Select Committee on Education and Skills Written Evidence

Memorandum submitted by The Medical Schools Council (formerly the Council of Heads of Medical Schools (CHMS))[117]

  CHMS represents the interests and ambitions of UK Medical Schools as they relate to the generation of national health, wealth and knowledge creation through the profession of medicine. As an organisation it occupies a unique position embracing undergraduate medical education, the entirety of health related research and a critical interface with the health service.


  University staff are, by definition, individuals with a personal commitment to search for absolute truths and a drive to uncover the correct—rather than the comfortable answer.

  It is a demonstration of a civilized society that public funds are committed to paying individuals simply to think. Occasionally this makes for an uncomfortable relationship with policy makers who are required to press forward a particular government agenda.

  Universities historically have had 2 roles—to create new knowledge through research and to transmit that knowledge through teaching. We would add a 3rd role—we live in a knowledge rich society, so information and knowledge management have become and will continue to be a very important role for HE.

  The one thing, however, that policy makers can rely on, is that university staff have a focused agenda dedicated to quality. It is imperative for the nation that this unbiased, rigorous and analytical base is supported as a bastion of quality and the search for truth.

  Universities are central to the effective delivery of medical education firmly rooted in an environment of enquiry and scholarship. It has been stated that whilst it is possible to train people to do today's task they must be educated for tomorrow's task. In no discipline is this more true than medicine where practitioners must daily cope with complexity, ambiguity and situations of uncertainty. The NHS, as the major employer of medical school graduates requires its doctors to provide:

    —  patient advocacy.

    —  accurate diagnosis and clinical reasoning.

    —  leadership.

    —  scientific knowledge.

    —  innovation.

    —  flexibility.

    —  empathy and good communication.

    —  team-working.

  Central to CHMS's role is the pro-active exploration of the role of the doctor in the future and the pursuit of educational solutions for workforce requirements that embrace the desired roles—both in the NHS and in the pharmaceutical and devices industries.

  CHMS believes that more needs to be done to define the profession specific requirements for the delivery of optimal patient care and to select into each professional cluster those students most able to fulfil these roles. Having articulated the requirements in terms of:

    —  caring;

    —  diagnosis;

    —  therapy;

    —  innovation; and

    —  leadership.

  more needs to be done to structure the working environment to facilitate the patient journey.

  Closer working between universities and schools and between universities and those delivering health care will be vital.

  It needs to be appreciated that the timescale from a basic scientific observation to an application with clinical impact can be as long as 50 years and realism must be factored into expectations and the outcomes of research expenditure.

  That being said, the very rigorous peer review of grant applications experienced in the UK has had an undoubted impact and the quality of the output of bio-medical research in the UK is second only to the US internationally—despite the relatively small scale of the investment compared with that of other nations. The quality of education provided by UK universities is demonstrably excellent and deserves continued support.

  In terms of the specific questions posed:

What do students want from universities?

  Socially and intellectually broadening experience that results in employability.

What should the student experience involve, including for international students?

  Transferable skills.

What do employers want from graduates?

  Fitness for purpose.

What should the government, and society more broadly, want from HE?

  Social and regional accountability; engines for the economy.


Is the current funding system fit for purpose? Is the purpose clear?

  In health, no. Medical education is by definition expensive because of the time it takes to expose students to patients in the variety of presentations of different pathologies necessary for them to be confident in their diagnostic abilities.

  There should be continued (and there is an argument for increased) funding of Higher Education from the public purse. Whilst more generous funding would undoubtedly be welcome and would further stimulate innovation, the relative stability of Funding Council income streams has been welcomed by Medical Schools—particularly when compared with difficulties faced, in the recent past, by colleagues in Schools of Nursing.

  The key issue to be resolved centres around funding from DH to cover clinical placements and the Duties of the Secretary of State for Health under the NHS Act to provide such facilities as are necessary for the clinical education of medical and dental students.

  The recent drive to delegate decision making to SHAs and the removal of ring fencing from the MPET budget has meant that SHAs have, without the required consultation, slashed education expenditure in order to meet short term financial imperatives.

  It is naïve to assume that service imperatives will not take priority over long term educational objectives. If the government has a policy of developing an effective, home-grown medical workforce, steps need to be taken to provide ringfenced funds to create the professionals required.

What are the principles on which university funding should be based?

  Evidence of cost.

Should the £3,000 cap on student fees be lifted after 2009 and what might be the consequences for universities and for students, including part-time students?

  The full impact of fees on debt averseness needs to be understood if the fee elevation, insensitively introduced, is not to jeopardize widening participation goals. Whilst lifting the fees "cap" will be possible, this is not a preferred option from the students' perspective and it has the potential to undo progress that has been made on widening access.

Should central funding be used as a lever to achieve government policy aims?

  It is inevitable but a measure of any society will be its willingness to consider other uses and value universities as generators of non proscribed ideas and culture advancement.

How well do universities manage their finances, and what improvements, if any, need to be made?

  They should look at adopting the technologies as are being applied in industry and even in the Health Sector. There is a considerable amount of unnecessary bureaucracy, complex tiers of governance and in an era driven by research excellence, less than adequate attention to the quality of the primary product: undergraduate fulfilment.

