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The State of Basic Medical Education Reviewing Quality Assurance and Regulation Chair’S Foreword

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The State of Basic Medical Education Reviewing Quality Assurance and Regulation Chair’S Foreword The State of Basic Medical Education Reviewing quality assurance and regulation Chair’s foreword Professor Peter Rubin Medical education is the bedrock on The General Medical Council has been from which those involved at all levels which high-quality healthcare is built. setting requirements for undergraduate of postgraduate training could voice Training is important but education is medical education for over 150 their views and contribute to key vital. Of course, the newly graduated years. Our challenge is to ensure that debates. The merger of PMETB with the doctor needs extensive knowledge and medical education reflects the evolving GMC this year will enable us to utilise practical skills and that is where training knowledge and ideas of contemporary the strengths of both organisations is important. But education during practice, and the ever-changing across the continuum of medical these formative years will establish expectations of society, while standing education, training and regulation the principles that will guide doctors firm and resisting change to the core as we consider and take forward through their ever-changing careers. values of professional practice. recommendations from the Lord Naren Medical students must be educated Patel review in 2010 and beyond. This publication gives our overview of in an atmosphere where excellence the current state of medical education is expected; and excellence means We are not complacent and, as ever, in the UK. We have highlighted learning that students must be curious about there are challenges ahead as there from our quality assurance reviews new ideas, want to know more and do always have been, but we believe that in recent years along with a number things better. Medical students must medical education is an area of which of examples of schools’ activities and be encouraged to be stimulated by the the UK can and should be proud. perspectives that have contributed to unknown, not intimidated by it; to work the development of medical education. with uncertainty, not run away from it; to question the status quo, not accept The Postgraduate Medical Education it as always right; to analyse, to weigh and Training Board (PMETB) has evidence and to challenge. It is this produced a similar review, The State education which will enable doctors to of Postgraduate Medical Education and Professor Peter Rubin lead change as the years go by. Training, which provided a platform Chair , General Medical Council 2 Contents Section 1: Regulation and assuring quality in basic medical education 04 What is QABME? 05 Who is involved? 06 QABME is a balancing act 07 Section 2: Developments in UK medical education 08 Expanding medical education and training 09 Ensuring professional behaviour and student fitness to practise 11 Patient and student involvement 14 Clinical practice 15 Assessment 19 Learning to work with other healthcare professionals 23 Diversity and widening access to medicine 26 Section 3: Schools’ experiences of QABME 34 School feedback on QABME 35 Taking a look from both sides 35 An established school perspective 38 QABME across the UK: a Scottish perspective 40 Section 4: Who are the visitors? 42 A specialty trainee 43 A healthcare and governance professional 44 A clinical quality regulator 45 A student 47 A surgeon 48 Section 5: Views on the road ahead 50 Confidence for patients 51 Greater collaboration on key challenges 52 Toward a future career 54 Confidence for graduates and employers 55 Contributors and acknowledgements 58 3 Regulation and assuring quality in basic medical education 4 Regulation and QA and Regulation In this section we introduce our programme for quality assurance of basic medical education (QABME). We look briefly at the GMC’s statutory duty and discuss how QABME brings together people with a range of experience to carry out quality assurance reviews. The GMC has a statutory duty By assessing the standard of basic under the Medical Act 1983 to medical education at all UK universities set and maintain the standards which offer qualifications leading to registration and a licence to practise for undergraduate medical with the GMC, the QABME process education. supports our primary purpose to protect patients and the public. We hold a list of universities that can award a primary UK medical qualification (Bachelor of Medicine What is QABME? and Bachelor of Surgery). The GMC QABME assesses whether medical The QABME programme consists of also has the power to add and remove schools are meeting the standards set two main aspects. Firstly, there is a universities from the list. out in Tomorrow’s Doctors. yearly submission from all medical schools detailing developments in, and Our requirements and standards for Teams of experienced visitors identify changes to, the curriculum, that also the knowledge, skills and behaviour of where changes are required and lists identified risks and innovations. graduates are set out in the publication recommend areas where schools could Secondly, there is a cycle of visits to Tomorrow’s Doctors. improve. The process was designed to each medical school; all established be developmental so that innovation medical schools have been reviewed in The GMC has the power to visit and good practice, as well as concerns, the first QABME visiting cycle, which universities to make sure that teaching could be identified. is consistent with these standards, was completed in November 2009. and to review examinations to make Before the QABME programme began, Through its QABME processes the sure that the standards expected are evidence was collected from medical GMC carries out systematic activities maintained. schools and from visits carried out by a to verify evidence that schools are small number of Council members. Universities and medical schools are meeting the required standards, and to responsible for operating a quality QABME began as a pilot in 2003 and provide confidence and assurance for management system that designs, is a formal and standardised process the GMC and the public that graduates delivers, monitors and reviews medical involving evidence collection and of UK medical schools are fit to start curricula and assessment programmes analysis, and verification visits to all UK employment as a foundation year one to meet the standards. medical schools. doctor. 5 Who is involved? Each visit and assessment is undertaken by a skilled and experienced visit team of GMC associates (known as ‘visitors’). They are drawn from medical education and clinical practice, but also include students and lay people with a variety of experience (for example, in regulation, healthcare and management). Medical schools provide evidence to the GMC, which is reviewed and analysed by visit teams before they visit schools where they meet with management, teaching and clinical staff and students, and observe teaching sessions and examinations. Visit teams consider the evidence While I’m the last person to say that submitted by schools, and the evidence collected on visits, to assess compliance all schools should run identical courses, with the standards in Tomorrow’s Doctors. A report on each school is I do think that they should all conform to submitted to the GMC Undergraduate “ Board following the review process, a basic set of principles. with requirements and recommendations for change. The requirements are another university and begun to offer into schools from the outside. It is all then monitored through the yearly separate programmes. too easy to get complacent and think submissions by each school to the you’re doing a good job. It sometimes Professor Peter McCrorie, a QABME GMC. The visit and review process lasts takes a view from outside to make you team leader, comments: ‘Schools really 12-18 months for each school. realise” that change is needed and that do take the QABME process very seriously maybe your course isn’t all it might be. The QABME programme also included and spend months preparing. Ensuring While I’m the last person to say that all reviews of four newly established schools run their courses according to schools should run identical courses, I medical schools over several years from the framework outlined in Tomorrow’s do think that they should all conform start-up until the first student cohort Doctors is a major achievement. graduated. In addition, during this time to a basic set of principles. The QABME a number of schools have established ‘Through the QABME visits, experts visits enable this to happen, while new courses, or have separated from from external institutions have looked allowing each school to develop its own 6 Regulation and QA and Regulation characteristics. Variety is important, but took back to their own teams the maintaining and enabling diversity. within boundaries.’ lessons being learned. After a period of The process should also support the scepticism the process is now accepted continuous improvement of basic Another QABME visitor, Professor as being a very useful tool as well as medical education in the UK through Trevor Beedham, says: ‘Each team providing reassurance for the public.’ constructive dialogue. member came from significantly different environments and there is Professor Stewart Petersen, a obvious mutual benefit to using the QABME is a QABME team leader, comments: standardised approach which still balancing act ‘The QABME process is structured, permits individuality and innovation. with properly trained and experienced A balance is sought between visitors and strict rules of evidence. ‘Once
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