Medical education in the United Kingdom

Medical education in the United Kingdom includes educational activities involved in the education and training of medical doctors in the United Kingdom, from entry-level training through to continuing education of qualified specialists. A typical outline of the medical education pathway is presented here. However training schemes vary and different pathways may be available.

Medical school

Assessments

Like many other university degrees, UK medical schools design and deliver their own in-house assessments. This practice is different from, for example, the United States, where a national licensing examination has been in place for over 20 years. Each UK undergraduate summative assessment in medicine is subject to the scrutiny of a formally appointed external examiner.

In 2003 a number of UK medical schools began to work together to increase quality assurance activities in the area of assessment as part of the Universities Medical Assessment Partnership (UMAP). UMAP is a collaborative item banking project seeking to build a quality assured written assessment item bank suitable for high-stakes examinations at all UK medical schools.

Qualities assurance of the undergraduate medical education

The UK General Medical Council (GMC) has the ability to reverse its endorsement of any medical undergraduate training course as part of its regular visiting schedule should a course fall short of the expected standards.

Due to the UK code for higher education, first degrees in medicine comprise an integrated programme of study and professional practice spanning several levels. The final outcomes of the qualifications typically meet the expectations of a higher education qualification at level 7 (the UK Master's degree). These degrees may retain, for historical reasons, "Bachelor of Medicine, Bachelor of Surgery" and are abbreviated to MBChB or MBBS.[1]

Specialty training and postgraduate studies

Following completion of medical school, junior doctors then enter a vocational training phase. In the UK a doctor's training normally follows this path:

Newly qualified doctors enter a two-year Foundation Programme, where they undertake terms in a variety of different specialities. These must include training in General Medicine and General Surgery but can also include other fields such as Paediatrics, Anaesthetics or General Practice.

Following completion of the Foundation Programme a doctor can choose to specialise in one field. All routes involve further assessment and examinations.

To train as a general practitioner (GP), after completing the Foundation Programme, a doctor must complete three years of speciality training. This comprises a minimum of 12 to 18 months of posts in a variety of hospital specialities - often including paediatrics, psychiatry, geriatrics and obstetrics & gynaecology.[2] The trainee spends the remaining 18 to 24 months as a General Practice Speciality Registrar - a trainee based in a GP practice. After completing this training and the membership exams of the Royal College of General Practitioners, the doctor can become a GP and can practise independently.

Hospital doctors are promoted after sitting relevant postgraduate exams within their chosen speciality (e.g. Member of the Royal College of Physicians MRCP, Member of the Royal College of Surgeons MRCS) and a competitive interview selection process from SHO to Specialty Registrar (StR) and eventually Consultant on completion of the CCT (Certificate of Completion of Training), which is the highest level in a speciality (with the exception of university-linked professors).

The competition is significant for those who wish to attain consultant level and many now complete higher degrees in research such as a Doctorate of Medicine (MD), which is a thesis-based award based on at least two years full-time research; or PhD which involves at least three years of full-time research. The time taken to get from medical school graduation to becoming a consultant varies from speciality to speciality but can be anything from 7 to over 10 years.

In the United Kingdom, doctors' training has been evolving, for example, with the introduction of run-through training programmes.[3] These offer direct entry to a typically longer training programme after foundation training (providing a pathway to consultant without an additional application step after the first 2-3 years). These changes were proposed in accordance with the government-instituted plan for Modernising Medical Careers. They formed part of a drive to offer streamlined training pathways, although in light of the COVID-19 pandemic of 2020, some have argued that current training frameworks are now too inflexible.[4] In UK trauma and orthopaedics, for instance, one study reported that trainees experienced a 43% reduction in surgical training activities due to the pandemic and all trainees in the study had their final examinations cancelled[5] - a situation incompatible with fixed, time-limited training pathways. In plastic surgery it has also been questioned whether the training standards set by the Joint Committee on Surgical Training (JCST) are achievable in the new training climate.[6] Issues with training frameworks across all medical specialties had been identified previously[7] and high-profile calls are now being made to change the system in favour of individualised training tailored to each trainee.[8]

NHS medical career grades

Medical career grades of the National Health Service
Year Current (Modernising Medical Careers) Previous
1 Foundation doctor (FY1 and FY2), 2 years Pre-registration house officer (PRHO), 1 year
2 Senior house officer (SHO),
minimum 2 years; often more
3 Specialty registrar,
general practice (GPST), 3 years		 Specialty registrar,
hospital speciality (SpR), minimum 6 years
4 Specialist registrar,
4–6 years		 GP registrar, 1 year
5 General practitioner,
4 years total time in training
6–8 General practitioner,
minimum 5 years total time in training
9 Consultant, minimum 8 years total time in training Consultant, minimum 7–9 years total time in training
Optional Training is competency based, times shown are a minimum. Training may be extended by obtaining an Academic Clinical Fellowship for research or by dual certification in another speciality. Training may be extended by pursuing medical research (usually 2–3 years), usually with clinical duties as well

Continuing medical education

Continuing medical education is now mandatory for all doctors, under guidelines from the General Medical Council and Clinical governance.

See also

  • Certificate of Completion of Training
  • Clinical governance
  • INMED
  • Modernising Medical Careers

References

  1. ↑ The UK quality code for higher education
  2. ↑ "CCT". www.rcgp.org.uk. Retrieved 2021-12-29.
  3. ↑ Jahangiri M, Hyde J, Sadler P, Tsui S (2021). "Training in cardiothoracic surgery: how far is the other side of the table?". Bull R Coll Surg Engl. 103 (2): 68–71. doi:10.1308/rcsbull.2021.33.
  4. ↑ Roche CD (2021). "Locked in – Locked out: Inflexibility in UK training". Trauma: 1–3. doi:10.1177/1460408621993755.
  5. ↑ Bodansky D, Thornton L, Sargazi N, Philpott M, Davies R, Banks J (2020). "Impact of COVID-19 on UK orthopaedic training". Bull R Coll Surg Engl. 103 (1): 121–122. doi:10.1308/rcsbull.2021.11.
  6. ↑ Daniels J, Moura F, Majeed Y, Bedford J (2020). "Can plastic surgery training meet current core standards?". Bull R Coll Surg Engl. 102 (2): e005. doi:10.1308/rcsbull.2020.e005.
  7. ↑ Elton C (2018). "Also human: the inner lives of doctors". Cornerstone, London, United Kingdom. {{cite journal}}: Cite journal requires |journal= (help)
  8. ↑ Mitchell T (2020). "Adapting for the future: flexibility of UK postgraduate training". Surgery. 38 (10): 670–674. doi:10.1016/j.mpsur.2020.07.004. PMC 7456398. PMID 32904590.
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