Tomorrow's Doctors: an improvement if evaluated

Abstract

On Sept 1, the General Medical Council (GMC)—the UK's medical licensing body—published an updated version of Tomorrow's Doctors, which sets out the undergraduate medical curriculum from the academic year 2011–12 onwards. As the overarching outcome for graduates, the new guide states that “graduates will make the care of patients their first concern, applying their knowledge and skills in a competent and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations”. Outcomes are divided into three categories: the doctor as a scholar and a scientist; a practitioner; and a professional. Under each category, there are several general outcome areas, followed by specific and detailed achievements. The doctor as a practitioner category includes the new requirement to be able to do 27 practical procedures safely and effectively, such as use of local anaesthetics, urinary catheterisation, and giving a blood transfusion. Prescribing has also been given particular prominence as one of the areas in which doctors in foundation year 1 felt least confident and most errors occurred, according to a survey by Ian Illing and colleagues for the GMC.Undoubtedly, this document is much improved and more comprehensive with important emphasis on patients' rights, communication skills, practical competence, cultural diversity, and medicine as a multidisciplinary profession with societal and sociological dimensions. Professionalism has for the first time been included as a concept and, although this could have been given more prominence, it is a very welcome first step. While the inclusion or omission of particular areas can be argued about, this new curriculum certainly reflects future challenges in health care and aims to equip students with the best possible preparation. How these goals can be translated into practice, however, in a system that is already stretched to its limits is unclear.The UK medical school and postgraduate landscape has changed substantially in the past 5 years. Medical students have increased from 30 600 in 2004 to about 39 000 now. New medical schools have opened. The postgraduate curriculum has changed with the introduction of both the foundation programme and the Postgraduate Medical Education and Training Board in 2005, which will merge with the GMC next year. It makes sense for the GMC to pay closer attention to a seamless transition from final-year students to foundation year doctors with student assistantships in the final year and a shadowing period before taking full foundation year responsibilities.What has not changed, however, is the low number of clinical academic consultants and teaching staff. Even worse, with continued close scrutiny on research output and emphasis on attraction of grants, teaching is increasingly perceived as a waste of precious time. The new Research Excellence Framework will not change this situation. Universities must ensure that teaching receives the status and recognition needed to ensure that all academics take up this important role. It should become part of every academic consultant's job plan. Teaching students in practical, real-life ward rounds, with enough time to teach and test background knowledge and understanding, as part of a clinical team, or in clinics and general practice, is the bedrock of learning through experience. Discussing actual patients in clinical settings aids the development of critical thinking and problem solving. Senior academic clinicians as role models can impart the meaning and principles of professionalism and the importance of research-based knowledge and enquiry.Tomorrow's Doctors states under the heading of capacity that “there will be enough staff from appropriate disciplines, and with the necessary skills and experience, to deliver teaching and support students' learning”. This sounds very optimistic, but possibly unrealistic under current circumstances. We urge the GMC to announce an independent and transparent monitoring and evaluation mechanism to provide an annual report card on the implementation of Tomorrow's Doctors.Without adequate numbers of staff, any comprehensive and carefully devised curriculum will be impossible to deliver, and outcomes and requirements will just be ticked off in what will become a mere bureaucratic exercise. Universities should rise to the challenge and abolish the dichotomy of teaching and research. Only if every academic clinician were required to dedicate a proportion of time to teaching, will tomorrow's doctors be fit for the future. On Sept 1, the General Medical Council (GMC)—the UK's medical licensing body—published an updated version of Tomorrow's Doctors, which sets out the undergraduate medical curriculum from the academic year 2011–12 onwards. As the overarching outcome for graduates, the new guide states that “graduates will make the care of patients their first concern, applying their knowledge and skills in a competent and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations”. Outcomes are divided into three categories: the doctor as a scholar and a scientist; a practitioner; and a professional. Under each category, there are several general outcome areas, followed by specific and detailed achievements. The doctor as a practitioner category includes the new requirement to be able to do 27 practical procedures safely and effectively, such as use of local anaesthetics, urinary catheterisation, and giving a blood transfusion. Prescribing has also been given particular prominence as one of the areas in which doctors in foundation year 1 felt least confident and most errors occurred, according to a survey by Ian Illing and colleagues for the GMC. Undoubtedly, this document is much improved and more comprehensive with important emphasis on patients' rights, communication skills, practical competence, cultural diversity, and medicine as a multidisciplinary profession with societal and sociological dimensions. Professionalism has for the first time been included as a concept and, although this could have been given more prominence, it is a very welcome first step. While the inclusion or omission of particular areas can be argued about, this new curriculum certainly reflects future challenges in health care and aims to equip students with the best possible preparation. How these goals can be translated into practice, however, in a system that is already stretched to its limits is unclear. The UK medical school and postgraduate landscape has changed substantially in the past 5 years. Medical students have increased from 30 600 in 2004 to about 39 000 now. New medical schools have opened. The postgraduate curriculum has changed with the introduction of both the foundation programme and the Postgraduate Medical Education and Training Board in 2005, which will merge with the GMC next year. It makes sense for the GMC to pay closer attention to a seamless transition from final-year students to foundation year doctors with student assistantships in the final year and a shadowing period before taking full foundation year responsibilities. What has not changed, however, is the low number of clinical academic consultants and teaching staff. Even worse, with continued close scrutiny on research output and emphasis on attraction of grants, teaching is increasingly perceived as a waste of precious time. The new Research Excellence Framework will not change this situation. Universities must ensure that teaching receives the status and recognition needed to ensure that all academics take up this important role. It should become part of every academic consultant's job plan. Teaching students in practical, real-life ward rounds, with enough time to teach and test background knowledge and understanding, as part of a clinical team, or in clinics and general practice, is the bedrock of learning through experience. Discussing actual patients in clinical settings aids the development of critical thinking and problem solving. Senior academic clinicians as role models can impart the meaning and principles of professionalism and the importance of research-based knowledge and enquiry. Tomorrow's Doctors states under the heading of capacity that “there will be enough staff from appropriate disciplines, and with the necessary skills and experience, to deliver teaching and support students' learning”. This sounds very optimistic, but possibly unrealistic under current circumstances. We urge the GMC to announce an independent and transparent monitoring and evaluation mechanism to provide an annual report card on the implementation of Tomorrow's Doctors. Without adequate numbers of staff, any comprehensive and carefully devised curriculum will be impossible to deliver, and outcomes and requirements will just be ticked off in what will become a mere bureaucratic exercise. Universities should rise to the challenge and abolish the dichotomy of teaching and research. Only if every academic clinician were required to dedicate a proportion of time to teaching, will tomorrow's doctors be fit for the future.