Wednesday, 6 March 2013

#Ukmeded : National Finals

Another #Ukmeded introduction to a chat post from me. This week's topic is to be National Finals, and I'm hoping to focus a little more on the more moral question of: are they something we should consider, rather than on the practicalities of implementing any such scheme.

The medical schools up and down the country each have their own style of teaching medicine, from Glasgow's PBL based system to Imperial's old school core science and clinical years. They have control over how they select their intake of students and what emphasis different elements of medicine are given within their courses and how they assess their students. Ultimately however, their aims must be broadly similar: to produce medical graduates who can work alongside each other across the country performing the same basic job with confidence, skill and safety. And in the more long term, medical graduates with the skills and knowledge to prepare them to progress through the various stages of post graduate training.

 The GMC's Tomorrow's Doctors "sets the knowledge, skills and behaviours that medical students learn at UK medical schools: these are the outcomes that new UK graduates must be able to demonstrate" (  The GMC uses a Quality Assurance of Basic Medical Education (QABME) to assess that this minimum standard has been met. However, many foundation doctors do not feel adequately prepared for their first job and there are worries about the consistency in competency of foundation doctors. (

But the ability to be a good doctor is about more than just basic competencies, and I personally believe it is important to be able to compare the quality of medical education between medical schools more formally. It would allow the public, the profession and students ourselves to be reassured that there is not an appreciable difference in the quality of junior doctor produced by different universities. 

I have met medical students from up and down the country and am lucky enough to count many of these amazing people my friends. I am sure that we would all like the chance to be judged on our own merits rather than our intelligence and ability misrepresented based on assumptions about the universities which we attend. Many people will say, "It's all right for you, you go to Cambridge, you'd do really well. I go to ... university and we couldn't compete". But that attitude is precisely the one I would love to have the data to challenge. I would personally like the opportunity to test myself against my whole cohort of medical students and be given the chance to compare my strengths and weaknesses and how well prepared I have been by my medical school.

If all medical schools are aiming to produce the best doctors possible from their intake then surely they too should be keen for the chance to prove the excellence of their students and teaching methods?

I am going to leave it there on my own opinions for just now, and suggest a few questions to consider and a few resources for thinking about the issue of national finals in more depth. Resources include current student attitudes to the quality of their education, comparison of the graduates of different medical schools pass rates in post graduate exams, and discussion by the GMC and MSC.

Questions to discuss (I can think of loads!): 

Should we have a national exit exam?

Should a national exit exam examine only basic competencies?

Should a national exit exam discriminate the quality of medical graduates?

Would such an exam give reassurance that the quality of medical graduates from medical schools is comparable?

Would such an exam give reassurance that the quality of medical education at different medical schools is comparable?

Could such an exam be used for ranking applicants to the Foundation Programme?

Would such an exam cause a "teach to the exam" attitude?

Would such an exam cause an increase in the average quality of medical graduates?

Would such an exam cause an increase in the average quality of medical education?

Would such an exam allow for variety of styles to remain across medical schools?

Would such an exam improve the preparation of students to later take post graduate exams?

Would such an exam reduce the current level of disparity seen between graduates of different medical schools first time pass rates in post graduate exams?

Are groups opposed to such proposals because they wish not to be compared in case that comparison is unfavourable?

Would differences between medical schools be down to selection procedure or teaching or both?

Could the comparisons made as a result of such an exam impact on current efforts to widen access to medicine?

Resources in no particular order:

Massive thanks to my friends @RoseTintdScrubs and Christopher King (who sadly isn't on twitter!) for all their help with collecting the resources and for all the discussion about this issue already!