A range of research investigations has developed within medical education. These apply to course monitoring, audit, development and validation, assessment methodologies and the application of educationally appropriate principles at undergraduate and postgraduate levels. Research is undertaken by medical educationalists whose backgrounds include teaching, social sciences and medicine and related health-care specialties, and who will hold a medical or general educational diploma, degree or other appropriate postgraduate quali?cation.
Development and validation for all courses are an important part of continuing accreditation processes. The relatively conservative courses at both undergraduate and postgraduate levels, including diplomas and postgraduate quali?cations awarded by the specialist medical royal colleges (responsible for standards of specialist education) and universities, have undergone a range of reassessment and rede?nition driven by the changing needs of the individual practitioner in the last decade. The stimuli to change aspects of medical training have come from the government through the former Chief Medical O?cer, Sir Kenneth Calman, and the introduction of new approaches to specialist training (the Calman programme), from the GENERAL MEDICAL COUNCIL (GMC) and its document Tomorrow’s Doctors, as well as from the profession itself through the activities of the British Medical Association and the medical royal colleges. The evolving expectations of the public in their perception of the requirements of a doctor, and changes in education of other groups of health professionals, have also led to pressures for changes.
Consequently, many new departments and units devoted to medical education within university medical schools, royal colleges and elsewhere within higher education have been established. These developments have built upon practice developed elsewhere in the world, particularly in North America, Australia and some European countries. Undergraduate education has seen application of new educational methods, including Problem-Based Learning (PBL) in Liverpool, Glasgow and Manchester; clinical and communications skills teaching; early patient contact; and the extensive adoption of Internet (World Wide Web) support and Computer-Aided Learning (CAL). In postgraduate education – driven by European directives and practices, changes in specialist training and the needs of community medicine – new courses have developed around the membership and fellowship examinations for the royal colleges. Examples of these changes driven by medical education expertise include the STEP course for the Royal College of Surgeons of England, and distance-learning courses for diplomas in primary care and rheumatology, as well as examples of good practice as adopted by the Royal College of General Practitioners.
Continuing Professional Development (CPD) and Continuing Medical Education (CME) are also important aspects of medical education now being developed in the United Kingdom, and are evolving to meet the needs of individuals at all stages of their careers.
Bodies closely involved in medical educational developments and their review include the General Medical Council, SCOPME (the Standing Committee on Postgraduate Medical Education), all the medical royal colleges and medical schools, and the British Medical Association through its Board of Medical Education. The National Health Service (NHS) is also involved in education and is a key to facilitation of CPD/CME as the major employer of doctors within the United Kingdom.
Several learned societies embrace medical education at all levels. These include ASME (the Association for the Study of Medical Education), MADEN (the Medical and Dental Education Network) and AMEE (the Association for Medical Education in Europe). Specialist journals are devoted to research reports relating to medical educational developments
(e.g. Academic Medicine, Health Care Education, Medical Education). The more general medical journals (e.g. British Medical Journal, New England Journal of Medicine, The Lancet, Annals of the Royal College of Surgeons) also carry articles on educational matters. Finally, the World Wide Web (WWW) is a valuable source of information relating to courses and course development and other aspects of modern medical education.
The UK government, which controls the number of students entering medical training, has recently increased the quota to take account of increasing demands for trained sta? from the NHS. More than 5,700 students – 3,300 women and 2,400 men – are now entering UK medical schools annually with nearly 28,600 at medical school in any one year, and an attrition rate of about 8–10 per cent. This loss may in part be due to the changes in university-funding arrangements. Students now pay all or part of their tuition fees, and this can result in medical graduates owing several thousand pounds when they qualify at the end of their ?ve-year basic quali?cation course. Doctors wishing to specialise need to do up to ?ve years (sometimes more) of salaried ‘hands-on’ training in house or registrar (intern) posts.
Though it may be a commonly held belief that most students enter medicine for humanitarian reasons rather than for the ?nancial rewards of a successful medical career, in developed nations the prospect of status and rewards is probably one incentive. However, the cost to students of medical education along with the widespread publicity in Britain about an under-resourced, seriously overstretched health service, with sta? working long hours and dealing with a rising number of disgruntled patients, may be affecting recruitment, since the number of applicants for medical school has dropped in the past year or so. Although there is still competition for places, planners need to bear this falling trend in mind.