  In terms of Research funding, CHMS believes that reform of the RAE over the last decade has driven up quality and that rigorous peer review should be the cornerstone of funding allocations. It is essential that all Medical Students be educated in a questioning and research-rich environment and that Medical Schools work closely with local, regional, national and international agencies to develop their research programmes. The increasing concentration of research funds in a small number of worldclass centres seems inevitable. However, we must maintain the ability for centres outside this small group to have access (on a competitive basis) to substantial funding for high quality research.


  The recent expansion in the numbers of Medical Schools means that there is now a good geographical distribution across the UK and that, coupled with immigration from the EU, the number of doctors envisaged by Wanless for 2020 might be achievable albeit with some difficulty as a result of the EUWTD. A challenge remains in securing the funds to permit higher specialist training for the increased student output. Central Planning by Government would be helpful in this area.

  Medical students are not fully registered at the point of graduation—this is creating difficulties because of increased numbers of EU graduates for Foundation Year 1 places in the UK. It would be helpful if the Medical Act were amended so that the F1 year was integral to the Medical degree.

  There also need to be much better ways for HE to keep pace with the rate of change in the NHS workforce. There needs to be much closer working between DH and DfES, although it is fully accepted that, with plurality of provision, increasing numbers of future medical graduates might not choose the NHS as their main employer.

Is the current structure of the HE sector appropriate and sustainable for the future?

  No; more mergers will be necessary to allow the dual demand of international competitiveness in research yet the ability of universities to contribute to regional economies and workforce requirements.


  CHMS strongly supports the underlying principles of the Bologna Process: enhancement of higher education across Europe; comparability of degrees; improved mobility within Europe of staff and students; promotion of European co-operation in quality assurance; and so on.

  However, CHMS is concerned that universal application of the two-cycle (bachelor and master) model to the undergraduate medical degree—and to similar degrees in dentistry and in veterinary medicine—is not appropriate. The UK has led in the development of modern undergraduate medical curricula: see, for example "Tomorrow's Doctors", from the Education Committee of the GMC, recognised Europe-wide as an important and leading statement of principles in medical education.

  Almost all medical degrees now follow a curriculum that is designed to be integrated throughout the five or six years of the medical course, and artificially to divide this in two is anti-educational, and regressive. Medical Schools could conceive of a structure which provided for a Bachelors Degree in bio-clinical sciences after 3 years and a Masters level qualifications two years later on achievement of the Primary Medical Qualification and provisional registration with the GMC. UK Medical Schools are entirely opposed to the implementation of a credit transfer system for medicine and a focus solely on outcomes. UK Medical Schools whilst accepting the need to define required outcomes and competencies wish to make clear that doctors are very much more than a string of competencies and that effective diagnostic and clinical reasoning skills can not simple be acquired through rote learning.

  In the UK the degree course is integrated both vertically and horizontally over its entire length and it would be impossible to accept students mid-way through the programme. Insensitive adoption of a 3+2 model could result in loss of the essential integration of clinical experience and science which promotes contextualised learning and has been one of the real advances in British Medical Education in recent years. Even if it were possible for medical degrees generally to be cut in two, this would largely be meaningless in the context of Bologna: the "bachelor" element in the course in one university could only lead to the "master" course being completed in another university if every aspect of the curricula were the same in the two universities, and there is no general need to encourage medical students to switch university in mid-course.

  We are aware that a few European countries have introduced a Bologna-style two cycle structure in medicine. For example, this has been done with care in the relatively few medical schools of the Swiss Confederation, and a student now might reasonably be able to do half of his or her medical school course in, say, Zurich, and the remainder in Basel. But this does not make mobility between countries possible.

  Other countries have adopted a cruder model than the Swiss. In Denmark, each medical course has arbitrarily been divided in two, with a bachelor degree being awarded at the end of the third year, irrespective of the curriculum or whether there is a natural break at this point in the course. There is no coordination between Danish universities in curricula, and so there can be no mobility at the end of the bachelor degree, even within Demark.

  Very large expenditures of time and money have been made in many countries, trying to fit medicine into the two cycle model, and we believe this has generally been an unjustifiable waste of European resources.

  The two cycle model is workable, and indeed desirable, in almost all other subjects. There is no evidence that Ministers considered the special position of medicine, dentistry and veterinary medicine at the original Bologna meeting, or at the preceding meeting in the Sorbonne. We believe that if, at the time, this special position had been pointed out to Ministers, they would have considered the exclusion of these subjects from the general two cycle model.

  We therefore urge Ministers at the Bologna Process London meeting in May 2007 to agree that "the two cycle model of bachelor and master degrees does not necessarily apply to first degrees in medicine, dentistry and veterinary medicine. It is admissible for these subjects to be studied in an integrated degree, of five or six years with total credits equal to the normal total for a bachelor degree and a master degree taken in sequence".

  This position is supported by the World Federation for Medical Education, the Association of Medical Schools in Europe, and by the Association for Medical Education in Europe. The organisations endorse the purpose of the Bologna Declaration and support that medical education as a part of higher education should be fully involved in the Bologna Process. However, the specificity of medical curricula and the current situation of European medical schools must be considered, and it is the opinion that the two-cycle division in a Bachelor and a Master degree would invalidate endeavours to integrate basic and clinical sciences in the medical curriculum.

  There is also a related problem with recognition of four-year integrated masters degrees within the Bologna Process. These do not conform to the Bologna model, although UK universities have argued that they meet the second cycle qualification descriptor in the Framework for Qualifications of the EHEA

December 2006

117   CHMS changed its name with effect from 17 May 2007. Back

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