GMC says it will watch curriculum reformsBMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6925.361 (Published 05 February 1994) Cite this as: BMJ 1994;308:361
Medical schools in the United Kingdom will have to change their curriculums dramatically and report annually to the General Medical Council (GMC) on the progress of their reforms. The GMC's latest recommendations on curriculum reform emphasise that the council will ensure that changes are implemented. Professor David Shaw, chairman of the GMC's education committee, said that the GMC had been urging medical schools to reduce the factual content of their courses since 1863.
* Students will be encouraged to teach themselves
“Most medical schools already seem to have major revisions of their curriculum going on at the moment. Change is happening quite rapidly. But we are committed to these reforms, and if we make an informal visit to a school and are unhappy with its progress then we have the power to request a formal visit. We will then make a report and ask the institution to respond to that report. We send both to the Privy Council.”
The GMC published its recommendations last month. Under the Medical Act 1983 its education committee is responsible for the quality and assessment of undergraduate education in the United Kingdom. Its chief recommendations are that the factual content of the course should be reduced; that a core curriculum that encourages students to teach themselves should be introduced; and that special study modules should be offered. These could include social science subjects, languages, and literature.
“Students enter university full of enthusiasm and have their curiosity washed out by multiple choice examinations,” said Professor Shaw. “We would like to see students meeting patients early on so that they get used to communicating with people other than their peers. They don't have to meet sick people - they could talk to pregnant women or disabled people.”
The recommendations emphasise the importance of developing attitudes “essential to the practice of medicine.” These include the ability to cope with uncertainty, the awareness of personal limitations, and he ability to adapt to change.
The GMC is not putting forward a national curriculum for medical schools to follow but says that the core curriculum, which should take up two thirds of study time, should be system based. This means that basic scientists and clinicians would have to get together and integrate their teaching, eliminating the preclinical and clinical divide. Exams would also have to change, warns the GMC, as they “currently put a premium on the acquistion of facts at the expense of reasoning.”
Angela Towle, author of Critical Thinking, a report on undergraduate medical education published by the King's Fund Centre in 1991, said that there were still big barriers to integrated education. “The GMC has gone part of the way to implementing reform, but the departmental structure of medical schools means that each department concentrates on its own bit of the curriculum,” she said. “The amount of money given to departments depends on how many students they have and how much teaching they do. We need an organisation that goes across the whole school.
“The curriculum committees of the medical schools want the GMC to lay down the law. The trouble is that the GMC's only sanction is like a nuclear deterrent - it can close a medical school, but it is never going to do that.
“The GMC has called its report Tomorrow's Doctors. Things are changing so rapidly that these reforms should be in place for today's doctors.”
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