The document summarizes the General Medical Council's review of its standards document "Tomorrow's Doctors". Key points:
- The GMC regulates medical education and ensures standards are met. It is merging with PMETB and will oversee education from undergraduate through postgraduate training.
- "Tomorrow's Doctors" sets standards for graduate competencies and provides a framework for medical school curricula. It was last updated in 2003 and needed review due to changes in medical training.
- The review engaged stakeholders and considered research finding some under-preparedness of graduates.
- The new standards document outlines 16 learning outcomes for graduates and standards for curriculum delivery, teaching, and assessment. It aims
3. General Medical Council: purpose
‘to protect, promote and
maintain the health and safety of
the public by ensuring
proper standards in the
practice of medicine’
5. Medical School
(4-6 years)
F1 year
(1 year)
F2 year
(1 year)
Specialty/
GP training
(3-8 years)
Specialist/G
P register
Provisional
registration
Full
registration
Certificate of completion
of training (CCT)
Medical School
(4-6 years)
F1 year
(1 year)Career stage
Employment/
regulatory
status
Student,
not
licensed
Employed, in training, licensed by GMC Employed,
licensed
Structure of UK education and training
Education standards The New Doctor
PMETB
standards
Tomorrow’s
Doctors
6. The GMC’s role in medical education
Promotes high standards
Currently covers undergraduate education and
the first year of training after graduation (F1)
Quality assures delivery of standards and
outcomes: 32 UK medical schools and F1
PMETB to be merged with GMC from 2010
(and GMC will then regulate undergraduate,
postgraduate and continued practice)
Co-ordinates all stages of medical education
7. Tomorrow’s Doctors
Sets standards for knowledge, skills
and behaviours of medical
graduates
Provides a framework for UK
medical schools for their own
curricula/schemes of assessment
First published 1993
Last reviewed & published 2003
Stress on communication skills and
integrated learning.
8. Why review Tomorrow’s Doctors?
Changes
Foundation Programme
PMETB
Pressures due to student numbers, EWTD,
patient throughput, move from old-style ‘firm’,
community-based training
Patient and employer expectations
Challenges, real or perceived
Prescribing and practical skills
Scientific knowledge
Professionalism, leadership, team-working
Assessment.
9. Sources for the review
QABME – eg. Assessment, clinical placement
experience, teacher and assessor training,
programme and quality management
GMC guidance – GMP, Medical Students,
Gateways
Educational frameworks – Tuning, Scottish Doctor,
Foundation Programme, PMETB
Engagement – educational bodies,
doctors/students, patients/public, employers
Research – Dr Jan Illing, How prepared are medical
graduates to begin practice?
10. Dr Jan Illing’s findings
UK students looked forward to ‘being a doctor’.
While communication is a strong area at graduation,
F1s were under-prepared for some complex
communication tasks.
Other clinical skills are well practised, but not in
contexts which sufficiently mimic the clinical
environment.
Knowledge of non-clinical areas such as legal and
ethical issues, and the operation of the NHS, was
lacking at the start of F1.
Prescribing was a significant area of under-
preparedness.
11. New Tomorrow’s Doctors – structure
Tomorrow’s Doctors
Outcomes for graduates Standards for delivery of teaching,
learning and assessment
12. Overarching outcome
‘Medical students are tomorrow’s doctors.
In accordance with Good Medical Practice, graduates will
make the care of patients their first concern, applying their
knowledge and skills in a practical and ethical manner and
using their ability to provide leadership and to analyse
complex and uncertain situations.’
13. Outcomes for graduates
Overarching outcome
The doctor as a
scholar
and scientist
The doctor as a
practitioner
The doctor as a
professional
14. Outcomes for graduates
16 outcomes (all with more detailed lower-level
outcomes)
Appendix listing 15 diagnostic procedures, 12
therapeutic procedures and 5 general aspects of
practical procedures
Responding to concerns about basic sciences,
prescribing, diagnosis, ethics and law, team-
working, improving healthcare…
15. Standards for delivery of teaching, learning and assessment
Standards
for
delivery
Patient
safety
Quality
assurance,
review
and
evaluation
Equality,
diversity
and
opportunity
Student
selection
Design &
delivery
of
curriculum
including
assessment
Support &
develop-
ment of
students,
teachers &
local
faculty
Manage-
ment of
teaching,
learning
and
assessment
Educational
resources
and
capacity
Outcomes
16. Standards for delivery: some key themes
Patient safety
Practical experience:
Placements planned and structured
Agreements between schools and
providers
Student Assistantships
Shadowing and induction into F1
Assessment
Student support, health, equality
Quality control and input from patients and
employers.
17. Next steps
Publication on 1 September 2009
Quality assurance:
Annual return from schools
Regional workshops
Consultation on QA options.
PMETB merger with GMC in April 2010
TD outcomes and standards to apply from 2011-12
18. Striking a fine balance (1)
‘The modern student never learns anything about
a thorough and full physical examination, but relies
entirely on reports from special departments.’
Henry Robinson, 1944
(cited in Peter Rubin, ‘Not what we used to be’,
BMJ 2008;337:a2905)
19. Striking a fine balance (2)
‘The burden we place on the medical student is far
too heavy…A system of medical education that is
actually calculated to obstruct the acquisition of
sound knowledge and to heavily favour the
crammer and the grinder is a disgrace.’
Thomas Huxley, 1876
(cited in Tomorrow’s Doctors, 1993)
Editor's Notes
F1 and F2 in new Foundation Programme with UK-wide curriculum
PMETB – Postgraduate Medical Education and Training Board
TD – Tomorrow’s Doctors
Currently students acquire first provisional and, after F1, full registration. From 16 November, they will also acquire a licence to practise.
