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Review of Tomorrow’s DoctorsDr Mairi Scott
General Medical Council
General Medical Council: purpose
‘to protect, promote and maintain the health and safety of
the public by ensuring proper standards in the
practice of medicine’
Our four functions
Education
Registration
Fitness to Practise
Standards for doctors.
Medical School(4-6 years)
F1 year(1 year)
F2 year(1 year)
Specialty/GP training(3-8 years)
Specialist/GP register
Provisional registration
Full registration
Certificate of completionof training (CCT)
Medical School(4-6 years)
F1 year(1 year)Career stage
Employment/regulatorystatus
Student, not licensed
Employed, in training, licensed by GMC Employed, licensed
Structure of UK education and training
Education standards The New Doctor PMETB standards
Tomorrow’s Doctors
The GMC’s role in medical education
Promotes high standards Currently covers undergraduate education and
the first year of training after graduation (F1) Quality assures delivery of standards and
outcomes: 32 UK medical schools and F1 PMETB to be merged with GMC from 2010
(and GMC will then regulate undergraduate, postgraduate and continued practice)
Co-ordinates all stages of medical education
Tomorrow’s Doctors
Sets standards for knowledge, skills and behaviours of medical graduates
Provides a framework for UK medical schools for their own curricula/schemes of assessment
First published 1993 Last reviewed & published 2003 Stress on communication skills and
integrated learning.
Why review Tomorrow’s Doctors?
Changes Foundation Programme PMETB Pressures due to student numbers, EWTD,
patient throughput, move from old-style ‘firm’, community-based training
Patient and employer expectations Challenges, real or perceived
Prescribing and practical skills Scientific knowledge Professionalism, leadership, team-working Assessment.
Sources for the review QABME – eg. Assessment, clinical placement
experience, teacher and assessor training, programme and quality management
GMC guidance – GMP, Medical Students, Gateways Educational frameworks – Tuning, Scottish Doctor,
Foundation Programme, PMETB Engagement – educational bodies, doctors/students,
patients/public, employers Research – Dr Jan Illing, How prepared are medical
graduates to begin practice?
Dr Jan Illing’s findings
UK students looked forward to ‘being a doctor’. While communication is a strong area at graduation,
F1s were under-prepared for some complex communication tasks.
Other clinical skills are well practised, but not in contexts which sufficiently mimic the clinical environment.
Knowledge of non-clinical areas such as legal and ethical issues, and the operation of the NHS, was lacking at the start of F1.
Prescribing was a significant area of under-preparedness.
New Tomorrow’s Doctors – structure
Tomorrow’s Doctors
Outcomes for graduates Standards for delivery of teaching, learning and assessment
Overarching outcome
‘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 practical and ethical manner and
using their ability to provide leadership and to analyse complex and uncertain situations.’
Outcomes for graduates
Overarching outcome
The doctor as a scholar
and scientist
The doctor as apractitioner
The doctor as a professional
Outcomes for graduates
16 outcomes (all with more detailed lower-level outcomes)Appendix listing 15 diagnostic procedures, 12 therapeutic procedures and 5 general aspects of practical proceduresResponding to concerns about basic sciences, prescribing, diagnosis, ethics and law, team-working, improving healthcare…
Standards for delivery of teaching, learning and assessment
Standards for
delivery
Patient safety
Quality assurance,
review and
evaluation
Equality,diversity
andopportunity
Studentselection
Design &delivery
of curriculum including
assessment
Support &develop-ment of
students, teachers &
local faculty
Manage-ment of
teaching, learning
and assessment
Educational resources
and capacity
Outcomes
Standards for delivery: some key themes
Patient safety Practical experience:
Placements planned and structured Agreements between schools and
providers Student Assistantships Shadowing and induction into F1
Assessment Student support, health, equality Quality control and input from patients and
employers.
Next steps
Publication on 1 September 2009Quality assurance:
Annual return from schools Regional workshops Consultation on QA options.
PMETB merger with GMC in April 2010TD outcomes and standards to apply from 2011-12
Striking a fine balance (1)
‘The modern student never learns anything about a thorough and full physical examination, but relies entirely on reports from special departments.’
Henry Robinson, 1944
(cited in Peter Rubin, ‘Not what we used to be’,BMJ 2008;337:a2905)
Striking a fine balance (2)
‘The burden we place on the medical student is far too heavy…A system of medical education that is actually calculated to obstruct the acquisition of sound knowledge and to heavily favour the crammer and the grinder is a disgrace.’
Thomas Huxley, 1876(cited in Tomorrow’s Doctors, 1993)