GP recruitment: could an undergraduate apprenticeship create the generalists the NHS needs?BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4408 (Published 22 October 2018) Cite this as: BMJ 2018;363:k4408
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We welcome the response to our article by Dr Yeung, as it highlights the fundamental principles that are key drivers for our work within the Department of Primary Care Education at Imperial College, utilising longitudinal placements for meaningful, authentic and active learning roles for our students alongside the provision of patient care in a symbiotic ‘service learning’ approach (1,2).
The Integrated Clinical Apprenticeship (ICA) as described in this article, is now in its third year of running and the evaluation of the course has shown students gaining meaningful roles, understanding medical complexity, tolerating uncertainty, developing a sense of belonging within their clinical teams and a meaningful relationship with their supervisors, peers and patients (work in process of being published).
Given the success of the apprenticeship model within this course, we are now developing a full-time longitudinal placement based in the final year of the MBBS at Imperial. Beginning in July 2019, the aim is to ultimately deliver this new course to all final year medical students over the coming years. This course, entitled F-Zero to reflect its purpose as an authentic apprenticeship to Foundation Year One, will be fully integrated between primary and secondary care. Students will be embedded in a clinical team in primary and secondary care across the full academic year, with responsibilities to manage (with supervision) their own cohort of patients in both settings.
We look forward to being able to publish our results of the evaluation of the ICA soon, to share our key findings and lessons learnt to continue the conversation in the UK of how such an apprenticeship model in undergraduate medical curricula has huge untapped benefits for students, patients and our healthcare system.
1. Simpkin AL, McKeown AM, Parekh R, Kumar S, Tudor-Williams G. A novel Integrated Clinical Apprenticeship: transforming medical students into student doctors. Educ Prim Care [Internet]. 2017 Sep 3 [cited 2018 Feb 4];28(5):288–90. Available from: https://www.tandfonline.com/doi/full/10.1080/14739879.2017.1319745
2. McKeown A, Parekh R. Longitudinal integrated clerkships in the community. Educ Prim Care. 2017;28(3).
Competing interests: All authors are employees of Imperial College London, involved in Undergraduate Primary Care Education and the development of longitudinally integrated curricula
Other schools and specialities should learn from the Imperial College London integrated clinical apprenticeship
Imperial College London is to be congratulated for setting up the integrated clinical apprenticeship.<1> Their director Kumar correctly stated that "medical students don’t want to sit in a lecture or the back of a GP surgery." Similarly, patients do not want to simply interact with "learners" who do not contribute to their care in a stretched NHS. Students are an invaluable resource that can help physicians to take complete histories from patients and perform various duties.<2> Moreover, physicians are often criticised for running late and interrupting patients.<3><4> Students can help in building rapport with patients that offsets the work shortage in the NHS. It does not mean students would be abused as free labour. By easing the workload of physicians, students have more teaching from physicians that further enhances their learning. That is the education model in various medical schools in North America.
When I was a student in a British medical school, my classmates and I were usually sent to take histories from stable patients who were waiting to be discharged. At times, patients questioned us, "Why are you here? What could you do for me?" We could be scheduled to go to a clinic on one day, and then watch a procedure the other day. We lacked opportunities to learn about teamwork, continuity of care, and overall management of patients. The consultants barely knew us, and struggled to give us constructive feedback. Although we all completed portfolios to document our clinical activities, some viewed this as a tick box exercise to collect clinicians' signatures.
We have heard enough about junior doctors' lack of readiness to practice.<5><6> Regardless of what specialities students want to pursue, all medical schools should adopt this undergraduate apprenticeship to enhance our future physician experience and quality of patient care.
1. Wilkinson E. GP recruitment: could an undergraduate apprenticeship create the generalists the NHS needs? BMJ. 2018;363:k4408.
2. Medical students: The most underutilised resource in the NHS. London, UK: British Journal of General Practice; 2018 Mar 4; cited [Jul 12, 2018]. Available from: http://bjgp.org/content/medical-students-most-underutilised-resource-nhs.
3. McCartney M. Margaret McCartney: Why GPs are always running late. BMJ. 2017;358:j3955.
4. Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, Castaneda-Guarderas A, Gionfriddo MR, Branda ME, et al. Eliciting the Patient's Agenda- Secondary Analysis of Recorded Clinical Encounters. J Gen Intern Med. 2018:https://doi.org/10.1007/s11606-018-4540-5.
5. Glass J. Is herd thinking in medical training leading us astray? BMJ. 2017;358:j4297.
6. 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 physician, but not for writing this letter.