pre-qualification and post-qualification.
The current Medical Act 1983 stipulates that doctors are either in or out of training. Being in the ‘out’ group is not attractive per se. But it also means that there’s no prospective way of looking at what doctors not in training, including locally employed doctors, are learning through their jobs. Undoubtedly, they are learning. How do we create pathways that acknowledge and utilise this lifelong learning formally, and help all doctors develop meaningful careers?
To achieve some of what I have described requires legislation. Before that can be introduced there are steps we can take here and now, such as reducing the burden of assessment in royal college exams and in workplace-based assessment, which is how we currently make judgments about people’s competence to progress through training.
The GMC can be an enabler for change, but much of this requires contribution and commitment from others, such as employers, medical schools, royal colleges and statutory education bodies.
For the last year we’ve been working in the background, particularly with the royal colleges and statutory education bodies We want to do this right, which means taking it slowly and carefully, and getting buy-in.
We are listening
But there is an urgency to this. We know there’s a lot of unease and unhappiness among the medical profession and there’s a perception that the GMC is not listening. But we are listening. Doctors matter very much and are an integral, invaluable part of patient care and patient safety.
We are about to discuss this work at GMC Council, to gain high level agreement that these are the right actions to take and to decide on our priorities. As part of our plan to engage stakeholders, we have initiated a four UK-country stakeholder group to advise and support us in this transformational programme.
We know stakeholders share our ambition to make these changes, and both I and my colleagues are looking forward to working with them.
You can read the GMC’s education statement on our website.
I don’t see any mention of the importance of developing lasting relationships with patients, which in my experience has been the basis for effective continuity of care, effective communication in both directions, and a satisfying professional life
Who is in the stakeholder group? How can doctors give feedback if the GMC are listening?
What consultation was undertaken to inform this?
I find it incredibly worrying that someone in this position can talk of needing to hold less of a repository of information in our heads, despite in the same breath identifying that patients are becoming more complex. The fact that information is available on the internet these days only helps once I, as the clinician, can identify what knowledge is likely to be at the other end of my Google search before I start.
“With up-to-date information at our fingertips via trusted sources on our smartphones we don’t need the huge repository in our heads from textbooks and lectures.”
-Excuse me for not bothering to learn anything at med school because I can check Karen’s post on Facebook Groups. It’s a “trusted source on my smartphone”
Why are you hell-bent on destroying the remaining value of British medical training? It is just sad to see and morale is so, so low…
Shocking really. You’re supposed to be upholding standards not dumbing them down by encouraging curriculums to be “streamlined” so that doctors can just google stuff.
Where is the engagement with doctors about using GMC to regulate physicians assistants?
I qualified from a very good medical school in the 1960s. It seems to me that the whole ethos of medical training as I knew it is being destroyed. And by the way my alma mater is being destroyed as well. I fear for patients in the future (which of course includes me).
Thanks for your questions.
We’ve engaged with statutory education bodies and other organisations who are involved in or responsible for education and training, such as royal colleges. We’ve also discussed the key principles with organisations representing doctors and doctors in training leaders. While there has been broad agreement on the overall aims, this is just the very beginning of our work.
Over the next 12 to 18 months we’ll be asking for feedback from doctors, patients and other stakeholders, about the principles in this statement. It’s vital that we work on this in collaboration, to make sure this supports doctors and the delivery of patient care. In due course we’ll be setting up more formal channels for communicating and of course consulting, and we’ll also keep all doctors updated on our progress using our communications channels, such as our newsletter for all doctors and our website.
GMC blog team