Annex A
Contents
Page
Introduction…………………………………………………………………………………
Principal recommendations..............................................................…….………….
Part 1
The goals of undergraduate medical education...............…….……….….…………
The generic aims and learning objectives of the undergraduate
medical curriculum........................……….......................…………..………….…
Part 2
Curricular structure, design, content and delivery……..….........….…...…………..
Structure………..……………………......................………….…….....…………..
The Core Curriculum………………………………………...……………..……
Special study modules……………………………………….…….…………...
Organisation of the SSM programme..………….………………….…
Additional elements……..………………………………………..……….…..…
Elective periods of study…………….…………………………………..
Intercalated degree courses.……………..…………………….…..…..
Curricular design…............……………..................................…………….……..
Content…………………………………………..................…...……………………
Curricular themes………………………………………….……………………..
Communication skills……………………………….……………..……..
Human biology……….……………………………………………………
Human disease……………………………………………………………
Clinical method, practical skills and patient care….…………...……..
Finding out: research and experiment……………………….….……..
Population health……………………………………………….………..
Disability and rehabilitation….……….………………………………….
The working environment in which medicine is practised……………
The individual in society.………………………………………….……..
Medico-legal and ethical issues………………………………………..
Alternative medicine..………………………………….……….……….
Preparation for professional practice..…………………………………
Delivering the undergraduate medical curriculum…………...…………..………
Supervisory structures…………………..................….……………….………
Teaching and learning………………………………………………………….
Learning resources and facilities………………………………………………
Student selection………….…..………………………………….……….…….
Student support…………………………………………………………….……
Part 3
Assessing student performance and competence
Schemes of assessment…………….………..................….…….………..……...
Appraisal………………………..................….……………………………………..
Maintaining standards…………………………........….…………………….…….
Student progress…………………………...................….…………………………
Conclusion……………………………..................…...…………………..……….
Annex A…………………………………….........…...……………………….…….
What the law says about undergraduate medical education.....………….…….
UK law……………………………………………………………………..……..
European Community legislation….………………………….………..………
Responsibility for undergraduate medical education..........…………………….
The GMC's responsibilities…………………………….………………….……
The universities with medical schools.…………………….………………….
The UK Health Departments.…………………….……………..……………..
The responsibilities of doctors …………………………..…….…………………..
The responsibilities of medical students………………………………………….
Annex B
Skills required by PRHOs on their first day in post.……………………………..
Introduction
Medical education is a continuum that should equip doctors to meet the standards set
out in Good Medical Practice throughout their professional lives. This publication is
about the first stage in this process, the undergraduate years.
The GMC’s Education Committee – a partnership between the Council and the
educational organisations that deliver undergraduate and postgraduate medical
education – is responsible in law for promoting high standards and for co-ordinating all
stages of medical education. In respect of the undergraduate phase, we are charged
with determining:
‘the extent of the knowledge and skill which is to be required for the granting of
primary UK qualifications, and… the standard which is to be required from
candidates at qualifying examinations ’.
We must also ‘secure that the instruction given in the universities in the UK to persons
studying for such qualifications is sufficient to equip them with knowledge and skill of
that extent’ and maintain the standard to be demonstrated at qualifying examinations.
As the Medical Act 1983 requires of us, we set out below our guidance about
undergraduate medical education. These recommendations provide the foundation for a
continuous educational process lasting from entry to medical school to retirement or
death. They augment and update the guidance we issued in 1993, when we published
Tomorrow’s Doctors.
People who qualify after successfully completing a recognised UK undergraduate
medical course are entitled to registration with the GMC, and to work for the first time as
doctors. The GMC, the public and employers therefore need to be satisfied that new
medical graduates have the clinical competence as well as the personal and
professional attributes required for initial practice. These recommendations describe the
knowledge and understanding, the skills and attitudes that are expected for the award
of a UK primary medical qualification. They are intended to:
•
Make explicit what is to be studied and assessed during this stage of
medical education.
•
Ensure consistent and comparable standards, based upon Good Medical
Practice and our educational guidance, among all UK providers of
undergraduate medical education, and all primary medical qualifications.
•
Ensure that the rigour of assessments leading to UK primary medical
qualifications is maintained.
Our guidance provides the framework within which the awarding bodies will create
detailed curricula and schemes of assessment. We wish to encourage innovation in the
A1
way in which the recommendations are implemented, and are not ourselves advocating
either a national curriculum or a national examination. However this does not preclude
the creation of regional consortia for curricular or assessment purposes, if this is the
wish of the awarding bodies.
The recommendations also provide the context within which we will make our
judgements about the quality of undergraduate teaching and of the qualifying
examinations. Bodies such as the QAA will refer additionally to their benchmarking
statement for medicine when carrying out their assessments of educational quality on
behalf of the higher education funding bodies.
Our guidance is structured as follows:
Part 1 identifies, in a form that is consonant with the key elements of Good
Medical Practice, the generic aims and learning objectives of undergraduate
medical education and what the new graduate should know, understand and be
able to do.
Part 2 describes how the medical schools should set about structuring,
designing and delivering undergraduate medical curricula.
Part 3 considers how the developing understanding, personal attributes and
skills of the student doctor can be assessed during the undergraduate course
and how readiness for practice as a pre-registration house officer (PRHO) can
be judged.
The principal recommendations are summarised on page three.
A2
Principal recommendations
The principles of professional practice set out in Good Medical Practice must be at the
heart of undergraduate medical education.
Medical curricula should encourage a questioning and self-critical approach to medical
practice, and foster the intellectual skills required for further personal and professional
development.
