Medical solution

January 30, 1998

Undergraduate medical education is about to descend yet again into a period of turmoil and indecision. Clinical academics are concerned about the financial squeeze from the National Health Service and Higher Education Funding Council (Richards report, THES, November 7), there are doubts about the adequacy of the Quality Assessment Authority related to clinical teaching, the suggestion that there should be two tiers to medical education - one at boffin level, the other for GP level - as well as the new General Medical Council curriculum which may introduce specialist training too early for doctors.

However, it is the recommendation of the Campbell report of a 20 per cent increase in medical student places which will bring the question of undergraduate medical teaching and its cost to the fore. I doubt if we can support Professor Tomlinson's celebration of the status quo (THES, November 21).

The medical undergraduate curriculum is a generic vocational training. Postgraduate education develops special skills, often with a return to basic sciences in their chosen speciality and re-education usually lasts throughout their professional life. A significant aspect of the United Kingdom undergraduate training, unlike that in Europe, is clinical teaching both in hospital and the community. This is expensive in time and money. Much of this training is undertaken by NHS staff, whose main occupation is patient care. The financial pressures within the NHS are eroding the ability of these staff to deliver this teaching. Research-driven funding in universities gives little support to clinical teaching by academic staff.

It would now seem clear that the overall direction, management and funding of UK undergraduate medical education should be undertaken by a single central organisation - a Medical Education Authority - with input from the NHS (the employer of the majority of medical graduates), the HEFCs (representing the universities whose premises are used for some of the teaching), the GMC (which ensures the quality of graduates) and the medical schools (who organise and deliver the teaching). This authority could be based on the present Council of the Deans of Medical Schools.

An important aspect of this authority's work should be to have strong representation on the trusts of teaching hospitals to ensure the adequacy of clinical facilities and teaching. Clinical skills and patient communication based on biomedical science are the principles of UK medical education designed to produce young doctors with insight into the human condition and adequate knowledge of the development, prevention and treatment of human disease and its consequences. Some medical schools are beginning to find it difficult to defend these principles against NHS and university short-term financial planning. They need the support of a central agency to maintain standards. This is not an abstract intellectual affair - eventually patient care will suffer.

John Wales, Senior lecturer in medicine, University of Leeds Honorary consultant physician General Infirmary, Leeds

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