Growth threatens global standards

December 6, 2002

More with less - THES reporters describe efforts around the world to meet the rising demand for trained medical staff without compromising quality

Continuing growth in demand for doctors has created a global employment market that is playing havoc with medical education.

In the UK, the government's response is to plan for an extra 1,900 medical-school graduates by 2008 - a 54 per cent increase on 2001-02. To deliver its promises on the National Health Service it plans 15,000 more doctors overall by that date.

But the medical profession fears that expansion could threaten training standards.

Ken Fleming, head of the medical sciences division at Oxford University, said: "There is pressure on medical schools to educate more people more quickly. But there is a difference between education and training. It takes longer to educate someone, to develop the mind. Training just involves learning a particular body of knowledge and set of skills."

Some 1,000 new medical school places were announced in the latest round of medical school expansion in 2001 - with almost 40 per cent of them going to universities offering four-year graduate-entry courses. Medical courses are traditionally five years long. The shift to graduate entry, or fast-track courses, brings the UK more in line with the US, where medical students are in effect graduates taking a second degree.

Dr Fleming said: "Graduate students can bring maturity to the course but I still have fears that the courses could become too short. Doctors need to be taught leadership skills, which take time."

Medical schools have to comply with recommendations set out by the General Medical Council. In turn, the GMC has to comply with a European Council directive that says that basic medical training must be at least a six-year course or 5,500 hours of theoretical and practical instruction.

The European Council requirement is met by the inclusion of the pre-registration house officer year in undergraduate courses. Students cannot fully register with the GMC until they have completed this.

But although this year is officially part of the university's remit, many lose contact with their students once they start working for NHS trusts. The GMC recently produced a consultation document looking at ways of ensuring that the education component of this year is not lost.

The GMC published guidelines on undergraduate education in August. They build on the radical 1993 recommendations, Tomorrow's Doctors , which abandoned a fact-based approach to medical education in favour of one that stressed problem-solving and continual development.

"This signalled a significant change in the form of our guidance. Our emphasis moved from gaining knowledge to a learning process that includes the ability to evaluate data as well as to develop skills to interact with patients and colleagues," the GMC said.

The recommendations take account of the inquiry into children's heart surgery at the Bristol Royal Infirmary. The inquiry stressed that health professionals needed to learn to work in teams and to communicate more. Students also needed to be taught about the NHS. It recommended that some universities piloted a core curriculum for doctors, nurses and other professionals.

The stress on multiprofessional education is alarming for medical schools without nursing faculties or courses for other health professionals. The British Medical Association has cautiously accepted the idea of a common core curriculum.

Sir Graeme Catto, president of the GMC and dean of the UK's largest medical school - Guy's, King's and St Thomas's - said that multidisciplinary education might be a good way forward but there needed to be more objective evidence of its benefits.

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