Champion fighting the rise of 'doctor factories'

June 8, 2007

Professor Sir John Tooke has been thrust into the heart of a fundamental debate about the direction and nature of UK higher education.

As dean of the Peninsula Medical School in Plymouth, Sir John is determined to resist the growing schism between teaching and research.

Nevertheless, his institution was highlighted in the House of Commons as an example of the growing divide between universities that can carry out research and those that may soon no longer be able to afford to.

Using Sir John's school to illustrate his point, Andrew Murrison, Conservative MP for Westbury, told the Commons: "We may see a shift towards universities that are principally involved in teaching, and I would not be surprised if medical schools were to take the lead in that. It is difficult to see how some universities, such as Plymouth, can provide a fully functioning research-based medical school."

Sir John is fighting to keep research an essential element of a medical education, and not just at Plymouth. As chairman of the Medical Schools Council, formerly the Council of Heads of Medical Schools, he is the champion for the whole medical school sector, and he is determined that the UK's medical schools will not be reduced to what Mr Murrison described as "doctor factories".

"The council's absolute commitment is to ensure that all medical education occurs in a research-rich environment," he says. He acknowledges that the degree of research intensity varies between institutions and that the divide is likely to widen after the 2008 research assessment exercise. "We will lobby to ensure that research takes place in all institutions, even if the nature and scale of that research differs."

Schools that are less successful in the RAE could capitalise on their links with the National Health Service and conduct more applied research, he suggests.

In parallel, he would like to see the Government set hospitals research targets linked to their income because trusts, which are under pressure to treat more patients faster, are reluctant to allow clinicians research time. "Trusts should see that it is not about research for research's sake or academic special pleading, it's about improving patient care.

Research-active hospitals are more likely to adopt evidence-based procedures than those that do little research."

Sir John's personal vision is of a chain of academic "health centres" with greater focus on translational medicine, epidemiology and chronic disease.

He says that while, "in the 20th century, London teaching hospitals promoted major advances in the technical side of medicine", such centres must now be complemented with a new model. "In the 21st century, the greatest challenges lie in tackling chronic diseases, problems associated with an elderly population and moving care closer to home." He envisages the centres using networks of community-based researchers.

The model chimes well with the Medical Schools Council's efforts to shake off the perception that, in terms of research, a hierarchy of medical schools exists headed by the likes of Oxbridge and Imperial College.

In other ways, Sir John - who was appointed by the Government in April to lead a review of the medical training reforms under the Modernising Medical Careers initiative - is very much the traditionalist. While careful not to rubbish the current movement towards the teaching of generic skills such as communication ("I'm not denying they are important"), he believes schools should provide a strong grounding in science. "There are certain 'must-haves'. We cannot simply rely on the skills needed for diagnosis being achieved by osmosis."

On paper, Sir John might seem an obvious choice to lead the review, for which he has stood down as chair of the Medical Schools Council until September. But he has clashed with the Department of Health over the shambolic new online application process for medical training posts. And his views on what is needed from the future workforce do not always match the DH's. The Government has driven a move towards "competency-based training", which measures trainees' ability to perform specific procedures.

The unspoken aim behind this, some doctors believe, is to train individuals as experts in those tasks alone. This would shorten training and allow non-medics to carry out some procedures. "Let's be clear about what a doctor brings to the healthcare team," Sir John says. It is all very well being competent to diagnose or treat a straightforward case, but what happens when a person has complications?

"Medicine is not like following a cookbook. Illnesses present in a huge variety of forms. Diagnosis is a complex cognitive task. Doctors need a capacity for critical reasoning to allow them to deal with uncertainty and reach a diagnosis when symptoms are not obvious. That's why they need in-depth training."

  • I graduated from St John's College, Oxford University
  • My first job was a house physician at King's College Hospital, London
  • My main challenge is that of any clinical academic - reconciling the demands of education, research and the health service
  • In ten years  I hope to be enjoying a lower golf handicap and catching more trout.

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