Intended for healthcare professionals

Rapid response to:


Medical students need experience not just competence

BMJ 2020; 371 doi: (Published 12 November 2020) Cite this as: BMJ 2020;371:m4298

Rapid Response:

Re: Medical students need experience not just competence

Dear Editor

We agree with much of the editorial from Dornan et al and especially that new graduates must be prepared for the everyday realities of post-graduate training. In recent years, we’ve been thinking differently about how training is organised, how doctors are assessed (1), and how to balance service pressures. A silver lining from the pandemic has been the acceleration of innovative training solutions, with the system delivering high quality care alongside core training needs. We must retain these positive changes so new doctors continue to build their knowledge and experience required to meet the standards for a modern health service.

The Foundation interim Year 1s intervention to boost our pandemic workforce seems to have better prepared students to begin work (2). We must learn from this experience to implement a more comprehensive approach to prepare graduates to confidently start their first job as doctors. This year’s NTS indicated that, despite unavoidable impact on training, most trainees felt well supported and able to escalate concerns (3).

The National Training Survey (NTS) and our State of Medical Education and Practice in the UK (SOMEP) reports are valuable barometers for the wellbeing of doctors in training. We continue to monitor training environments to ensure support and have seen a renewed focus on wellbeing at all levels of the profession (4). As highlighted, preparedness to join the workforce has been flagged via SOMEP as an area for improvement. However, our 2019 SOMEP report also found 82% of doctors in training rated their overall experience as positive (5). Trainees reported a reduction in working over their hours and a deviation ‘from their intended training pathway’ was found to have a positive impact on risk of burnout – since 2016, over half of all F2 trainees have pursued this course but over 85% have subsequently returned to training within three years. Given that a large proportion continue to work for the NHS (and not as locums) we question the extent to which this causes a discontinuity in patient care.

Flexibility is important both in career paths as well as the very skills doctors in training learn. Patients benefit significantly when doctors combine specialist skills with general clinical capabilities. During the pandemic many doctors worked effectively across multi-professional teams, specialties, and different care contexts. We continue to explore flexible structures with education partners that give doctors this varied experience, including continuing to make curricula more agile and responsive to service needs. The pandemic has already streamlined curricular outcomes, including reducing the number of assessments and changing their format.

Specialty training has begun to shift towards more evaluation of capabilities and competence in the workplace. Whilst there is a space for examinations, we believe that assessing doctors in their authentic environment should be the preferred approach where possible, with an overall aim of reducing assessment burden but ensuring high training standards.

Finally, the importance of leadership and collaboration should continue to be highlighted and built on. These values are present throughout our outcomes for education and training (6,7) and wider work to create inclusive environments and promote professional behaviours. Doctors should be encouraged to develop their professional capabilities from the outset of their careers, particularly where they can help lead and shape the health service for the benefit of patients. With the careful balance of early responsibility, continuing focus on professional development, and clearly outlined supervision in the UK, it is clear why it is often held up as an international benchmark.

1) Medical Licensing Assessment
2) Early provisional registration for final year medical students (March 2020)
3) National Training Survey (October 2020)
4) Supporting a profession under pressure
5) The state of medical education and practice in the UK (2019)
6) Outcomes for graduates (2018)
7) Generic professional capabilities framework (2017)

Competing interests: No competing interests

20 November 2020
Professor Colin Melville
Medical Director and Director, Education and Standards
General Medical Council
350 Euston Road