Another factor to be considered for the future is the nature of the medical curriculum. In Britain and western Europe, the age structure of a probably declining population will become top-heavy with senior citizens. In the ?nancial interests of the countries affected, and in the personal interests of an ageing population, it would seem sensible to raise the pro?le of preventive medicine – traditionally rather a Cinderella subject – in medical education, thus enabling people to live healthier as well as longer lives. While learning about treatments is essential, the increasing specialisation and subspecialisation of medicine in order to provide expensive, high-technology care to a population, many of whom are suffering from preventable illnesses originating in part from self-indulgent lifestyles, seems insupportable economically, unsatisfactory for patients awaiting treatment, and not necessarily professionally ful?lling for health-care sta?. To change the mix of medical education would be a di?cult long-term task but should be worthwhile for providers and recipients of medical care.... medical education
Nursing is changing rapidly, and today’s nurses are expected to take on an extended role – often performing tasks which were once the sole preserve of doctors, such as diagnosing, prescribing drugs and admitting and discharging patients.
There are four main branches of nursing: adult, child, mental health and learning disability. Student nurses qualify in one of these areas and then apply to go on the nursing register. This is held by nursing’s regulatory body, the Council for Nursing and Midwifery. Nurses are expected to abide by the Council’s Code of Professional Conduct. The organisation’s main role is protecting the public and it is responsible for monitoring standards and dealing with allegations of misconduct. There are more than 637,000 quali?ed nurses on the Council’s register, and this is the main pool from which the NHS and other employers recruit.
The criticisms about nurses’ education being too academic, and persisting problems of recruitment of nurses into the NHS, were among factors prompting a strategic government review of the status, training, pay and career opportunities for nurses and other health professionals. The new model emphasises the practical aspects of the education programme with a better response to the needs of patients and the NHS. It also o?ers nurses a more ?exible career path and education linked more closely with practice development and research, so as to provide greater scope for continuing professional education and development.
About 60 per cent of RNs work in NHS hospitals and community trusts. But an increasing number are choosing to work elsewhere, either in the private sector or in jobs such as school nursing, occupational health or for NHS Direct, the nurse-led telephone helpline. Others have dropped out of nursing altogether. The health service is facing a shortage of quali?ed nurses and many trust employers have resorted to overseas recruitment drives. The government has launched a major nurse recruitment and retention campaign and is promoting family-friendly employment practices to lure those with a nursing quali?cation currently working outside the NHS back into the workforce. Nursing is a mainly female profession and a third of nurses work part-time.
Nurses’ pay has for long compared unfavourably with other professional employment opportunities, despite being determined by an independent Pay Review Body. With the recruitment of nurses a perennial problem, the government’s strategy, Making a Di?erence, is to set up a new pay system o?ering greater ?exibility and opportunities for nurses and other health-service sta?. In 2005, a newly quali?ed sta? nurse earned around £16,000 a year, while one of the new grade of consultant nurses could command an annual salary of between £27,000 and £42,000. Nurse consultants were introduced in spring 2000 as a means of allowing nurses to progress up the career ladder while maintaining a clinical role.
The nurse of today is increasingly likely to be part of a multidisciplinary team, working alongside a range of other professionals from doctors and physiotherapists to social workers and teachers. A further sign of the times is that many registered nurses are being asked to act in a supervisory role, delegating tasks to nonregistered nurses working as health-care assistants and auxiliaries. In recognition of the latter’s increasing role, the Royal College of Nursing, the main professional association and trade union for nurses, has now agreed to extend membership to health-care assistants with a Scottish/National Vocational Quali?cation at level three.
Midwifery Midwives (see MIDWIFE) are practitioners who o?er advice and support to women before, during and after pregnancy. They are regulated by the Council for Nursing and Midwifery (formerly the UK Central Council for Nursing, Midwifery and Health Visiting). Registered nurses can take an 18month course to become a midwife, and there is also a three-year programme for those who wish to enter the profession directly. Midwifery courses lead to a diploma or degree-level quali?cation. Most midwives work for the NHS and, as with nursing, there are problems recruiting and retaining sta?.
Health visiting Health visitors are registered nurses who work in the community with a range of groups including families, the homeless and older people. They focus on preventing ill-health and o?er advice on a range of topics from diet to child behavioural problems. They are employed by health trusts, primary-care groups and primary-care trusts.... nursing
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