Medical curricula must provide students with the knowledge, attitudes and skills they
need to practise as doctors, and promote a seamless transition from student to PRHO.
Medical curricula must provide students with opportunities to develop a range of generic
skills in addition to those required for medical practice.
The definition and development of curricula must be the joint responsibility of basic
scientists and clinicians, so that basic scientific knowledge and clinical practice are
integrated in teaching and learning activities.
The burden of factual information on students must be kept to an essential minimum.
This should be monitored constantly and any unnecessary material removed.
Medical curricula must have a defined core which constitutes no less than 70% of total
learning time.
Medical curricula must include special studies modules that allow students to study
areas of interest in depth. SSM programmes should constitute between 25 and 30% of
total learning time.
A3
Part 1
The goals of undergraduate medical education
1.
The primary purpose of undergraduate medical education is to produce
graduates who are fit to practise in accordance with the professional standards we set
for all doctors. This goal can only be achieved if the curriculum is of a range, depth and
rigour sufficient to provide students with the intellectual tools, knowledge and
understanding, practical attributes and professional attitudes required for their first
experience of clinical practice as pre-registration house officers.
The generic aims and learning objectives of the undergraduate medical curriculum
2.
In Tomorrow’s Doctors we stipulated that the medical student should:
a.
Acquire a knowledge and understanding of health and its promotion, and
of disease, its prevention and management, in the context of the whole individual
and his or her place in the family and society;
b.
Acquire and become proficient in basic clinical skills, such as the ability to
obtain a patient’s history, to undertake a comprehensive physical and mental
state examination and interpret the findings, and to demonstrate competence in
the performance of a limited number of basic technical procedures;
c.
Acquire and demonstrate attitudes necessary for the achievement of high
standards of medical practice, both in relation to the provision of care of
individuals and populations and to his or her own personal development.
3.
These remain the overall goals of the vocational component of undergraduate
medical education. In addition, students must acquire and become proficient in a range
of generic skills that should be possessed by all graduates of higher education
programmes. These include the ability to present information clearly, manage and
manipulate data electronically, manage time and resources efficiently, work as a team
member and teach effectively. These skills should also be reflected in the published
goals and objectives of all medical school curricula.
4.
The aims and learning objectives that follow outline, in broad terms, the
professional qualities the medical graduate should possess on first registration. Taken
together they summarise the knowledge, understanding, skills and attitudes that will
allow students to meet the goals of this period of training. All students must be able to
demonstrate that they have achieved these elements, if they are to prove their fitness to
become a registered practitioner on graduation.
5.
The lists are not intended to be comprehensive, and awarding bodies will need to
build on these for the purposes of curricular development and planning. However, all
A4
undergraduate medical curricula must include aims and learning objectives that are
consistent with those set out below.
Good clinical care
Aim
6.
The undergraduate medical curriculum should allow students to acquire the
clinical understanding and competence to practise under supervision, initially as a
PRHO within the NHS, or within another health care system, and to build on for the
development of their future careers.
Learning objectives
7.
The medical graduate should:
a.
Have an awareness of:
i.
the working environment in which medicine is practised;
ii.
the social and cultural environment in which medicine is practised.
b.
Have the necessary knowledge and understanding of:
i.
the basic and clinical sciences that underpin medical practice;
ii
the body of clinical experience that informs medical practice.
c.
Have, in addition to the physical, biological and social sciences basic to
medicine, a knowledge and understanding of:
i.
disease presentation and the means of recognising, investigating
and treating mental and physical ill health;
ii.
disease processes;
iii.
patients’ responses to illnesses;
iv.
the environmental and social determinants of mental and physical
diseases, impairment, disability and handicap;
v.
the principles of health promotion and disease prevention;
vi.
the principles of therapy, including:
• the management of acute illness;
• the prescription, administration and actions of drugs;
• the care of the chronically sick and disabled;
• rehabilitation, institutional and community care;
• the amelioration of suffering and the relief of pain;
• the care of the dying;
vii.
reproduction, including:
• pregnancy and childbirth;
• fertility and conception;
• psychological aspects.
d.
Demonstrate proficiency in communication skills and the other skills
A5
essential for a doctor, including:
i.
the ability to:
• obtain and record a comprehensive patient-centred history;
• perform a complete physical examination and a mental state
assessment;
• interpret the findings obtained from the history and the physical
examination;
• make clinical decisions based on evidence;
• reach a provisional assessment of patients’ problems and
formulate with them plans for investigation and management;
ii
practical procedures such as:
• basic and advanced life support;
• venepuncture and other procedures involving veins;
• calculating drug dosage and recording the outcome accurately;
iii
computing skills as applied to medicine.
Relationships with patients and colleagues
Aim
8.
The undergraduate medical curriculum should promote acquisition of the skills
and professional attitudes and behaviour that facilitate effective and appropriate
interaction with patients and colleagues.
Learning objectives
9.
The medical graduate should:
a.
Have knowledge and understanding about human relationships, including
interaction with individuals and groups.
b.
Demonstrate respect for patients and colleagues that encompasses,
without prejudice, diversity of background and opportunity, language, culture and
way of life.
c.
Be willing to give patients the information they ask for about their
condition, its treatment and progress.
d.
Respect the right of patients to decline treatment or to take part in
teaching or research.
e.
Treat information about patients as confidential and only pass it on without
consent in exceptional circumstances where the patient or others would be put at
risk.
f.
Recognise the obligation to elicit and address patients' health care needs
A6
through consultation with them and their relatives or carers.
g.
Have a knowledge of, and respect for, the roles of other health and social
care workers.
h.
Demonstrate teamworking and leadership skills.
Professional standards and behaviour
Aim
10.
