Five new medical schools: a decline in standards is inevitableBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1868 (Published 02 May 2018) Cite this as: BMJ 2018;361:k1868
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While the matter of employment and increasing the number of home-grown doctors is not for the GMC, we decide which organisations can award UK primary medical qualifications, and we will not allow the increase in student numbers or additional medical schools to lead to any decline in the high standards that UK medical education offers.
Our standards are there to ensure patients do not come to harm by making sure that doctors and medical students are properly supported in their training.
All new medical schools are subject to an intensive process of visits and scrutiny which includes visiting new schools at least once a year from before students start right through until the first cohort have graduated.
When a new medical school application is put forward we decide whether or not we will quality assure that school. If they don’t meet our requirements at that very early stage of development, we won’t allow them to progress through the process. If they appear to meet our requirements, we visit to determine if the school is meeting the standards we set out in Promoting excellence: standards for medical education and training. Only then can they accept applications from prospective students.
The schools then have to demonstrate, through a robust quality assurance process, how they continue to meet these standards from when the first students start right through until they graduate. Only once we are satisfied that these standards have been met, and will continue to be met, we decide if the school can be approved to award medical degrees. Where this does not happen, and where we have evidence that schools are not meeting our standards, we can act, and indeed we have done so in the past by delaying start dates for students or not allowing a school to award a medical degree.
None of this is, or ever will be, a ‘box ticking exercise’.
Competing interests: No competing interests
I agree with Prof Harris’s concern about the quality of medical training with increasing number of students but inadequate number of teaching staff.<1> I came from a British medical school which admitted about 400 new students each year. Students were overcrowded and at times struggled to gain experience. For instance, during anatomy sessions, we did not have enough demonstrators, and were simply told the school had inadequate funding to accommodate everyone. In clinics, three students could be scheduled to go to the same consultant. The consultant could then tell us the clinic room is too small, so some of us should go to the library instead.
In hospital, when students asked to join ward rounds, they could be told, “You just want to clerk someone for your portfolio, right?” Then, students would be sent off to see a very stable patient in which the admitting team had minimal interest. Very often, three to four students surrounded one patient to take history and perform examination. After we finished, we did not always have any doctors to go through our findings. Some patients questioned what is the point of this history-taking and examination, and declined to interact with students. Some patients even complained that they had been seeing students all day, and none of them contributed to their care.
I appreciate the opportunity to be in medical schools, and understand I could have lost this opportunity if medical schools reduced their intake. However, I would appreciate even more if more funding could be allocated to improve quality of the training, rather than purely increase the intake.<2> I heard of senior doctors feeling dissatisfied with the new graduates’ unpreparedness to practice.<3> This may very well be due to lack of opportunities for students to gain adequate experience before graduation.<4>
1. Harris PF. Five new medical schools: a decline in standards is inevitable. BMJ. 2018;361:k1868.
2. Yeung EYH. Reducing medical school dropouts. BMJ. 2018;361:k1872.
3. Glass J. Is herd thinking in medical training leading us astray? BMJ. 2017;358:j4297.
4. Yeung EYH. How are junior doctors supposed to learn without the opportunity? BMJ. 2017;359:j5057.
Competing interests: I have been paid for working as a medical doctor, but not writing this letter.