The state of medical edu-ka-shun

In my blog, I’ll do my best to decipher the latest health publications and news, from GMC reports through to the Francis Inquiry.  Hopefully this will be as informative to you (especially those with interviews coming up) as it will be for me!  As clinicians, we are often blissfully unaware of the what is happening within the political arena of the NHS, even though much of what is decided in Whitehall will ultimately have an impact on the clinical environment we all work in.

 The state of medical education and practice in the UK (GMC September 2011)

 Interestingly, this is the first report of its kind from the GMC.  As the title suggests, it is an observational report of medical training, education and standards of practice, with a broad aim of describing the shape of medical practice as it stands now, and a glimpse of what the future holds.  I’ve summarised the report below, section-by-section, and included my own comments at the end.  

The first chapter describes some interesting trends in workforce demographics. The number of female doctors is rising – in fact, 62% of foundation trainees in 2010 were female.  The implications for future practice clear, and this is likely to accelerate changes that are already taking place, with more doctors requesting part-time practice, career breaks and flexible contracts.  In fact, the report predicts that female doctors will outnumber male doctors in around 10 years! Of interest, the average age of doctors has fallen to mid-30s, and over time, this will also shift the balance of experience, affecting how we plan our service provision.

The next section discusses medical education and trainee satisfaction.  The GMC concur that European Working Time Directive (EWTD) has had a negative impact on training, quoting that 45% of trainees have had to cover gaps in the rota, often at night, as a result of the Working Time Regulations.  Although this view is shared by RCP and RCS, interestingly it is not the stance of the BMA – perhaps we’ll leave that for a separate blog!

The third chapter discusses variations in standards of medical practice.  Of note here, the GMC report that a substantial number of complaints relate to the doctor-patient interaction, with many of the doctors removed from the register specifically facing communication-related concerns.  In 2010, the GMC received 7,153 new complaints, but only 73 were ‘struck off’ (amounting to less than 1 in 3,000 doctors).  There is also some discussion about overseas doctors: in the UK, under EU law, employers are not allowed to test the English language skills of European nationals.  Clearly this is a contentious issue, and highlights the need for employers (i.e. Trusts) to be responsible for ensuring that their staff have appropriate language skills for their job.

In the last section, entitled ‘Achieving better medical practice’, the GMC set out six key areas where they believe action and further debate are needed:

1. Professional and leadership are crucial to good medical practice
2. Regulatory bodies need to redefine how they work
3. Doctors must be and encouraged and supported in raising concerns
4. Overseas qualified doctors need better support
5. Doctors need to be equipped to deal with evolving healthcare needs
6. Our understanding of medical education needs to be improved

Regarding the last point on medical education, the GMC are due to commence an evaluation of the impact of Tomorrow’s Doctors (2009) in 2013 – this will be worth keeping an eye on.

In summary, the GMC report is a landmark review, and in my view flags up some keys issues, particularly related to the workforce demographics and variations in standards of practice.  Re-evaluating EWTD is clearly a priority, as it dictates training opportunities and service delivery, creating rota problems that will only be exacerbated in times to come.

That’s it for now; I look forward to hearing your views!