The undergraduate medical curriculum should encourage recognition and
acceptance of the obligation to practise in the best interests of patients at all times.
Learning objectives
11.
The medical graduate will:
a.
Have knowledge about and understanding of:
i.
the ethical and legal issues relevant to the practice of medicine;
ii.
the organisation, management and provision of health care,
including quality, economic and social issues;
iii.
the principles of clinical governance including risk management.
b.
Demonstrate the following attitudes essential to the practice of medicine:
i.
awareness of the moral and ethical responsibilities involved in
individual patient care and in the provision of care to populations of
patients;
ii.
awareness that doctors should strive to provide the highest
possible quality of patient care at all times;
iii.
awareness of personal and professional limitations, and a
willingness to seek help when necessary;
iv.
awareness of the importance of the trainee’s own health, and its
impact on his or her ability to practise as a doctor.
Personal and professional development
Aim
12.
The undergraduate medical curriculum should foster the knowledge and
understanding, attitudes and skills that will promote effective lifelong learning and
support professional development.
Learning objectives
A7
13.
The medical graduate should have:
a.
Approaches to learning that are based on curiosity and the exploration of
knowledge rather than on its passive acquisition.
b.
The capacity and incentive to acquire and apply new knowledge and the
ability to adapt to changing circumstances throughout their professional life.
c.
An understanding of doctors' obligation to teach colleagues, and the skills
and commitment required to develop their ability to teach.
e.
The ability to engage in reflective practice and a willingness to audit their
own work and that of others.
d.
The following attitudes:
i
awareness of the need for continuing professional development
allied to the process of continuing medical education, in order to ensure
that high levels of clinical competence and knowledge are maintained;
ii
acceptance of the responsibility to contribute as far as possible to
the advancement of medical knowledge in order to benefit medical
practice and further improve the quality of patient care.
iii
willingness to provide leadership in the face of uncertainty and
change.
f.
Skills in the following areas:
i.
oral/written communication, including making presentations;
ii.
problem-solving/handling of numerical data;
iii.
IT/information retrieval;
iv.
study;
v.
research;
vi.
understanding and interpretation of evidence;
vii.
time management;
viii.
self-audit.
Part 2
Curricular structure, design, content and delivery
Structure
14.
The undergraduate medical curriculum should comprise a compulsory core
course and opportunities for special study. Ideally provision should also be made for
electives and other additional elements. The majority of student time should be devoted
to the core curriculum, although a substantial proportion (between 25% and 33% of total
curricular time) should be given over to special study modules.
A8
15.
Students must not be allowed to opt out of any part of the core course. Special
study modules are also an important element of the curriculum. Students who perform
poorly on the core curriculum should not be required to forgo the learning opportunities
offered by such modules. Other means of undertaking remedial education and training
must be found.
The core curriculum
Objective
16.
The core component of the course should provide all students with the basic
knowledge, understanding, personal attributes and skills required at the start of the preregistration year.
Outcome
17.
Students who have completed the core course satisfactorily should have met the
requirements for employment in any pre-registration house officer post in the UK. They
should also have demonstrated adherence to the professional standards expected of all
registered practitioners.
Special study modules
Objective
18.
The special study module programme should augment the core course by
providing all students with the type of experience otherwise obtained only by those
intercalating a BSc or PhD degree.
19.
In particular students, should have the opportunity to:
a.
Learn about and begin to use research skills.
b.
Exercise greater control over their own learning, thereby enhancing their
self-directed learning (SDL) skills.
c.
Study topics of particular interest.
d.
Develop greater confidence in their own problem-solving and other skills
and abilities.
e.
Present the results of their work verbally, visually or in writing.
Outcome
20.
This element of the curriculum should engender an approach to medicine that is
A9
constantly questioning and self-critical, and should foster the long-term intellectual,
personal and professional development of the future doctor.
21.
While some students may be prompted by their special study modules to
consider particular career destinations, the primary aim of this part of the course should
not be to influence specialty choices.
Organisation of the SSM programme
22.
It will be for the medical schools to decide the specific proportion of curricular
time to be devoted to SSMs.1 Schools must also decide whether students will be
engaged in such study at all stages of the course, or during blocks of time specially set
aside for this. Schools may require students to undertake at least one module from
each of a number of subject groupings, and may guide students who are
under-performing in a particular area to select a module that will enhance their
understanding.
23.
The majority of special study modules will be in subjects directly related to
medicine, whether laboratory based or clinical, biological or behavioural, research
orientated or descriptive but they need not be exclusively so. The modules offered will
depend on the interests, resources and individual enthusiasms of medical school staff
and to some extent on the wider range of opportunities within their universities.
24.
Students may have opportunities to study non-medical subjects. However,
schools should require students to undertake a balanced programme of modules, and
ensure that at least two thirds of the modules undertaken by each student are in
medically related fields.
Additional elements
25.
The additional elements may take a variety of forms, including elective periods of
study and intercalated degree courses.
Elective periods of study
Objective
26.
The general purposes of electives are to provide breadth of experience for
students, and to increase student choice. Overseas electives enable students to
become involved in medical systems where needs and means of tackling them are
unfamiliar. Electives can also enable students to pursue special academic interests, to
gain experience in specialised units, or to work with different patient communities in the
UK.
1
See also paragraph ….(14 at present)
A10
27.
We wish to see electives continue, although we acknowledge that occasionally it
may be necessary to require students to use periods of elective study to repeat a core
component or to make good any gaps in their experience.
Intercalated degree courses
28.
We strongly support the continuation of intercalated degree courses as part of
the medical curriculum. Such courses should be made available to the greatest possible
number of students, although it will be for schools to determine appropriate entry
criteria.
