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Yet Another Exam

December 20, 2013

Through the Twitter grapevine and Shaun Lintern, I learnt today that Health Education England are planning on shifting full GMC registration to the end of medical school and creating an entrance exam to the UK Foundation Programme,  effectively to the NHS.

HEE’s proposals can be found here ->

And the BMA’s reponse here ->

Where to begin?

Firsrtly, GMC registration. This is required to be a fully qualified doctor and is granted after the first year of foundation training. The recently published Shape of Training review into postgraduate medical education recommended moving registration to the end of medical school. This means someone will be fully qualified as a doctor, despite never having worked one day as one. Furthermore, this change would require profound changes to medical school curricula.

Furthermore, to work as a doctor requires GMC registration,  which requires a foundation job. Without one, a medical graduate who wants to work as a doctor is essentially unemployed. This has been the subtext of oversubscription to the foundation programme for the past three years. Since this is a waste of ~£270K of taxpayer money, the UK government have guaranteed foundation programme jobs for all UK medical graduates. A promise they have kept for the past three years, even creating new jobs to meet demand. However,  oversubscription is a mildewy problem, one that will not go away.

Moving full registration to the end of medical school would mean that a foundation job is no longer necessary for employment as a doctor. This would remove the onus from the government to provide foundation places for all medical graduates. Those £270K investments who do not get a foundation place could find jobs in the private sector or abroad – But what will their training look like then?

Then there’s that exam.

I sit my medical school finals, both written and practical, to qualify as a doctor. I sit the situational judgement test to rank for foundation programme jobs (though in my opinion,  it is an equaliser so London doesn’t drain the brightest doctors away from the rest of the country). I sit the National Prescribing exam so I don’t kill patients with drug errors. This new exam is to enter the foundation programme and postgraduate training in the NHS.

This does provide an answer to founation programme oversubscription. Students who don’t score highly enough simply won’t get a place, thank you very much, next please!

Congratulations! You’ve passed finals…but you’re not good enough for the NHS.

Again, the problem of fully qualified,  fully registered doctors not in training.  These would be fully registered doctors so nobody would be compelled to make sure they find work. The private sector could hoover them up but would there be standardisation of training? Is there even an obligation to train junior doctors? Or they could take their chances abroad,  taking £270k and ~5 years investment with them.

I don’t know. The more I write, the less I understand.

In short, I am woefully ignorant of the landscape of postgraduate medical training in the current climate. As a final year student hoping to qualify as a doctor within the next twelve months, I find myself ancious to be in such a vulnerable and underprepared position.

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