Undergraduate medical education: present state and future needs.

There is a growing concern that all is not well with undergraduate medical education. Indeed, representatives of 67 countries at the world conference on medical education in 1988 were in little doubt that medical education is in a poor state.' Furthermore, one medical dean has referred to a crisis in undergraduate education,2 and some of the shortcomings of medical education have been referred to as scandals.3 In 1987 and again in 1988 the General Medical Council (GMC) education committee reported that British medical schools were having difficulty in achieving their educational objectives.4 (The claim that medical schools actually had educational objectives came as a considerable surprise to many working within them.) The GMC blamed reductions in funding of the university system and the financial constraints on the NHS. Loss of academic staff between 1981 and 1987 was equivalent to the closure of two medical schools. I believe that the responsibility for this unhappy state of affairs resides within the medical schools. Although a squeeze on resources has not helped, it has not been the critical factor. I do not believe that improvements in student selection procedures would have a major impact. There is no denying, however, the striking difference between the bright, interesting 18 year olds seen at interview and the weary, disillusioned , unquestioning absorbers of information seen during the clinical years. The most influential factor in this change must be medical school. Undergraduate teaching is uneven in quality, variable in commitment, and lacking in coordinated objectives.2 The main problem is that British medical schools are attracting some of the most able young people in the country and simply boring them to death. The consequence is that the students are the losers. And if medical students are losing out today, patients will lose out tomorrow.2 I think that patients are already losing out. Indeed, a large proportion of graduates have a poor grasp of clinical logic, are uncertain in their choice of diagnostic tests, make poor decisions in prescribing, have limited communication skills, and have a poor grasp of ethical principles (D Metcalfe, unpublished work). Even more alarmingly, studies have shown that a significant minority of senior medical students and house officers are deficient in the basic clinical skills of taking a history and making a physical examination.7 If matters are to be rectified we need a fundamental rethink of the role of medical schools in producing the doctors …