Objective
29.
Intercalated degrees should provide students with the opportunity to:
•
•
Enhance their developing research skills;
Study in depth, over an extended period, areas of particular interest.
30.
In many schools these courses are offered over discrete time periods, although
they could run as a thread throughout the course. Where courses are offered by
departments outwith the medical school, steps should be taken to ensure that teaching
and learning opportunities are consonant with the aims and objectives of the medical
curriculum. Medical schools should also ensure that students being taught in other
departments are given additional support to prevent them from becoming isolated.
Curricular design
31.
When devising, implementing and reviewing curricula medical schools should
take account of the following principles.
32.
Definition of the core curriculum should be the combined responsibility of basic
scientists and clinicians integrating their contributions to a common purpose. The core
curriculum may be system-based, problem-based or organised in another manner.
Whatever its form, the core curriculum and the arrangements for special study should
be made known to students and all teaching staff.
33.
In framing the core curriculum, medical schools will need to have regard not only
to this guidance but also to the requirements of those who will employ their graduates,
including the aims and working principles of the NHS.
34.
Medical schools should have particular regard to the need to promote a
seamless transition from student to fully registered doctor and beyond, into specialist
training and independent medical practice as a consultant or general practitioner. The
undergraduate curriculum should therefore prepare students for their first experience of
clinical practice as pre-registration house officers. It should also allow them to begin to
plan their future medical careers, and lay the groundwork for postgraduate and
A11
continuing medical education, and personal development.
35.
We welcome attempts to widen access to the medical course and to develop
new and innovative programmes that cater for graduate entrants. However, medical
schools wishing to devise shortened graduate-entry courses must ensure that these
Recommendations are addressed, and that such programmes comply with the
legislative framework, comprising UK and European laws, which governs all primary
medical qualifications. They must also ensure that such courses:
a.
Are designed to avoid repetition of candidates’ prior learning.
b.
Allow students time for reflection and personal growth, or to make good
any omissions arising because of ill health, or difficulties in coming to terms with
a particular element of the course.
Content
36.
The content of the core curriculum should be directed towards attainment of the
goals and objectives for this stage of a doctor's training, and preparation for initial
practice and future postgraduate and continuing medical education. There should be an
appropriate balance between academic and practical elements, and areas should be
studied in sufficient breadth and depth.
37.
The programme should be intellectually challenging with an increasing level of
demand being placed on students as they progress through the course. Curricula
should be monitored continually, to ensure that the burden of factual information on
students has been kept within acceptable limits.
Curricular Themes
Communication skills
38.
Students must have opportunities to develop and hone the range of skills and
techniques that are necessary to communicate clearly, sensitively and effectively with
patients and their relatives, and colleagues from a variety of health care professions.
These skills will assist them in fulfilling the various roles they must undertake as a
registered practitioner, including clinician, team member, team leader and teacher.
39.
Students should be able to communicate with individuals irrespective of their
social, cultural or ethnic backgrounds, and to interact with individuals and groups. They
need to be aware that some individuals use different methods of communication, for
example deafblind manual and British Sign Language. They should also learn how to
deal with individuals who cannot speak English, including working with interpreters.
40.
There should be opportunities to practise communicating in a variety of media
and forms, including the spoken and written word. There should also be guidance about
A12
how to cope in difficult circumstances, for example when breaking bad news, coping
with problem patients, dealing with difficult and violent patients, treating severely
disabled patients and assisting vulnerable patients, including children.
Human biology
41.
This term subsumes the organisation and function of the body at molecular,
cellular, organ and whole body level. This theme comprehends all the basic medical
sciences which, as we have indicated elsewhere, should continue to be studied
throughout all years of the curriculum.
Human disease
42.
This refers to abnormal structure and function and embraces the natural history
of human diseases, the body’s defence mechanisms and responses to illness. It
includes an understanding of the genetic and environmental factors which determine
disease and the response to treatment.
Clinical method, practical skills and patient care
43.
From the outset students should have opportunities to interact with people from a
wide range of social, cultural and ethnic backgrounds. This might involve visiting
families in which a baby is expected, or where there is an elderly or disabled member,
or participation in community projects not necessarily medically related. Contact with
patients can facilitate early acquisition of the skills of history taking and examination.
During the later years of the course students should have the opportunity to become
increasingly proficient in history taking, clinical examination and planning patient care.
Finding out: research and experiment
44.
Students should be aware of biological variation, and have an understanding of
scientific method, including the principles of experimental design, and develop the
ability to obtain and critically evaluate knowledge. They should also be able to use a
variety of media for storing, retrieving and manipulating information.
Population health
45.
The study of diseases in the context of their impact on populations as well as on
individuals requires additional dimensions of thought and the deployment of analytical
techniques with which the student should be familiar. The assessment of population
needs in relation to the provision of services, the practice of medicine in a resource
limited environment, the targeting of special areas of concern, the influence of
environmental and social factors on diseases, the promotion of health and the
prevention of illness will be relevant to all parts of the curriculum.
Disability and rehabilitation
A13
46.
The curriculum should attach importance to responses to illness and the
provision of help towards recovery as well as the management of chronic disease and
of relapse and the minimising of impairment, disability and handicap. It should
emphasise the rights of people with disabilities, doctors' duties towards disabled
patients under relevant legislation, the way that the organisation of society can affect
the opportunities available to disabled people, and the potential strengths and
contribution of such individuals. Consideration should also be given to issues
surrounding the needs of parents with disabled children.
The working environment in which medicine is practised
47.
