Students and Universities - Innovation, Universities, Science and Skills Committee Contents

Memorandum 26

Submission from the Medical Schools Council


  The Medical Schools Council represents the interests and ambitions of UK Medical Schools as they relate to the generation of national health, wealth and knowledge through biomedical research and the profession of medicine. As an organisation it occupies a unique position embracing medical undergraduate education, the entirety of health related research and a critical interface with the health service. Optimal patient care will not occur without a commitment to research to address unmet patient needs—and a commitment to the education of the next generation of doctors. Together with the hard copy of this submission, we have supplied Select Committee members with a copy of our recent book—Improving Lives, 150 Years of UK Medical School Achievements. The book provides the clearest possible demonstration of the profound contribution of UK Medical Schools to the well being of Society. The ground-breaking advances emanating from Medical Schools which have doubled life-expectancy over the last 150 years, continue apace. In summary, our evidence presented below demonstrates that UK Medical Schools

    — Are making good progress in seeking to select those applicants who will make the very best doctors of the future

    — Are sharing best practice in seeking to attract applicants representative of the full spectrum of society

    — Are working with the GMC to ensure that the education provided develops doctors who are fit to practise and who have the knowledge, skills, attitudes and behaviours that will prepare them for a changing world over the course of their careers

    — Are developing common records of achievement and are working together to develop improved assessment processes

    — Are ensuring that the education of medical students occurs in a research rich environment that equips them always to question the evidence base and creates practitioners of the future, keen both to participate in and to support research.

    — Are instilling in students their obligations always to enhance their scope of practice and to lead developments in ever-improved patient care.

    — Require acknowledgement in the Research Excellence Framework, of funds received from the National Institute for Health Research and paid to NHS organisations to support joint research initiatives

    — Would welcome greater commitment to education and research by NHS institutions. In particular we suggest that a demonstrable commitment to education and research form part of the NHS Operating Framework and that the Care Quality Commission requires evidence of this commitment in its annual appraisal of Trusts.


  1.  The UK Clinical Aptitude Test (UKCAT) was conceived to improve the fairness and objectivity of the Admissions process for medicine. It arose partly from a widespread feeling that A-levels were failing to discriminate between candidates at the upper end of the scale of academic ability and also because of the additional worry that A levels appeared to be testing an ability to learn facts rather than an aptitude for critical thinking and problem-solving. A new tool for selection for medicine offered the opportunity to select on the basis of characteristics that medical schools require in those who will make the very best doctors of the future: the ability to handle complexity and ambiguity, to cope with stress, to be empathetic. It was also hoped that it would help to widen access to medicine by identifying potential in applicants from less-advantaged educational backgrounds and avoid the problems associated with under-estimation of A level scores in such students.

The UKCAT test is an appraisal of aptitudes, not of knowledge, measuring verbal reasoning, quantitative reasoning, abstract reasoning and decision analysis. Being a test of aptitude, not of knowledge of any curriculum, this should mean that candidates from all educational backgrounds are competing on equal terms and that and the advantage from specific teaching for the test is minimised. It has now been used for three application rounds and evidence is emerging that it is meeting these objectives. A fee is charged for the test to meet the cost of delivery and of a research programme to probe its performance but students on Educational Maintenance Allowances or on income support do not have to pay the fee.

  2.  Widening Participation/ Access—Medical Schools have been at the forefront of a range of initiatives to encourage school children from less privileged backgrounds to consider medicine as a career. Initiatives include adjusted entry criteria for those from areas of educational disadvantage, summer schemes in medicine for students from local schools and targeted outreach work where medical students visit local secondary schools, providing mentoring and aspirational role models to whom secondary school children can relate. Furthermore some schools offer four year graduate programmes in medicine and 6 year programmes which include a foundation to medicine/ pre-medical year; both of these types of courses offer individuals from a broader range of academic backgrounds the opportunity to study medicine. The Medical Schools Council is in the process of updating its database of widening access initiatives, better to reflect achievements and good practice in this area across the UK and hopes to have completed the project by spring 2009.

  3.  Fitness to Practise—The GMC's primary responsibility is to protect patients and so it will not admit on to the Medical Register a person deemed unfit to practise. Medical students need to understand that the highest standards of professional behaviour are required from them. The Medical Schools Council and the GMC are working closely together to define the attitudes and behaviours required of medical students and to make clear both to applicants and to students that behaviour that might be tolerated in students on a non-medical course is unacceptable in a future medical professional.

  4.  The MSC is also working with the GMC as it revises Tomorrow's Doctors—the framework for medical education in the UK.


  5.  The population of clinical academics in the UK has declined since 2000—however the first signs are emerging that initiatives taken to stem the decline are starting to have an effect. It will be essential to ensure that clinical academia—with its challenging mix of teaching, research and service delivery—remains an attractive career option—particularly for women who now make up 60% of the student population. In the meantime, a great deal of teaching of medical students inevitably takes place in the NHS. It is vital that Trusts are correctly recompensed for this activity—and that teaching is seen as an important activity that is factored properly into job plans. The MSC welcomes the move towards greater transparency in the allocation of SIFT (the service increment for teaching). However it will be essential that the proposed new model—in which the a uniform per capita allocation will be made—has a mechanism to prevent destabilisation of those Trusts which for historical reasons, currently receive very much more than the proposed revised figure, an excess that largely supports tertiary services.

6.  150 years of UK Medical School Achievements, demonstrates the important contribution from every single Medical School in the UK. The MSC welcomes the increased funding for bio-medical research and the acknowledgement of the importance of research both to UK plc and to individual lives. Translational research is often published in journals which, in previous RAEs had not been deemed high impact. The new Research Excellence Framework must adequately capture and recognise research for patient benefit—and it must recognise funds competitively awarded by NIHR—as of equal value to, for example those awarded by the Research Councils

  7.  Education, Research and Service Delivery form the three pillars of the NHS. The culture of target delivery militates against a commitment to the apparently less pressing needs of education and research. This situation will not change until Trust Chief Executives are incentivised to take education and research as seriously as service delivery. This should be a key objective for the new Care Quality Commission, and should be incorporated into the NHS Operating Framework. The Secretary of State for Health, in his response to Sir John Tooke's Inquiry into Modernising Medical Carers, accepted that SHA CEOs should be appraised annually on the steps taken to nurture the health/education relationship. It would be helpful if the results of such appraisals could be published in order that the local community might monitor the commitment to fostering ever closer working.


  8.  Medical degrees are not classified in the UK and the MSC wishes this system to continue. Medical Schools support the introduction of a Higher Education Academic Record—and are actively involved in constructing a template for a common record of achievement. It is intended that such a record could help inform allocation of posts in the Foundation Programme—which takes place immediately after the end of the undergraduate degree.

9.  The GMC is responsible for quality assurance of the medical education programmes offered by the UK's Medical Schools—through QABME—the Quality Assurance of Basic Medical Education wherein Schools are inspected in detail by a team of visitors twice every 10 years. Medical Schools are however keen to provide further evidence of the consistency of the products they deliver. They have recently created the Medical Schools Council Assessment Alliance and will be working together to develop a pool of examination questions.

January 2009

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