Medical education: a prescription for change

Giving universities oversight of postgraduate training will greatly improve its quality, argues Alastair Buchan

June 11, 2015
Bottles of prescription pills

A recent article in these pages discussed the imperative for undergraduate medical education to be based in universities, and for universities to have control of what they teach (“Sleepwalking into a crisis”, Opinion, 7 May). However, medical education does not end there. It is also imperative for postgraduate medical education and training to be based in universities, and for universities to have control of its quality management.

In total, it takes between 10 and 15 years of continuous education and training to become a GP or a hospital consultant. But, beyond the first three or four years, all accountability for providing this lies with the NHS – with the sole exception of programmes for clinical academics. After graduation, junior doctors enrol in foundation and specialty training programmes run by NHS postgraduate deaneries in teaching hospitals and general practices. The deaneries commission and quality-manage postgraduate education and training according to the standards of professional regulatory bodies, such as the royal medical colleges and faculties. The latter set and oversee the specialty curricula within these programmes and award qualifications and memberships (this, incidentally, is why a national examination at the end of medical school, as advocated by Terence Stephenson in his letter to Times Higher Education of 14 May, is unlikely to improve the overall quality of medical education).

As a dean of medicine at one of our top university medical schools and a practising researcher and acute care physician, I believe the exclusion of universities has a deleterious effect on quality. This is because trainees miss out on the considerable expertise and resources that universities have to offer, and are subject to the forever changing political agendas to which the NHS is beholden – the current one focusing on short-termist cost-cutting. But medical education and training in the 21st century must be based on the latest discoveries in research made in universities, together with bedside teaching in hospitals and true patient engagement.

Advances in fostering research and innovation across universities and the NHS have been made since the establishment of the National Institute for Health Research in 2006. NHS-university partnerships, such as Biomedical Research Centres and Collaborations for Leadership in Applied Health Research and Care, have been established that focus on innovative translational health research with immediate patient benefits. It is thanks to these – tendered for every five years – that medical research and undergraduate medical education in the UK are among the best in the world, with 16 UK universities among the world’s top 100 for clinical, preclinical and health subjects according to THE’s World University Rankings 2014-15 (my institution, the University of Oxford, has been number one for the past four years).

One solution for fixing the broken continuum of postgraduate medical education and training would be to create a National Institute of Health Education and Training modelled after the NIHR. Such a body would commission postgraduate education and training every five years from NHS-university partnerships – which would design the courses based on the latest advances in science and according to the standards set by the relevant royal medical colleges and faculties. Our universities are highly competitive and therefore competition for the provision of postgraduate education and training would greatly improve quality.

Nor would this be a leap in the dark. Giving universities responsibility for the quality of postgraduate medical education and training is already standard practice in the US, Australia, Asia and Canada – where I have spent most of my career. The first step towards this model in the UK would be for NHS-university partnerships to host postgraduate deaneries, as is already the case with the Wales Deanery, hosted by Cardiff University. I hope that the new government will be able to take a long-term view and adopt the arrangement more widely. Patients expect that UK medical education and training is geared to producing the best doctors in the world. But that will be the reality only if universities are involved at all stages in the process.

Alastair Buchan is professor of stroke medicine, dean of medicine and head of the Medical Sciences Division at the University of Oxford.

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Article originally published as: A prescription for change (11 June 2015)

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