30th George Swift Lecture: generalism in undergraduate medical education — what's next?

Abstract

In his 1984 George Swift Lecture, The World Turned Upside Down , Julian Tudor Hart proposed that medical education should be community-based, led by academic departments of general practice, and delivered through extended networks of practices. In the intervening quarter of a century much of his vision has come to pass. Academic GPs are leaders of medical education in many of our undergraduate schools, and two schools now have GPs as deans. GP-led primary care research is also highly valued in a number of universities, and its outputs are changing practice. Meanwhile, the role of the GP seems to be changing, away from providing personal continuity of care and towards leading multidisciplinary teams in the triage of acute problems and organisation of care for chronic diseases. The future GP may have to act as a specialist in complex comorbidity and polypharmacy, providing a second opinion for non-medical GPs. So should we now be preparing future doctors for a role as community-based consultant medical generalists? If so, what are the implications for primary care based undergraduate and postgraduate teaching, and research? In 1984 Julian Tudor-Hart proposed a vision of ‘the world turned upside down’, in which undergraduate medical education was largely based in the community.1 He pointed out that the undergraduate curriculum in the 1980s was controlled largely by specialists, with less than 10% of teaching delivered outside hospitals. As a result it was not preparing students for general practice, the commonest career destination. He proposed that the curriculum should be community-based, led by academic departments of general practice, and delivered by extended networks of general practices. In his 2006 George Swift Lecture John Spencer revisited Julian's vision of the world turned upside down and showed how much of that vision had come to pass. The particular experiences it offered …