Students should learn to recognise that the working environment is constantly
changing, and be prepared to manage and lead change. They should have
opportunities to develop an understanding of how health services, including the NHS,
work. This should involve awareness of current developments and guiding principles in
the NHS, for example clinical governance, clinical audit, the significance of health and
safety-risk management strategies, and the importance of teamworking within a multiprofessional environment.
48.
It is important that the curriculum prepares students for practice in a culturally,
ethnically and socially diverse environment.
The individual in society
49.
This includes human development and aspects of psychology and sociology
relevant to medicine. It should run throughout the curriculum and should cover child and
adult development, ethnicity, gender, age and occupation, as well as the impact of
psychological factors on health and disease and issues relating to palliation and care of
the dying. It should include consideration of a range of social and cultural values, and
differing views about healthcare and illness. It should also address issues such as race
and prejudice, alcohol and drug abuse, domestic violence and abuse of the vulnerable
patient.
Medico-legal and ethical issues
50.
There should be guidance on the key ethical and legal dilemmas confronting the
contemporary practitioner. Students should also have opportunities to consider the
ethical and legal dimensions of day to day practice. For example, students should learn
how to:
•
•
•
•
Handle patient complaints;
Ensure that patients' rights are protected;
Provide appropriate care for vulnerable patients;
Confront issues such as the withholding or withdrawing of lifesaving treatment,
and the practice of medicine within the context of finite financial resources;
A14
•
•
Maintain confidentiality;
Deal with problem colleagues.
51.
Students should also understand the practical and ethical considerations that
should be taken into account when seeking patients' consent. These include:
•
•
•
•
•
•
•
Providing sufficient information about conditions and possible treatments;
Responding to questions;
Knowing who is the most appropriate person to obtain consent;
Gaining consent in emergencies;
Establishing a patient's capacity to give consent;
Statutory requirements that may need to be taken into account;
Gaining informed consent.
Alternative medicine
52.
Teaching and learning should promote an understanding of, and respect for, the
health beliefs of individual patients. There should be consideration of factors that
encourage some patients to seek treatments that do not conform to conventional
medical practice. All students should have opportunities to familiarise themselves with a
range of alternative and complementary remedies available to patients, including those
that may be offered in the primary care setting. There should also be consideration of
the efficacy, applicability and limitations of such remedies.
Preparation for professional practice
53.
Students are being prepared for a career in the medical profession. There should
be opportunities for them to develop an understanding of comparative health care
provision, including a knowledge of the structures and functions of the NHS.
54.
Objective information should be provided about career structures and
progression in the NHS, which will enable students to begin to plan their careers in a
coherent manner. They should be helped to identify their interests, strengths,
weaknesses and personal circumstances, so that they can consider job and career
options that will be appropriate and fulfilling.
55.
During the final year of the curriculum there should be opportunities that help to
prepare students for their first PRHO post, and ease the transition between
undergraduate education and general clinical training. These should include:
a.
Consideration of medico-legal issues which PRHOs need to be aware of
from their first day in post, such as gaining consent and maintaining
confidentiality.
b.
Consideration of the practical knowledge and skills required, for example
of diagnosis and patient management, good prescribing practice, record keeping
A15
and working with other members of the health care team.
56.
Students must be properly prepared to function as a doctor from the first day of
their employment as a PRHO. We strongly encourage the provision of opportunities for
students to shadow the PRHO in the post that they will take up on graduation. This
would provide invaluable experience for students, allowing them to familiarise
themselves with the facilities that are available and staff with whom they will work. It
would also provide an early opportunity to establish working relationships with future
clinical and educational supervisors and the chance to consider their future needs for
formal education.
57.
Schools will need to consider when it would be most appropriate for students to
gain such experience, although it would be desirable if shadowing attachments could be
as close to the point of employment as possible. It will also be for schools to determine
the most appropriate length of time for such attachments, although these should be of
no less than two week's duration.
Delivering the medical curriculum
Supervisory structures
58.
The design, implementation and continuing review of curricula and assessment
schemes demand the establishment of effective supervisory structures with
interdisciplinary membership and adequate representation of junior staff and students.
Lines of authority and responsibility should be clearly defined and understood.
59.
Schools must set in place arrangements which allow curricular change to be
planned, implemented and monitored so that high quality medical education is provided
at all times. Many schools have found that the management of curricular change has
been enhanced by consolidating its educational expertise within a medical education
unit.
Teaching and learning
60.
The exploration of knowledge, and the critical evaluation of evidence should be
promoted and should ensure a capacity for self-education; the undergraduate course
should be seen as the first stage in the continuum of medical education that extends
throughout professional life.
61.
Learning systems should be informed by modern educational theory and should
draw on the wide range of technological resources available; medical schools should be
prepared to share these resources to their mutual advantage.
62.
Schools should provide students with a variety of teaching and learning
opportunities, which combine an appropriate balance of large group teaching with
A16
small-group sessions, practical classes and opportunities for self-directed learning.
63.
Clinical teaching should adapt to changing patterns of health care and should
provide experience in a variety of environments including primary care and community
medical services as well as within the hospital setting. The basic and clinical sciences
should be taught in an integrated fashion throughout the course.
64.
Schools must ensure that all teachers have the requisite knowledge and skills for
the courses which they deliver. Staff development programmes should be provided to
enhance teaching and assessment skills, and all staff should be encouraged to attend
these. The quality of teaching should be assessed through a variety of mechanisms
including staff appraisal, student feedback and peer review of teaching, so that high
standards can be maintained.
Learning resources and facilities
65.
