Memorandum submitted by The Medical Schools
Council (formerly the Council of Heads of Medical Schools (CHMS))
CHMS represents the interests and ambitions
of UK Medical Schools as they relate to the generation of national
health, wealth and knowledge creation through the profession of
medicine. As an organisation it occupies a unique position embracing
undergraduate medical education, the entirety of health related
research and a critical interface with the health service.
NEXT 10 YEARS
University staff are, by definition, individuals
with a personal commitment to search for absolute truths and a
drive to uncover the correctrather than the comfortable
It is a demonstration of a civilized society
that public funds are committed to paying individuals simply to
think. Occasionally this makes for an uncomfortable relationship
with policy makers who are required to press forward a particular
Universities historically have had 2 rolesto
create new knowledge through research and to transmit that knowledge
through teaching. We would add a 3rd rolewe live in a knowledge
rich society, so information and knowledge management have become
and will continue to be a very important role for HE.
The one thing, however, that policy makers can
rely on, is that university staff have a focused agenda dedicated
to quality. It is imperative for the nation that this unbiased,
rigorous and analytical base is supported as a bastion of quality
and the search for truth.
Universities are central to the effective delivery
of medical education firmly rooted in an environment of enquiry
and scholarship. It has been stated that whilst it is possible
to train people to do today's task they must be educated for tomorrow's
task. In no discipline is this more true than medicine where practitioners
must daily cope with complexity, ambiguity and situations of uncertainty.
The NHS, as the major employer of medical school graduates requires
its doctors to provide:
accurate diagnosis and clinical reasoning.
empathy and good communication.
Central to CHMS's role is the pro-active exploration
of the role of the doctor in the future and the pursuit of educational
solutions for workforce requirements that embrace the desired
rolesboth in the NHS and in the pharmaceutical and devices
CHMS believes that more needs to be done to
define the profession specific requirements for the delivery of
optimal patient care and to select into each professional cluster
those students most able to fulfil these roles. Having articulated
the requirements in terms of:
more needs to be done to structure the working
environment to facilitate the patient journey.
Closer working between universities and schools
and between universities and those delivering health care will
It needs to be appreciated that the timescale
from a basic scientific observation to an application with clinical
impact can be as long as 50 years and realism must be factored
into expectations and the outcomes of research expenditure.
That being said, the very rigorous peer review
of grant applications experienced in the UK has had an undoubted
impact and the quality of the output of bio-medical research in
the UK is second only to the US internationallydespite
the relatively small scale of the investment compared with that
of other nations. The quality of education provided by UK universities
is demonstrably excellent and deserves continued support.
In terms of the specific questions posed:
What do students want from universities?
Socially and intellectually broadening experience
that results in employability.
What should the student experience involve, including
for international students?
What do employers want from graduates?
Fitness for purpose.
What should the government, and society more broadly,
want from HE?
Social and regional accountability; engines
for the economy.
Is the current funding system fit for purpose?
Is the purpose clear?
In health, no. Medical education is by definition
expensive because of the time it takes to expose students to patients
in the variety of presentations of different pathologies necessary
for them to be confident in their diagnostic abilities.
There should be continued (and there is an argument
for increased) funding of Higher Education from the public purse.
Whilst more generous funding would undoubtedly be welcome and
would further stimulate innovation, the relative stability of
Funding Council income streams has been welcomed by Medical Schoolsparticularly
when compared with difficulties faced, in the recent past, by
colleagues in Schools of Nursing.
The key issue to be resolved centres around
funding from DH to cover clinical placements and the Duties of
the Secretary of State for Health under the NHS Act to provide
such facilities as are necessary for the clinical education of
medical and dental students.
The recent drive to delegate decision making
to SHAs and the removal of ring fencing from the MPET budget has
meant that SHAs have, without the required consultation, slashed
education expenditure in order to meet short term financial imperatives.
It is naïve to assume that service imperatives
will not take priority over long term educational objectives.
If the government has a policy of developing an effective, home-grown
medical workforce, steps need to be taken to provide ringfenced
funds to create the professionals required.
What are the principles on which university funding
should be based?
Evidence of cost.
Should the £3,000 cap on student fees be
lifted after 2009 and what might be the consequences for universities
and for students, including part-time students?
The full impact of fees on debt averseness needs
to be understood if the fee elevation, insensitively introduced,
is not to jeopardize widening participation goals. Whilst lifting
the fees "cap" will be possible, this is not a preferred
option from the students' perspective and it has the potential
to undo progress that has been made on widening access.
Should central funding be used as a lever to achieve
government policy aims?
It is inevitable but a measure of any society
will be its willingness to consider other uses and value universities
as generators of non proscribed ideas and culture advancement.
How well do universities manage their finances,
and what improvements, if any, need to be made?
They should look at adopting the technologies
as are being applied in industry and even in the Health Sector.
There is a considerable amount of unnecessary bureaucracy, complex
tiers of governance and in an era driven by research excellence,
less than adequate attention to the quality of the primary product:
In terms of Research funding, CHMS believes
that reform of the RAE over the last decade has driven up quality
and that rigorous peer review should be the cornerstone of funding
allocations. It is essential that all Medical Students be educated
in a questioning and research-rich environment and that Medical
Schools work closely with local, regional, national and international
agencies to develop their research programmes. The increasing
concentration of research funds in a small number of worldclass
centres seems inevitable. However, we must maintain the ability
for centres outside this small group to have access (on a competitive
basis) to substantial funding for high quality research.
