Imagine that you have been assigned to organize a degree program in a new country’s laboratory or craft-based institution. Practical or hands-on experience might be a vital component of the course.
You soon discover that organizational aspects are different from what you had hoped. The laboratories are not yours, and you need administrative control over them. You also need to find out what reagents and materials are available. More than 90% of teaching will be provided by staff from another organization (an organization that, although much loved, has long-standing staffing and financial problems).
Your students may have chosen to study in your city, but the student population is growing, so local facilities need to be improved. Students must travel long distances each day or spend several weeks outside of their hometowns. You will be satisfied if you receive an email listing all teaching staff.
Anyone who tried to explain undergraduate clinical medicine education to colleagues at non-medical universities will recognize the above cartoon. Let me offer a more sympathetic perspective.
What courses are taught
The five-year standard course consisted of three years of clinical attachments and two years of basic science. While some clinical experience is available in the first two years, it is minimal, and the binary divide remains.
University staff from other faculties will be familiar with the structure of the first year. Lecture-based teaching is the predominant method of instruction. Classes can be as large as 400 students in some schools. Tutorials and problem-based learning sessions are also standard features. The university campus is the central location for students. They follow common university semester terms. Students will all follow the same syllabus with routine exams. However, there are limited options for bespoke research projects and group work. Although there are few written assignments and essays, most assessments focus on factual recall and understanding.
Each year’s clinical experience is different. All students must study the same material, so there is little choice. However, clinical teaching is organized into clinical modules. Each module can be grouped with specific modules within one year. These modules are completed asynchronously by students each year. Students move through the modules in smaller groups, usually four to fifteen students than they did in preclinical years.
Students are required to complete 30 to 36 modules during their three years of clinical experience. Each module lasts from one to six weeks. Students will likely spend time in peripheral locations. The exact clinical exposure varies between different centers that deliver the same module in any given year.
Students may, for example, spend their first year in a subject such as cardiology, surgery, psychiatry, or primary care. Students who pass the assessment at the end of each year are eligible to progress to year 4. Modules in year 4 are typically more specialized and shorter. Examples include dermatology, ophthalmology, and renal medicine.
Most schools’ final year of clinical training is intended to prepare students for their foundation year. Halfway through the last year, the final exams are taken. There are often electives in other centers in the UK and overseas. You may also have the opportunity to shadow junior doctors.
Students work forty hours per week as they progress through their clinical years. The majority of teaching is done by NHS staff at different levels of seniority. Some of these are provided in the evenings and on weekends.
Teaching student doctors
Medical schools employ non-clinical academic staff and clinical academics. These latter are used within the NHS and paid mainly under NHS pay scales. However, the NHS pay scales may vary between devolved countries and England. Pension arrangements may also differ. The standard clinical academic contract dictates that 50% of the time be spent on patient care and 50% on research or teaching.
Because of the requirement to train in two different professions, funding clinical academics and recruiting for clinical academic jobs can be complicated. Nearly half of all university clinical academics receive funding from the NHS or non-university sources like research funders and charities. Lecturers are more likely to be funded by the NHS than professors. There are significant differences in staffing by devolved nation and specialty and short-term shifts in staffing. Most medical schools, especially the newer ones, employ less clinical academic staff and focus on something other than research. The UK’s approximately 3,000 clinical academic staff has not kept up with the student population nor reflected the substantial increase in NHS doctor numbers in the past 30 years.
Medical education funding
Students can choose from two funding streams. The Office for Students in England is the first. Although the medical student tariff is higher than that of dentistry and veterinary science in England, the exact amount will vary between devolved countries. Another stream of NHS funding is available to cover the extra costs associated with student education. This includes staff time and facilities. Although exact numbers vary between the devolved countries and England, the sum per student annually, including student tuition fees, is more than PS50,000.
The calculations that underpin the funding streams may seem difficult to justify, as many are historical. Most people assume that research at universities is subventioned and the NHS subsidizes that funding for teaching. Notable is that these amounts of money are comparable to the tuition fees for a prestigious but smaller ivy league medical school in the US.