Intended for healthcare professionals

Learning In Practice

Reform of undergraduate medical teaching in the United Kingdom: a triumph of evangelism over common sense

BMJ 2004; 329 doi: (Published 08 July 2004) Cite this as: BMJ 2004;329:92
  1. Gareth Williams (, dean1,
  2. Alice Lau, fourth year medical student1
  1. 1 Faculty of Medicine and Dentistry, University of Bristol, Bristol BS8 1TH
  1. Correspondence to: G Williams
  • Accepted 28 January 2004

There is an urgent need to test whether the current reforms in training of doctors are the right answer to the shortcomings of traditional training

The past decade has seen concerted attempts to revolutionise undergraduate medical training in the United Kingdom. Advocates for change have claimed that traditional teaching is old fashioned and too detailed and produces doctors with poor interpersonal skills (box). Key reforms, endorsed by the UK General Medical Council (GMC), included the deliberate reduction of factual knowledge and the replacement of didactic teaching with problem based learning (PBL) directed by the students themselves.1 About a third of UK medical schools have now embraced these principles.

This strategy is entirely untested in UK medical students, and no evidence exists that it will produce better doctors. Here, we argue that the “new” ideology may actually damage medical training in this country and that educational reform is being driven by enthusiasm for change rather than by rational responses to the shortcomings of traditional curriculums.

What do doctors really need to know?

It is true that practising doctors do not use large tracts of the knowledge they acquired as students. This redundancy is particularly striking in the basic medical sciences (for example, anatomy, biochemistry, physiology, pathology, and pharmacology); why should undergraduates learn biochemical pathways that even consultants in metabolic medicine do not need for their everyday work? The desire to abolish so called information overload prompted the GMC to recommend that “factual information must be kept to the essential minimum that students need at this stage of medical education.”1 Careful pruning of superfluous detail carries obvious benefits, but we believe that the GMC's advice has in some cases been followed to potentially dangerous extremes.

Some medical schools have now largely abandoned formal teaching of basic medical sciences, leaving students to explore these crucial areas alone or …

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