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Review Of Tomorrow's Doctors

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Review Of Tomorrow's Doctors

  1. 1. Review of Tomorrow’s Doctors Dr Mairi Scott General Medical Council
  2. 2. 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’
  3. 3. Our four functions Education Registration Fitness to Practise Standards for doctors.
  4. 4. Medical School (4-6 years) F1 year (1 year) F2 year (1 year) Specialty/ GP training (3-8 years) Specialist/G P register Provisional registration Full registration Certificate of completion of training (CCT) Medical School (4-6 years) F1 year (1 year)Career stage Employment/ regulatory status 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
  5. 5. 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
  6. 6. 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.
  7. 7. 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.
  8. 8. 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?
  9. 9. 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.
  10. 10. New Tomorrow’s Doctors – structure Tomorrow’s Doctors Outcomes for graduates Standards for delivery of teaching, learning and assessment
  11. 11. 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.’
  12. 12. Outcomes for graduates Overarching outcome The doctor as a scholar and scientist The doctor as a practitioner The doctor as a professional
  13. 13. 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 procedures Responding to concerns about basic sciences, prescribing, diagnosis, ethics and law, team- working, improving healthcare…
  14. 14. Standards for delivery of teaching, learning and assessment Standards for delivery Patient safety Quality assurance, review and evaluation Equality, diversity and opportunity Student selection 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
  15. 15. 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.
  16. 16. Next steps Publication on 1 September 2009 Quality assurance:  Annual return from schools  Regional workshops  Consultation on QA options. PMETB merger with GMC in April 2010 TD outcomes and standards to apply from 2011-12
  17. 17. 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)
  18. 18. 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)