Memorandum 26
Submission from the Medical Schools Council
STUDENTS AND
UNIVERSITIES
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.
ADMISSIONS
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.
THE BALANCE
BETWEEN TEACHING
AND RESEARCH
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.
DEGREE CLASSIFICATION
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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