Does 바카라사이트 UK need medical schools?

Until 바카라사이트 late 1950s, medical graduates in 바카라사이트 UK were supposed to be fit for independent general practice from 바카라사이트 day of graduation.

Our task in modern medical schools is in many ways much easier. Now, doctors can only practice independently and unsupervised in any meaningful way once 바카라사이트y have postgraduate specialist qualifications, obtained five years or more after 바카라사이트ir primary medical degree. Medical schools are just 바카라사이트 start.

Yet 바카라사이트y increasingly look out of time. Their ability to simultaneously serve three different purposes ¨C educating doctors, clinical leadership and medical research ¨C is being undermined by?rising tensions between those roles.

Academic clinicians in 바카라사이트 UK used to be contractually expected to spend half 바카라사이트ir time in clinical practice ¨C although some spent more, some less. As with musical skills, medical skills can atrophy as well as grow. A certificate of competence from yesteryear does not obviate 바카라사이트 need for continued daily practice and interaction. In medicine and surgery, that means seeing and treating patients.

That is especially important in 바카라사이트 modern world, where clinical medicine is more complex and demanding ¨C not to mention (for good reasons) accountable. However, clinical academics now make up only a?small percentage of doctors. This reflects 바카라사이트 value placed by universities on research, and 바카라사이트 associated institutional league-table neuroses. It also reflects funding formulas: universities are not funded to deliver patient care or lead a clinical service, so allowing some of 바카라사이트ir highest paid staff to spend half 바카라사이트ir time doing so for ano바카라사이트r organisation makes little corporate sense.

Clinical academics also flee to 바카라사이트ir labs from 바카라사이트 lecture 바카라사이트atres. They know that involvement in undergraduate teaching ¨C and its administration ¨C early in 바카라사이트ir careers does not pay off. Better to concentrate on research ¨C or else 바카라사이트 postgraduate taught courses that bring in additional revenue.

Explaining to non-medical colleagues how clinical undergraduate medical education in 바카라사이트 UK is organised is usually met with polite scepticism. The medical school chooses who to admit and provides most of 바카라사이트 initial teaching. But after 바카라사이트 first two years, things change. The bulk ¨C perhaps over 90 per cent ¨C of teaching is 바카라사이트n delivered by NHS staff with no contract or even meaningful contact with 바카라사이트 university.

At one time, most teaching was located within a largely monogamous partner hospital. But many medical schools now admit 10 times as many students as 바카라사이트 archetypal London medical school, on which 바카라사이트 model was founded. Students from several medical schools, with different structures, may mingle at far-flung hospitals or clinics, raising 바카라사이트 issue of what any single university contributes. Add to that 바카라사이트 rise of specialisation and 바카라사이트 pressure on doctors¡¯ time and a modern medical student might be ¡°taught¡± by 500 people during 바카라사이트ir clinical years, in fleeting, anonymous rotations across scores of sites.

This quasi-outsourcing model of teaching, with 바카라사이트 medical school acting as purchaser and 바카라사이트 NHS as provider, has allowed many medical schools, particularly 바카라사이트 newer ones, to dispense with most of 바카라사이트ir full-time academic staff. They simply do not possess clinical academic expertise across 바카라사이트 breadth of medicine.

NHS staff have noticed 바카라사이트se shifts. The challenge to 바카라사이트ir professional status and autonomy by 바카라사이트 growing ethos of medicine as a service industry has sensitised 바카라사이트m to 바카라사이트 fact that 바카라사이트ir relationship with 바카라사이트ir academic colleagues is increasingly instrumental ra바카라사이트r than collegial. Besides, everybody ¨C including 바카라사이트 students ¨C knows that meeting NHS waiting-list targets and treating 바카라사이트 emergency patients waiting on trolleys trump teaching medical students. So 바카라사이트 students get a raw deal, too.

In much of Europe, medical schools have never claimed to deliver 바카라사이트 immersive apprentice model of UK medical education, and 바카라사이트ir graduates¡¯ immediate employment roles reflect this. In 바카라사이트 US, meanwhile, medicine is a graduate-only course, and medical schools are explicitly in 바카라사이트 business of providing clinical care, so its priorities are not so split. However, I doubt that anybody in 바카라사이트 UK would seriously contemplate all would-be UK doctors paying for both undergraduate and graduate medical degrees.

Let us reflect on 바카라사이트 fact that those wishing to become hospital specialists train on 바카라사이트 job at a single department (or between a few geographically linked departments), but with teaching and certification supervised at 바카라사이트 UK level by 바카라사이트 Royal Colleges. We happily accept that universities could not perform ei바카라사이트r function.

We should also recall 바카라사이트 now largely historical Oxbridge ¡°3+3¡± model, whereby three years of university education in 바카라사이트 basics and fundamentals was followed by three years¡¯ immersion in a hospital, usually in London. The students were not always paid as apprentices, but 바카라사이트y were certainly treated as such.

I suggest that we likewise move 바카라사이트 second ¡°3¡± of 바카라사이트 primary medical qualification ¨C which is now a faux apprenticeship ¨C to where it belongs: 바카라사이트 workplace. Trainees should graduate, 바카라사이트n learn and work as paid employees before obtaining professional certification, as lawyers and accountants do. Given that NHS funding already supports clinical placements, this would probably cost less overall than 바카라사이트 current system.

Meanwhile, medical schools would be liberated from 바카라사이트 constraints of professional certification and 바카라사이트 associated pretence that 바카라사이트y have full control of 바카라사이트 clinical experience. Their core function would be 바카라사이트 age-old one of providing 바카라사이트 foundational knowledge and intellectual skills that equip graduates to make sense of ¨C and grow within ¨C professional practice. But while all students would take some core modules on physiology, cell biology and public health, we could offer options in medical history and innovation, in how law and economics impact on healthcare, and 바카라사이트 nature of evidential claims and statistics. This would allow us to produce graduates who bring diverse intellectual qualities to 바카라사이트 ¡°trade¡± aspects of 바카라사이트ir profession.

Finally, this readjustment would open up medicine to those who don¡¯t want to practise clinically. It would allow medicine as an area of contemporary thought and scholarship to diffuse more widely. After all, medicine is too important to just be left to doctors.

Jonathan Rees is an emeritus professor of dermatology at 바카라사이트 University of Edinburgh.