THE HE SECTOR
The recent expansion in the numbers of Medical
Schools means that there is now a good geographical distribution
across the UK and that, coupled with immigration from the EU,
the number of doctors envisaged by Wanless for 2020 might be achievable
albeit with some difficulty as a result of the EUWTD. A challenge
remains in securing the funds to permit higher specialist training
for the increased student output. Central Planning by Government
would be helpful in this area.
Medical students are not fully registered at
the point of graduationthis is creating difficulties because
of increased numbers of EU graduates for Foundation Year 1 places
in the UK. It would be helpful if the Medical Act were amended
so that the F1 year was integral to the Medical degree.
There also need to be much better ways for HE
to keep pace with the rate of change in the NHS workforce. There
needs to be much closer working between DH and DfES, although
it is fully accepted that, with plurality of provision, increasing
numbers of future medical graduates might not choose the NHS as
their main employer.
Is the current structure of the HE sector appropriate
and sustainable for the future?
No; more mergers will be necessary to allow
the dual demand of international competitiveness in research yet
the ability of universities to contribute to regional economies
and workforce requirements.
CHMS strongly supports the underlying principles
of the Bologna Process: enhancement of higher education across
Europe; comparability of degrees; improved mobility within Europe
of staff and students; promotion of European co-operation in quality
assurance; and so on.
However, CHMS is concerned that universal application
of the two-cycle (bachelor and master) model to the undergraduate
medical degreeand to similar degrees in dentistry and in
veterinary medicineis not appropriate. The UK has led in
the development of modern undergraduate medical curricula: see,
for example "Tomorrow's Doctors", from the Education
Committee of the GMC, recognised Europe-wide as an important and
leading statement of principles in medical education.
Almost all medical degrees now follow a curriculum
that is designed to be integrated throughout the five or six years
of the medical course, and artificially to divide this in two
is anti-educational, and regressive. Medical Schools could conceive
of a structure which provided for a Bachelors Degree in bio-clinical
sciences after 3 years and a Masters level qualifications two
years later on achievement of the Primary Medical Qualification
and provisional registration with the GMC. UK Medical Schools
are entirely opposed to the implementation of a credit transfer
system for medicine and a focus solely on outcomes. UK Medical
Schools whilst accepting the need to define required outcomes
and competencies wish to make clear that doctors are very much
more than a string of competencies and that effective diagnostic
and clinical reasoning skills can not simple be acquired through
In the UK the degree course is integrated both
vertically and horizontally over its entire length and it would
be impossible to accept students mid-way through the programme.
Insensitive adoption of a 3+2 model could result in loss of the
essential integration of clinical experience and science which
promotes contextualised learning and has been one of the real
advances in British Medical Education in recent years. Even if
it were possible for medical degrees generally to be cut in two,
this would largely be meaningless in the context of Bologna: the
"bachelor" element in the course in one university could
only lead to the "master" course being completed in
another university if every aspect of the curricula were the same
in the two universities, and there is no general need to encourage
medical students to switch university in mid-course.
We are aware that a few European countries have
introduced a Bologna-style two cycle structure in medicine. For
example, this has been done with care in the relatively few medical
schools of the Swiss Confederation, and a student now might reasonably
be able to do half of his or her medical school course in, say,
Zurich, and the remainder in Basel. But this does not make mobility
between countries possible.
Other countries have adopted a cruder model
than the Swiss. In Denmark, each medical course has arbitrarily
been divided in two, with a bachelor degree being awarded at the
end of the third year, irrespective of the curriculum or whether
there is a natural break at this point in the course. There is
no coordination between Danish universities in curricula, and
so there can be no mobility at the end of the bachelor degree,
even within Demark.
Very large expenditures of time and money have
been made in many countries, trying to fit medicine into the two
cycle model, and we believe this has generally been an unjustifiable
waste of European resources.
The two cycle model is workable, and indeed
desirable, in almost all other subjects. There is no evidence
that Ministers considered the special position of medicine, dentistry
and veterinary medicine at the original Bologna meeting, or at
the preceding meeting in the Sorbonne. We believe that if, at
the time, this special position had been pointed out to Ministers,
they would have considered the exclusion of these subjects from
the general two cycle model.
We therefore urge Ministers at the Bologna Process
London meeting in May 2007 to agree that "the two cycle model
of bachelor and master degrees does not necessarily apply to first
degrees in medicine, dentistry and veterinary medicine. It is
admissible for these subjects to be studied in an integrated degree,
of five or six years with total credits equal to the normal total
for a bachelor degree and a master degree taken in sequence".
This position is supported by the World Federation
for Medical Education, the Association of Medical Schools in Europe,
and by the Association for Medical Education in Europe. The organisations
endorse the purpose of the Bologna Declaration and support that
medical education as a part of higher education should be fully
involved in the Bologna Process. However, the specificity of medical
curricula and the current situation of European medical schools
must be considered, and it is the opinion that the two-cycle division
in a Bachelor and a Master degree would invalidate endeavours
to integrate basic and clinical sciences in the medical curriculum.
There is also a related problem with recognition
of four-year integrated masters degrees within the Bologna Process.
These do not conform to the Bologna model, although UK universities
have argued that they meet the second cycle qualification descriptor
in the Framework for Qualifications of the EHEA
117 CHMS changed its name with effect from 17 May