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QABME – Quality Assurance of Basic Medical Education
QAFP – Quality Assurance of Foundation Programme
The General Medical Council (GMC) sets the standards and outcomes for basic medical education in the United Kingdom (UK). This covers undergraduate education and the first year of training after graduation.
For undergraduate medical education the standards for the knowledge, skills and behaviours that medical students should learn are set out in our guidance Tomorrow’s Doctors.
These standards provide the framework that UK medical schools use to design their own detailed curricula and schemes of assessment.
Additionally, the standards set out in Tomorrow’s Doctors are also those against which the quality of undergraduate teaching and assessments are judged by our Quality Assurance of Basic Medical Education (QABME) programme of visits to all medical schools. These visits ensure that medical schools are teaching the required skills and knowledge to the right standard.
The GMC last reviewed/published these standards in 2003.
TD has a high international reputation and is well known for its emphasis on communication skills and integrated learning.
We have been reviewing TD since 2007.
The creation of the Foundation Programme introduced a national curriculum for the period after graduation, for which all UK graduates need to be prepared. In its short life PMETB has introduced a new approach to standard setting and quality assurance in postgraduate training. Student numbers have significantly increased, partly due to the establishment of 4 new medical schools. At the same time training on clinical placements on the apprenticeship modelled has been compromised by the EWTD, shorter hospitals stays for patients and the decline of the traditional firm. And the expectations of patients, and therefore employers, have continued to rise.
In addition UK medical education and the current TD have been criticised. It’s been alleged that new graduates sometimes have poor prescribing and practical skills. Some doctors allege that new graduates lack basic scientific knowledge. There has been a lot of interest in the nature of professionalism and the role of doctors in team-working and providing leadership. Also there has been a lot of interest in assessment methods and some debate on whether the UK should introduce a national examination.
The review of TD has drawn on the findings from the GMC quality assurance process. For example, assessment has repeatedly been an area of concern.
Also we have considered recent GMC publications – the new edition of GMP, guidance on professional values and fitness to practise for medical students, and the Gateways guidance on supporting medical students with disabilities.
We have carefully mapped our proposals against existing frameworks including the Tuning competences, The Scottish Doctor, the Foundation Programme curriculum and the standards set by PMETB for postgraduate training.
For Tuning see http://www.tuning-medicine.com/index.asp: “The Tuning Project began in 2000 as an initiative funded by the European Commission to develop common core learning outcomes/competences for degree programmes in Europe. It aimed to promote harmonisation in the Higher Education sector in support of the Bologna Declaration and subsequent developments. Beginning in 2004, the Tuning (Medicine) Task Force has now generated and gained widespread consensus on a set of learning outcomes for primary medical degree qualifications in Europe…”
We have thoroughly engaged with the GMC’s key interest groups.
And we have commissioned research, particularly from Dr Jan Illing and colleagues on the preparedness of the UK graduates. This important research has been published on the GMC website. In particular…
Jan Illing’s research report is available on the GMC website.
New structure separates out the standards for delivery (apply to medical schools) from the outcomes we expect graduates to achieve
Basic sciences – para 8
Prescribing – para 17
Diagnosis – para 14
Ethics and law – para 20
Team working – para 22
Improving healthcare – para 23
Standards as used for postgraduate training (PMETB) and the Foundation Programme (GMC and PMETB).
Patient safety – Domain 1
Practical experience – discussed across various domains but especially Domain 5 para 84 and paras 103-110
Assessment – paras 85-90 and 111-121
Student support – paras 123-125 and 130-136
Student health – para 126 and paras 137-144
‘Equality, diversity and opportunity’ – Domain 3
Quality control and input from patients and employers feature at various points in Domains 2, 7 and 9.
The impact of the new Tomorrow’s Doctors will be evaluated through the Quality Assurance of Basic Medical Education.
Medical schools will be required to complete an Annual Return for 2009/10 that will generate qualitative information about schools’ progress and plans for implementation as well as quantitative and comparable data for benchmarking.
The GMC will also organise a series of regional workshops, primarily in April-May 2010, to provide opportunities for medical schools, employers and postgraduate deaneries, among others, to discuss collaboration to date, challenges and responses, and plans or opportunities for joint working to implement Tomorrow’s Doctors.
We will also develop for consultation a set of options for the systematic quality assurance of medical schools from 2010 and a measures tool to extrapolate the requirements in Tomorrow’s Doctors and set out how the GMC will test whether each standard is being met.
The review raised several issues that could not be fully resolved through changes to the text of Tomorrow’s Doctors. Potential projects and topics for further consideration include:
The development of a list of common conditions likely to be encountered by Foundation Programme doctors to be covered in curricula.
The development of supplementary guidance on assessment and on external examiners, research into the assessment of professionalism and the consideration of other options for ensuring appropriate consistency in assessment.
The development of supplementary guidance on Student Selected Components.
The development of supplementary guidance on reasonable adjustments to the competences set out in Tomorrow’s Doctors, analysis of the competences required of F1 doctors, policy development in relation to the competences that may be required in specific rotations in the Foundation Programme and consideration of the statutory framework for medical education and training in relation to individuals with disabilities.
The development of supplementary guidance on supervision, Student Assistantships and electives.
The development of supplementary guidance setting out standards for undergraduate teachers and trainers.
Research into how best to develop effective team-working.
Consideration of options for a greater GMC role in relation to student selection and widening participation.
The development of guidance on shadowing and induction into the Foundation Programme and the NHS and support for UK-wide arrangements for periods in which final year students can shadow the F1 doctor in the post they will take up.
Review of the information that should be shared between educational providers, graduates’ employers and the GMC in relation to individuals’ knowledge, skills and behaviour, and the confidentiality safeguards that should apply.