Both the core curriculum and the special study modules should promote studentcentred learning. Students should have access to appropriate learning resources and
facilities including libraries, computers and teaching accommodation. The level of these
facilities should be kept under review to ensure that they remain appropriate. Students
should be able to comment about the facilities and suggest new resources that should
be made available.
66.
Students should have opportunities to develop and refine clinical and practical
skills in an appropriate learning environment, in which they are supported by teachers,
prior to deploying these in clinical situations. Skills laboratories and centres, in which a
range of manikins and equipment are available, together with access to skilled
teachers, provide an excellent context for such training.
Student selection
67.
Although student selection is not directly within our remit, we have an interest in
ensuring that only those who are fit to become doctors are admitted to medical school.
It is therefore important that schools put in place selection procedures that are valid,
transparent, objective and fair.
68.
Admission criteria and information about the selection process should be
published so that applicants know what is expected of them. Selectors should include
academic and clinical teaching staff and, wherever possible, lay members and student
representatives. All selectors should be trained to ensure that they are familiar with the
admissions criteria and are able to apply these consistently and fairly. Selectors should
also be aware of the requirements of current equal opportunities legislation.
Student support
69.
Schools must have regard for the wellbeing and welfare of their students.
A17
Students must have access to appropriate academic and pastoral support at all stages
of the curriculum. This should included named members of staff who act as contact
points for students with problems, together with information about the support networks
that are available. Particular attention must be given to ensuring that there is sufficient
support during the predominantly clinical years of the course, and for those students
undertaking clinical attachments at peripheral sites.
70.
Schools should also stress to students the importance of looking after their own
health, and encourage them to register with a general practitioner. Students should be
made aware of the full range of occupational health services, including counselling, that
is available to them.
Part 3
Assessing student performance and competence
Schemes of assessment
71.
A system of progressive assessment should monitor the acquisition and
utilisation of core knowledge, explore attitudes and certify achievement of competence
in the skills demanded by the course.
72.
It is essential that assessment systems adequately test achievement of the aims
and learning objectives of the curriculum and reflect the nature of the course. In addition
to providing a vehicle for students to demonstrate their capacity to reason in the clinical
setting, they must also encourage appropriate learning skills and reduce emphasis on
the uncritical acquisition of facts.
73.
The special study modules must be rigorously assessed to ensure that both
students and teachers recognise and respect their importance. No student should be
allowed to graduate who has not satisfied the examiners in these components of the
course.
74.
All students must produce evidence of their experiences during the elective
period, which is capable of being assessed by their school.
75.
Separate arrangements will be made for the assessment of student performance
on intercalated bachelor’s and doctoral degree programmes.
76.
A variety of techniques should be deployed to allow teachers to judge students'
achievements and determine their readiness to progress to the next stage of a course.
Students should be provided with regular and consistent information about their
development and progress. Feedback about performance in assessments can help
students and teachers to gauge strengths and weaknesses and alter teaching and
learning accordingly. However, in addition to such information students should be able
to seek academic advice and guidance from identified members of staff as and when
A18
required.
77.
Near the point of graduation there should be a coherent assessment of senior
students to ensure that they have demonstrated overall fitness to practise as a PRHO.
Success in the course must mean that the graduate is ready to take responsibility,
under supervision, for the care of patients.
78.
In developing schemes of assessment and judging student performance,
account should be taken of current guidance on best practice in assessment.
79.
It is important that students and staff are made aware of the distinction between
formative and summative assessments. Students should also have clear information
about how summative assessments will contribute to their overall results.
80.
To ensure that schemes of assessment are transparent, fair and maintain
appropriate standards, procedures must be put in place to ensure that:
a.
All examinations and assessments are designed to address the objectives
of the course and conform to published criteria.
b.
Students are given explicit instructions about what is expected of them in
any assessment component.
c.
Examiners are trained to carry out the tasks assigned to them and apply
the School’s assessment criteria consistently.
d.
Use is made of external examiners to ensure that the requisite standards
are maintained.
Appraisal
81.
Students should be subjected to ongoing, structured, appraisal by their clinical
teachers during the predominantly clinical years of the course. This will allow the
medical school to gauge their clinical knowledge and competence, their ability to work
in a team and their attitudes to patients and colleagues. It will also provide students with
information about their progress and performance, allowing them to address any areas
of concern that have been identified. Students should be given training in appraisal
techniques, so that they know what is expected of them as an appraisee, and are
prepared to carry out appraisals later in their medical career.
82.
Procedures other than formative assessments, which allow students and their
teachers to monitor experience and progress, should be developed. Instruments such
as clinical logbooks and personal portfolios, which allow trainees to identify strengths
and weaknesses and to focus their learning appropriately, are two examples of these.
Their use will impress upon students the importance of maintaining a portfolio of
evidence of attainment, which will become necessary once they have qualified and their
A19
professional performance is subject to periodic revalidation.
Maintaining standards
83.
In the interests of the public, and the integrity of professional standards,
awarding bodies must ensure that each student obtains the clinical experience laid
down in the curriculum and demonstrates proficiency in the essential skills.
Student progress
84.
Universities with medical schools have a responsibility to the public, the
employers of doctors and the medical profession for the quality of their graduates, who
are progressing from undergraduate medical education, through the PRHO year, to
specialist post-registration medical training. Schools must ensure that only those
students who are fit to practise as PRHOs are allowed to complete the undergraduate
course and gain provisional registration. Students who do not meet the required
standards in terms of demonstrating appropriate attitudes, knowledge and
understanding, or skills must be directed to alternative career paths, as explained in our
guidance on student health and conduct.
85.
