Intended for healthcare professionals

Rapid response to:

Observations Medical Training

Moving the point of doctors’ registration

BMJ 2014; 348 doi: (Published 25 April 2014) Cite this as: BMJ 2014;348:g2863

Rapid Response:

Re: Moving the point of doctors’ registration

Niall Dickson clearly identifies several major problems with the proposal to move the point of full registration to the end of the undergraduate course.

Undergraduate schools will also encounter major difficulties. Currently their final examination measures what students can do as students. What they will actually do as doctors remains somewhat conjectural. If graduation leads to full registration then schools will need both to ensure that final year students play a much more active role in the care of patients than heretofore and to measure and judge that activity. Indeed much has been attempted over many years to do just that, nevertheless the transition to F1 remains fraught.

Perhaps there is an opportunity here to rethink the relationships between the schools and the employing authorities, between training and education, between preparation for the next job and preparation for a life of change. Perhaps something important was lost when postgraduate deans and the F1 year ceased, in practice, to have much connection with medical schools.

Could we make the final undergraduate year, F1 and perhaps F2 a true continuum in both education and training to which both the schools and the employers would contribute? A good start would be to ensure that the next versions of the GMC’s Tomorrow’s Doctors and The New Doctor were better articulated than at present.

Perhaps final year students should have an employment contract and receive a small salary thus clarifying their role in the workplace (F1 salaries could be reduced to keep the change cost neutral). This would stop students being sent home after hours with the phrase, ‘you’re a student; you don’t need to be here’. Perhaps any assessment at the end of F2 could be a Master’s degree? EU employment law might have much to say about some of this but current political imperatives are for change, perhaps much change.

Overall there needs to be a better understanding between medical schools and NHS employers about their relative strengths and weaknesses, roles and responsibilities. The GMC is perhaps best placed to facilitate this.

Competing interests: No competing interests

06 May 2014
John B Cookson
Retired undergraduate dean
Hull York Medical School
University of York YO10 5DD