EDITORIAL

The General Medical Council revises a key document: Tomorrow's Doctors

El General Medical Council revisa un documento clave: Tomorrow's Doctors

Arcadi Gual

Director de Educación Médica. Secretario de la SEDEM. E-mail: agual@ub.edu

Since 2nd September the British General Medical Council (GMC) website [1] now offers a new updated version of one of the most significant documents in the training of physicians, Tomorrow's Doctors, which was first published in 1993. We deem this work to be of such importance that we have devoted this editorial to it so that those who are not familiar with the document will have the chance to read it and those who are already acquainted with the two previous versions can see the changes that have been introduced.

The document deals with undergraduate training, that is to say, the training of students in faculties of medicine, but it is not limited to university education and also covers the three stages of the educational continuum, which is the prime virtue of this invaluable work. Graduate, specialised and continuous training must not be considered or, even more important, administered (or managed) as though they were watertight compartments.

Its introduction, one short but fertile page, outlines the obligations -that's right, I said obligations- to be fulfilled by any physician who wishes to be registered in the GMC. These duties are summarised in six sections that can be found and read in the document, but I would like to take the liberty of transcribing a sentence from Good Medical Practice, also written by the GMC, which serves as inspiration for the six sections: 'Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity'.

The first part of the document reviews the different duties to be fulfilled by the five leading players in doctor training in the United Kingdom, i.e. the GMC, faculties of medicine, the National Health Service (NHS), physicians and, of course, students. These duties, as is to be expected, supplement one another and together go to complete the training of physicians. It is interesting to discuss some of these duties because simply detailing them increases the intrinsic value that they already have.

One of the duties of the GMC is to promote a high standard of quality in medical education. Yet, it seems still more interesting to comment on the 'decision-making' duties of the GMC as regards the knowledge, skills and attitudes required of candidates, as well as on the responsibility it has to ensure that the resources allocated for teaching and learning are sufficient to allow students to reach the GMC's requirements.

It seems obvious that, among other duties, faculties of medicine must manage and improve the quality of their programmes of study, provide students and faculty with the academic support they need, and uphold the principle of equality. But although we acknowledge the value of the previous points, as we understand it the main responsibility of faculties of medicine lies in the process of selecting their students and their duty to ensure that only students who have proved to be in possession of the outcomes required by the GMC graduate at the end of their studies.

The NHS, obviously, is responsible for providing the media, facilities and human resources needed for clinical teaching, but it is also responsible for training doctors as teachers and for ensuring that teaching is assessed in an appropriate way.

Physicians are responsible for maintaining principles of professional practice in accordance with Good Medical Practice, for developing the skills and practical abilities of competent teachers, and for supervising their students in order to further their learning and to guarantee patients' safety.

Finally, students also have to carry out a number of duties. First of all, they are responsible for their own learning, including all the aims of Tomorrow's Doctors, whatever their preferences or religious beliefs might be. They must take responsibility for patients' safety by always remaining within the limits of their skills and abilities, and they must voice any concerns about the patient's safety or about the conduct of others that may be incompatible with good professional practice.

It is not difficult to see that there are certain parallelisms with our own system, but there seem to be more differences than similarities. It is very likely that, as a theoretical proposal, an agreement could easily be reached in our sociocultural medium about many if not all of the duties mentioned. Nevertheless, the structure of our educational system in rigid, watertight compartments not only makes this difficult, but in fact prevents it altogether. How can it be impossible to implement something we all agree on?

The second part of the document reviews the 'Outcomes for graduates', which we must understand is being the results of the learning process they have followed. These outcomes are grouped in three sections: the doctor as a scholar and a scientist (five items), the doctor as a practitioner (seven items) and the doctor as a professional (four items). Altogether throughout their undergraduate studies, doctors have to acquire a total of 16 -only 16!- different outcomes.

The last, and longest, part of the document sets out the standards that would be expected for the delivery of teaching, learning and assessment (in a satisfactory way, we assume). Briefly, these standards are structured under the following nine domains: 1. Patient safety; 2. Quality (assurance, review and evaluation); 3. Equality, diversity and opportunity; 4. Student admission (selection); 5. Design and delivery of the curriculum (including assessment); 6. Support and development of students, teachers and the local faculty; 7. Management of teaching, learning and assessment; 8. Educational resources and capacity; and 9. Definition of outcomes.

It is difficult to find such a comprehensive up-to-date document on the training of doctors, one that covers everything from the conceptual framework to the most practical material matters. Very few works take into account the training a doctor has to receive within the educational continuum and are oriented towards a context that is so similar to our own. I believe it to be a good reference that could be of great value for each and every one of our universities, our health institutions, our health care services and our administrations. I do not feel myself to be in a position to ask those involved to copy this or that from Tomorrow's Doctors, but I will ask them to read it, and to re-read it several times. To fail to do so would be unforgivable.

References

1. General Medical Council. Tomorrows' Doctors. URL: http://www.gmc-uk.org/education/documents/gmc_td_2009.pdf.        [ Links ]