So, the GMC have decided to introduce a national licensing exam (‘passport to practice’). Their website says:
Medicine is an increasingly mobile profession, and we believe that a single national licensing examination would not only help to ensure that UK-trained graduates meet the required standards, but that international medical graduates seeking to practise here have been examined and evaluated to the same high level. Further work would be required on the position of doctors from the European Union.
Worthy of detailed thought, but a number of points come to mind. First, the metaphor of a ‘passport’. What they describe is a passport for non-UK persons, rather than UK medics. Second, within the EU we already have a medical ‘passport’. Indeed the last sentence of the above quote is, to say the least, strange. Are we seriously going to erect hurdles for UK citizens, but not say those of Holland or Germany who want to practice in the UK. And what of those of us who hold non-UK EU citizenship, but practice here. Medicine is indeed an increasingly mobile profession, and I think it needs to be much more so, but the logical follow through is that we need transnational standards or a series of reciprocal recognition treaties.
This strikes me more about the GMC trying to justify its own survival and, once again, expanding into domains where it has little genuine competence. What is the betting it will be an MCQ paper? Certification close to graduation in medicine is fool’s gold.
The NYT offers short videos most days. I enjoy watching them, partly because I am trying to produce some very humble efforts for student teaching. I am keen to learn. I am gradually finding my way through FCPX, audio recording and how to produce simple animations. One of today’s videos is about the sound studio Skywalker Sound. Some of what is said is not surprising. Most us know how sound influences our degree of fear in scary films, and how sound and music sets action in context. And yet, the degree of sophistication and invention does surprise me. Films are very complicated giant artefacts, the result of large teams working collectively, but with a mixture of authority, vision, and emergence. Contrast this with the novel, or even the modern textbook. In the former there is a single creator at work, and accepting the need for publishers, typesetters and so on, the cast is small. Textbooks might involve more staff in their creation but, in general, I do not think most textbooks are as sophisticated or skilful as most films. A course module might not stand comparison either.
So, what has this got to do with medical education? Well, in an earlier post on the importance of design, I described my own (middle or late-life?) epiphany. In medicine the idea that you just string modules together, with lecturers who have rarely sat down together, all producing their own little snippets, is no longer sensible. A bit like trying to make sense of a William Burroughs novel. Asking externals to come to exam boards rather than being involved in the development of course material is another reflection of a broken system. So, whilst in many disciplines, an individual lecturer might produce a series of lectures, and students may indeed get used to the style, feedback and so on, for medicine I do not think this system is appropriate. Medicine is, by its nature multimedia, but is frequently delivered by people who have little oversight of what students are supposed to know. The origins of this are of course in the apprentice system: whereas postgraduate education can follow this model to a limited degree (although the various NHSs are doing their best to destroy it), much of undergraduate medicine is still sadly bums on seats in lecture theatres. Depressing, given how much the kids are paying. We need the equivalents of sound teams, video teams, animators, support staff etc. And stars!