Single test for all doctors: urgent need to expand UK undergraduate medical education
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3467 (Published 30 June 2015) Cite this as: BMJ 2015;350:h3467All rapid responses
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... but apparently missing out Brisbane.
Dr Alexander refers to the Apothecaries' and other non-university bodies' medical qualifying examinations. There is something he needs to know: like the Norwegian Blue, they have ceased to be.
Following an original report over 30 years ago in the much-lamented World Medicine [1] and subsequently pursued in these columns to the evident dismay of the Worshipful Society of Apothecaries [2,3], the scandal of what were then known in the GMC as the 'NULBs' (non-university licensing bodies) was drawn to public attention as back door entries to medicine.
After GMC visitations and much acrimonious dispute, these three qualifications (LMSSA from the Apothecaries, the Scottish Triple Qualification, the the English Royal Colleges' Conjoint Examination) soon ceased to be available to UK medical students . Inspection of the GMC's List of Registered Medical Practitioners shows the final awards of the three qualifications to UK registrands to have been in 2003, 1999 and 2000 respectively.
These "existing structures" thus no longer exist -- happily in my view as the assessments were seriously flawed, most particularly due to the overall low standard of the candidature and the consequent difficulty for examiners of setting passing standards comparable with those of the university medical schools. The UK medical profession supported this perception [4].
The GMC is right to be setting up its own independent assessment procedures which will create a level playing field for all those medical students and doctors seeking to practise in the UK, whether from domestic medical schools or from overseas.
1. Wakeford RE 'Loophole for unfit students?' World Medicine 1983 29th October 14-15
2. Wakeford R 'LMSSA: a back door entry to medicine?' BMJ 294 890-891 4 April 1987
3. See BMJ editions subsequent to the above for the expostulations
4. Wakeford R 'Apothecaries reduce exams' BMJ 1989;298:604
Competing interests: None beyond those declared in the original letter
Why is more bureaucracy being suggested to have another qualifying exam for UK medical graduates? Is it just because we have become a nation of such politically correct people that we cannot see sense?
If a further exam is required, they already exist, the conjoint qualification or the Scottish triple qualification not to mention the Apothecaries. The NHS and/or the GMC would no doubt rather waste money on a new bureaucracy or quango than use an existing structure.
To contemplate a central exam would be difficult because not all medical schools have the same strengths. In some parts of the country pathology is a much stronger part of the curriculum than in others. Anatomy is taught in some places and remarkably not at all in others! Perhaps this means a different exam would be required for those who know anatomy and those who only know about molecules. How ridiculous!
Competing interests: No competing interests
Unusual tolerance of disparity in medical school education is a worry for one and all.
Dear Editors
I wish to highlight Dr W Leslie Alexander's assertion in the recent rapid response in which it was alleged that "not all medical schools have the same strengths" and that "Anatomy is taught in some places and remarkably not at all in others! " and thus as a result " a central exam would be difficult" (to implement, I presume).
It is not the allegation that some UK medical schools have poor or no teaching of basic medical science like anatomy within their current curriculum (this being an open secret within the medical community). Rather, it is the fact that Dr Alexander's suggestions that in spite of this the introduction of a qualifying exam is a senseless and unnecessary bureaucracy for UK medical graduates and this disparity in undergraduate medical education should be accommodated by having different exams (and possibly threshold) for graduates from different medical schools.
Perhaps Dr Alexander has in mind the future "complete doctor" as a composite of medical graduates from different medical schools each with their own "strong points". Or medical graduates who cherry pick what information they want to consign to memory, and the rest relying on apps and "Dr Google".
I certainly hope this is not our future.
Australia is also facing her own growing 'lost' generations of medical graduates with far weaker foundation of basic medical sciences than those from a decade ago; the education (or lack of) in anatomy in many Australian medical school curricula has been an evergreen topic in the ANZ Journal of Surgery for the last 15 years. However, the recent letter to the Editors by Dr Francois du Toit (ref 1) elegantly illustrated the situation faced by practicing clinicians in the following extract:
"Over many years as an orthopaedic surgeon in full-time public service in NZ and Australia, I observed the result of training based on the ‘anatomy starvation diet’. Students and junior doctors develop an increasingly blasé attitude of ‘I do not need to know this’. Realization of their inferior knowledge should stimulate the inclination to be taught. On the contrary, this is a sign of having been dumbed down.
"Recently, I have been an external examiner for third and fourth year medical students. I tried to find out just how much knowledge of anatomy they were required to have. The answer was that I was not to be too strict, and failing any student was basically unheard of (and likely to be overruled). What I did find out was that the anatomy curriculum of that university had been compiled without any orthopaedic input at all. Shorter courses, hence limited knowledge seriously hampers our newly qualified doctors."
How does one help people who do not believe they have a problem?
Reference
1. du Toit, F. (2015), Re: Postgraduate Diploma in Surgical Anatomy: The University of Melbourne experience. ANZ Journal of Surgery, 85: 394. doi: 10.1111/ans.13041
Competing interests: I have previously written in support of national licensing exams for all medical graduates (domestic and international) wishing to practice in UK and Australia. I also know Dr du Toit personally.