More Medical School places will not solve doctor shortage

University of Leicester’s Professor Philip Baker looks at the flaws in the Health Department’s future-proofing

The increase in funded medical school places from 2018 announced by Health Secretary Jeremy Hunt is obviously good news – but there is a snag.

It takes seven years to train a doctor and even longer to train specialists, and the proportion of medical graduates who do not go on to work in the NHS is a shocking 30%.

Given the present critical doctor shortages in many parts of the country, set to worsen as hundreds more GPs retire over the next few years, what is going to happen to patient care in the interim? Even with more places to offer, medical schools still need to take a hard look at the way we train our future doctors if we are to play our part in addressing this worrying situation.

We also need to make sure that the new trainee places are fairly distributed to areas of the country, such as the East Midlands, where there is the most acute need, and not, as so often happens, concentrated in London and the south-east.

Each year we get some of the brightest, creative, imaginative students on the planet who have all been able to show to us their commitment to medicine through a highly competitive application process for medical school places.  Our challenge is to make sure they retain that questioning spirit and excitement throughout their training. If we don’t, there is a risk that up to a third of the new recruits will leave the profession instead of supplementing, or maybe even replacing, some of the highly committed and dedicated doctors from overseas who are making such a huge contribution to our health services.

Increasing the number of places must go hand in hand with widening access to our courses

Handcuffing these graduates to stay in the service for four years, as has been suggested, cannot be the entire answer.  Patients do not want to be treated by people who do not want to be here; medical schools need to work with the NHS to ensure that medical graduates are appropriately equipped for the tasks they undertake, and that they work in supportive and nurturing environments.  

Medicine is an amazing, fantastically rewarding career and we are sometimes too quick to highlight the problems and too slow to demonstrate what a privilege it is to be a doctor.  Medical schools have a responsibility to inspire and motivate our students.

Medical education must be about more than imparting knowledge.  Medical knowledge is increasing exponentially; it is estimated that the doubling time of medical knowledge in 1950 was 50 years; in 1980, 7 years; and in 2020 it is projected to be 0.2 years—just 73 days.  Instead of simply teaching our students, we need to train them for lifelong learning, and to encourage them to retain their spirit of curiosity.

Here at the University of Leicester Medical School we have overhauled our medical training programme, turning it into more of an apprenticeship model and giving students the opportunity to gain clinical experiences from year one. They will be much closer to seeing the job, doing the job, and understanding it, and so will be better prepared when they actually start work in hospitals or the community.  Increased clinical contact will contextualise their learning. It’s much easier to understand why all the physiology, biochemistry and anatomy needs to be learned and understood when you see it in the context of patients you meet on the ward.

With our new curriculum and the new funding for extra training places we could at last take a giant step towards ensuring the UK has a truly world-class national health service

We have increased the proportion of the course dedicated to general practice and community medicine and are actively addressing the questions of why so many young doctors complete the training but do not practice.  For example, medical schools are very good at teaching students to deal with particular conditions, be it a heart attack or a particular kind of cancer, but we have perhaps been less good at dealing with the concept of uncertainty.  It is quite challenging for a newly qualified doctor to be in a situation where they do not know initially what is wrong with a patient, but still have to look after them and decide on the best course of treatment.

Doctors have to manage against a series of possible conditions and decide what is most likely to be causing the symptoms and take action in an emergency when you are not certain that it is the right thing to do.   We are increasing the training on dealing with uncertainty and putting greater emphasis on other aspects, such as communication with colleagues and patients.

Another startling statistic is that in the UK around 80% of doctors come from 20% of schools.  Increasing the number of places must go hand in hand with widening access to our courses.  If you are taking your students from a very small percentage of schools then it leaves an enormous untapped potential of caring, bright, motivated young people who you are not reaching.

At Leicester University, helped by generous local philanthropy, we are starting a medical foundation year and working with local schools in challenging areas to identify bright students who have great potential but might not quite achieve the highest A-level grades.  We will identify students with great potential before they sit their A-levels and invite them in for a year to work and learn with us. Assuming they meet our requirements, they will join our medical programme at the end of that year.

Last year the University of Leicester celebrated the 40th anniversary of its medical school with the opening of a new £42 million Centre for Medicine. The original medical school was established in the 1970s to help address regional imbalance in the provision of medical staff and services.  Those inequalities still exist, but with our new curriculum and the new funding for extra training places we could at last take a giant step towards ensuring the UK has a truly world-class national health service.

Professor Philip Baker is Pro-Vice-Chancellor and Head of the College of Medicine, Biological Sciences and Psychology, and Dean of Medicine, at the University of Leicester

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