Changes to medical education over the past 20 years

This article highlights the impact of some influential changes to undergraduate and postgraduate medical education over the past two decades. Figure 1 outlines some of the key junctures that have affected the quality and experience of medical education since 1992.

Change in emphasis

In 1993, the General Medical Council (GMC) published Tomorrow's Doctors: Recommendations on Undergraduate Medical Education . 1 This report recognised that there were disparities in what medical schools expected students to know on completing their final examinations and recommended that all medical schools moved towards working to a "core curriculum."

This meant defining and standardising requirements that needed to be satisfied before a final year medical student became a foundation year 1 doctor-then called a preregistration house officer. Tomorrow's Doctors signalled a change in the delivery of undergraduate medical education, with the emphasis moving from gaining knowledge through "the memorising and reproduction of factual data" and the deployment of lectures or seminars to a learning process that includes "critical study of principles and the development of independent thought" and opportunities for students to study areas in depth that are particularly of interest to them. This was accompanied by providing opportunities to develop skills to interact with patients and colleagues.

This shift of emphasis has had a positive effect on undergraduate medical education. Data from the 1995 BMA cohort study, which began two years after the publication of Tomorrow's Doctors , and the subsequent 2006 BMA cohort study 2 indicate that undergraduate education has continued to improve as a result of the adoption of core curriculums.

When asked to rate the extent to which their undergraduate course had prepared them for their first years as doctors, the 2006 cohort indicated positive improvements for each of the different key skills compared with the 1995 cohort. The table indicates improvements in communication skills and the understanding of medical ethics.

Good	Adequate	Poor
2006	1995	2006	1995	2006	1995
Communication with other health professionals	63	26	33	46	4	28
Communication with patients	86	50	14	41	0	10
Understanding of medical ethics issues	42	19	51	54	7	27
Patient management skills-diagnosis	48	37	49	54	4	9
Clinical skills	51	45	44	43	6	12
Laboratory skills	19	13	51	50	30	35

Change...