Universities with medical schools should therefore establish robust procedures,
including an appeals process, to deal with students who are causing concern on
academic and non-academic grounds, such as ill health or poor conduct. It is
particularly important that consistent arrangements are established for dealing with
students and PRHOs. This will help to manage the transition from undergraduate
medicine to the pre-registration year.
86.
information about these procedures should be publicised so that medical
students are aware of the system, and understand their rights and obligations.
87.
The precise nature of these procedures may vary between universities,
depending upon each university's statutes and individual circumstances. It will be for
universities and their medical schools to determine the most appropriate form of such
procedures for themselves. However, Universities UK (UUK) and the Council of Heads
of medical Schools (CHMS), have produced helpful guidance about establishing such
procedures, to which universities will wish refer to when establishing fitness to practise
procedures.
Conclusion
88.
The Education Committee of the General Medical Council has statutory powers
to monitor the quality of medical education. At the undergraduate stage it does this
through:
a.
Formal visits and inspections, which consider the quality of teaching and
assessment.
A20
b.
Ad hoc and follow-up visits, which explore concerns identified at a particular
school.
c.
Annual monitoring of curricular changes and developments.
89.
From 2003 the Committee will commence a series of statutory visits to all
medical schools and report formally to the Privy Council on the quality of medical
education and student assessment throughout the UK. The Committee will determine
the form of these visits and keep schools informed about the procedures that will be put
in place to underpin the visits programme.
A21
Annex A
What the law says about undergraduate medical education
UK law
90.
The powers and duties of the GMC’s Education Committee under Part II of the
Medical Act 1983, as amended by subsequent legislation, are summarised in the
following section.
91.
Medical graduates who hold a primary UK qualification awarded after passing a
qualifying examination are entitled to provisional registration. The GMC has no
discretion in this respect.
92.
Provisional registration allows the new doctor to begin a professional career,
working under supervision as a pre-registration house officer. Our guidance in The New
Doctor describes the requirements for this period of general clinical training, as well as
the experience needed for full registration.
93.
Primary UK qualifications include degrees of bachelor of medicine and bachelor
of surgery awarded by the universities listed at Section 4 of the
Medical Act 1983, and the licentiates in medicine and surgery awarded by the Royal
Colleges of Physicians and Surgeons in the UK, and the Society of Apothecaries.
These are the bodies that may hold qualifying examinations, either alone or in
combinations specified in the Act or otherwise approved by the Education Committee.
European Community legislation
94.
The purpose of European Council Directive 93/16 is to facilitate the free
movement of doctors through the mutual recognition of primary and specialist
qualifications held by EEA nationals.
95.
Article 23 of the Directive stipulates that the period of basic medical training for
the medical profession shall comprise a six-year course or 5,500 hours of theoretical
and practical instruction given in a University or under the supervision of a University.
The term ‘basic medical training’ defines the period leading up to full registration. The
Directive makes no provision for part-time training during the undergraduate phase.
96.
In the UK, both the undergraduate course and the pre-registration house officer
year are legally under university governance. This means that the period of general
clinical training which new graduates undergo may be counted towards the
requirements of the Directive. Science graduates admitted to accelerated courses of
medical training may be permitted to count part of their previous undergraduate studies
towards the period specified in the Directive.
A22
97.
Before being awarded a qualification that confers eligibility to practise medicine,
the EEA Medical Directive requires a student to have:
a.
Adequate knowledge of the sciences on which medicine is based and a
good understanding of the scientific methods including the principles of
measuring biological functions, the evaluation of scientifically established facts
and the analysis of data.
b.
Sufficient understanding of the structure, functions and behaviour of
healthy and sick persons, as well as relations between the state of health and
physical and social surroundings of the human being.
c.
Adequate knowledge of clinical disciplines and practices, providing the
student with a coherent picture of mental and physical diseases, of medicine
from the points of view of prophylaxis, diagnosis and therapy and human
reproduction.
d.
Suitable clinical experience in hospitals under appropriate supervision.
Responsibility for undergraduate medical education
The GMC's responsibilities
98.
The GMC is responsible for:
a.
Determining the knowledge and understanding, the skills and the
professional attributes required of the graduating medical student.
b.
Ensuring (through written enquiries and on-site visits) that the
opportunities for teaching and learning provided by UK universities with medical
schools are such that by the end of the course, students are able to meet the
GMC’s requirements.
c.
Setting the standard of proficiency to be achieved by graduating medical
students at qualifying examinations or assessments.
d.
Ensuring (through written enquiries and on-site inspections) that the
standard of proficiency it has set is maintained by the university and
non-university examining bodies at qualifying examinations.
e.
Appointing inspectors of qualifying examinations and assessments, and
visitors to medical schools and would-be medical schools, to report their opinion
about the ‘sufficiency’ of the examinations/assessments and about the quality of
the teaching and learning opportunities.
f.
In the light of the outcome of visits and inspections, recommending to the
A23
Privy Council the recognition, continued recognition or derecognition of primary
medical qualifications awarded in the UK.
g.
Granting provisional registration to holders of primary UK qualifications.
h.
Considering applications under Section 10 (4) of the Medical Act 1983
(see paragraph 102i below).
The universities with medical schools
99.
The universities with medical schools must comply with these
Recommendations, and with the requirements of the EEA Medical Directive, when
designing and implementing their curricula, and putting in place arrangements for the
assessment of students.
100. The universities have a responsibility to the future patients and employers of
their students, and to the profession, for the fitness for purpose of their medical
graduates. Only those graduates who can demonstrate attainment of the goals and
objectives set out in this guidance, and compliance with the professional guidance in
Good Medical Practice, should be awarded a degree giving entitlement to GMC
registration and access to professional practice.
