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)