MEDEV

School of Medical Sciences Education Development

Introduction

In August 2005, fundamental changes to UK postgraduate training were introduced through the Modernising Medical Careers (MMC) initiative and implemented as the Foundation Programme with the aim of producing better trained doctors and improving patient care.The previously unstructured postgraduate training was replaced by a two-year general training which would form a bridge between medical school and specialist or general practice training.The curriculum was developed by the Academy of Medical Royal Colleges in consultation with NHS staff and other stakeholders, and describes the core competences that should be achieved during the foundation training (MMC 2005).

In the light of these changes, King’s College London School of Medicine through its education committee appointed a skills review group tasked with exploring the implications for the undergraduate curriculum of the new postgraduate training. The group was asked to identify curriculum areas where graduates felt ill-prepared for the Foundation Programme with the aim of adjusting the undergraduate course in the following academic year. In the UK, the General Medical Council (GMC) provides guidance on and monitors undergraduate medical education and the pre-registration year of the Foundation Programme (GMC 2003). The undergraduate course at King’s is based on GMC recommendations and is continuously reviewed and updated to take account of clinical and educational developments. Despite this, some graduates reported feeling under-confident in their skills competencies in the first year Foundation Programme.

Review of the Foundation Programme curriculum

The authors, as members of the skills review group, crosschecked the Foundation Programme skills curriculum against the King’s undergraduate skills curriculum and highlighted possible areas of deficiency. We discussed these in a focus group with King’s graduates who were mid-way through their first year Foundation Programme and highlighted the curriculum skills they considered they had been inadequately prepared for during the undergraduate course. The authors discussed the relevance of these views with key undergraduate and postgraduate educators, including the Director of the South East Thames Foundation School, Undergraduate Dean, and other members of the skills review group, and sought consensus on areas of the undergraduate skills curriculum where there was potential for improvement.

These included:

• The management of acutely ill patients.
• Patient safety issues especially continuity of patient care, risk management and team working.
• Practical prescribing including drug delivery and monitoring, dose calculations, prescription writing skills, use of prescribing formularies, adverse drug reactions, pain control, and safety procedures for controlled drugs.
• Professional development and accountability with emphasis on careers reflection and guidance.
• Communication with non-English speaking patients and use of interpreters.

Recommendations for curriculum change

The skills review group recommended an action plan for curriculum change to the education committee. Working parties were appointed and asked to design new modules or strengthen existing modules for implementation in the following academic year. These included:

• Workshops on care of acutely ill patients and patient safety issues (year 5) .
• Workshops on practical prescribing (years 3 and 5). - Career planning: aptitude tests, reflection on potential careers, and career “taster” special study modules (years 1-5).

Other proposals would involve longer-term planning and wider consultation with faculty and NHS staff before introducing changes. These included:

• A review of therapeutics teaching involving clinicians, pharmacologists, pharmacists, foundation programme doctors, and web-designers to identify potential improvements.
• The design of eLearning modules on prescribing issues which would complement clinical experiences in years 4 and 5.
• The design of a communications training module on use of interpreters for non-English speaking patients.
• A review of Foundation Programme assessment tools and their applicability to undergraduate skills assessment e.g. formative self-assessment of skills.

Since undertaking our review, national reports have highlighted that many medical students feel unprepared for the skilled prescribing needed in their early clinical years and this has led to considerable anxiety about the adequacy of medical student training in prescribing skills (Aronson et al. 2006). We subsequently set up a working party to consider how best to address this problem.

Conclusions

This curriculum review has highlighted the need for medical schools to respond pro-actively to changes in postgraduate training by reviewing their undergraduate programmes and informing faculty about the need for curriculum change. Awaiting recommendations from an MMC review of the Foundation Programme before taking action would have delayed adjustments to the undergraduate course, although these will also inform curriculum change. The timely response by undergraduate teachers to our recommendations led to the implementation of new curriculum modules on the undergraduate medical programme within 12 months of the start of the Foundation Programme and should ensure a more seamless transition from undergraduate to postgraduate training. It will be important to evaluate whether the strengthened curriculum produces doctors who feel better prepared for the Foundation Programme.

The authors acknowledge the advice of the following staff at King’s College London School of Medicine: Professor John Rees, Undergraduate Dean, Dr Jan Welch, Director of South East Thames Foundation School, and the Skills Review Group.