101. In awarding their degrees the universities are certifying to the GMC that each of
their graduates has completed in full a course that complies with our guidance about
undergraduate medical education and with the requirements of the Medical Act and of
the Directive.
102.
The particular duties of the universities with medical schools include:
a.
The selection of medical students, having regard to the qualities needed
in a doctor, as set out in Good Medical Practice well as in our guidance in
Student Health and Conduct, and advice from the Health Departments on
matters that may affect the graduate’s eligibility for professional practice.
b.
Providing information to the GMC, on request, about their arrangements
for teaching/assessing medical students and any other matters broadly relating
to the curriculum and/or the qualifying examinations.
c.
Facilitating the work of Education Committee inspectors or visitors
appointed under Sections 6 or 7 of the Medical Act 1983.
d.
Ensuring that intercalated degrees aside, all students complete the
undergraduate course within a period of seven years.
e.
Ensuring that, as required by the European Primary Medical Qualifications
Regulations, degree certificates or other evidence of award of a primary UK
A24
qualification make it explicit if students have spent more than 12 months of their
training outwith the EEA.
f.
Ensuring that primary UK medical qualifications are awarded only to those
who have completed the majority of their clinical training in the UK or EEA.
Normally, no more than one year of clinical training should be undertaken outside
the UK or EEA.
g.
Ensuring that teachers, trainers and clinical supervisors, as well as those
who assess student performance, understand and implement the guidance
contained in these recommendations and in our publication The Doctor as
Teacher, and are provided with the training necessary to fulfil their role.
h.
Establishing appropriate mechanisms for the planning and implementation
of curricular change, as well as for the on-going review of the course.
i.
Applying to the GMC under Section 10 (4) of the Medical Act 1983 for
approval of an alternative pattern of pre-registration house officer experience for
any of their students who are or will be prevented by a lasting physical disability
from embarking on or completing some of the experience needed for full
registration.
The UK Health Departments
103. The Health Departments have a duty to make facilities in NHS hospitals and
other premises available for the clinical training of medical students.
104. The Health Departments are also responsible for determining the basis on which
clinical medical students may have access to patients on NHS premises.
105. Clinical training of medical students requires close and effective liaison between
universities with medical schools and their NHS partners.
The responsibilities of doctors
106. All doctors have a professional obligation to contribute to the education and
training of other doctors, medical students and non-medical health care professionals
on their team. Every doctor should therefore be prepared to oversee the work of
medical students, and make sure that they are properly supervised
107. Every doctor that is appointed to provide clinical training or educational
supervision for medical students should demonstrate commitment to our professional
guidance in Good Medical Practice. They must also accept their obligation to teach.
108. Teaching skills are not necessarily innate, but can be learned. Those who accept
special responsibility for teaching should take steps to ensure that they develop and
A25
maintain the skills of a competent teacher.
109. Doctors should be honest and objective when appraising the medical students
they have supervised or trained. Patients may otherwise be put at risk.
The responsibilities of medical students
110. Medical students must accept responsibility for their own learning, including
attainment of the aims and objectives in this guidance.
111. As future professionals, medical students should conform to the guidance in
Good Medical Practice from their earliest days on the course, and understand the
implications if they fail to do so. In particular, medical students should appreciate the
primacy of patient protection, even if this conflicts with their interests or those of friends
or colleagues.
112. Medical students must abide by guidance issued by the Health Departments and
others about their access to patients in NHS hospitals and community settings. They
should also be aware of any departmental guidance for healthcare workers, which may
have an impact upon their practice once they have gained registration.
113. Medical students should be aware that under Section 49 of the Medical Act 1983
it is an offence for persons who are not registered medical practitioners to pretend to be
qualified doctors.
A26
Annex B
Practical skills frequently required by pre-registration house officers2
1.
Any of the following skills may be required from the first day of the preregistration year. They should not be undertaken without proper training.
a.
Obtain valid consent
b.
Calculate drug dosage accurately
c.
Write a prescription
d.
Procedures involving veins*
•
•
•
•
•
e.
venepuncture
insert cannula into peripheral vein
give intravenous injections
mix and inject drugs into intravenous bag
use a pump to give drug treatment
give intramuscular and subcutaneous injections*
f.
Arterial blood sampling
g.
Suturing
h.
Perform an ECG*
•
conduct an exercise ECG
i.
Basic cardiopulmonary resuscitation
j.
Perform basic respiratory function tests*
k.
Administer oxygen therapy safely
l.
Correct use of a nebuliser
2
This annex is reproduced from our Recommendations on general clinical training, The New Doctor,
1997.
A27
m.
Gastrointestinal
•
•
Insert nasogastric tube*
proctoscopy
n.
Bladder catheterisation*
o.
Lumbar puncture (for diagnostic purposes)
p.
Control of haemorrhage
Tasks marked * should not be undertaken routinely by PRHOs. NHS Trusts are
encouraged to agree arrangements whereby these tasks are assigned to other health
care professionals with appropriate training and experience.
2.
Satisfactory clinical and educational progress during the pre-registration year will
enable PRHOs to obtain full registration. Bearing in mind the fact that they will shortly
be working as SHOs, PRHOs during the last few months of training may expect to
observe, and under appropriate supervision to learn to carry out, the following:
a.
Advanced life support
b.
Central venous cannulation
c.
Tap a pleural effusion
d.
Treat a pneumothorax
e.
Perform a sigmoidoscopy
f.
Perform abdominal paracentesis
g.
Joint injection/aspiration
h.
Lumbar puncture for therapeutic purposes
3.
In addition to the skills mentioned above there will be opportunities specific to
each PRHO post for acquiring other practical skills.
A28