Medics fear narrow clinical assessment

MEDICAL academics are concerned that hospital- and community-based clinical teaching will not be fully assessed in the subject reviews due to start in England next autumn.

A meeting of the Association for the Study of Medical Education heard fears that plans for assessing clinical teaching, a key part of medical degrees, may be insufficient. Subject reviews have replaced teaching quality assessments.

Sam Leinster, director of medical studies at Liverpool University, said: "The Quality Assurance Agency is proposing to visit three sites where clinical teaching takes place. But our clinical medical students are dispersed over ten hospitals, where they are taught by 50 clinicians at each, as well as in numerous clinics and GP practices.

"Visiting hospitals and clinics just three times will not provide a very good sample. The basic medical education is being delivered. It seems perverse not to look at such a large chunk of the curriculum."

Professor Leinster added that the recent medicine TQA in Wales had involved assessors visiting a much larger proportion of clinical sites in the weeks leading up to the medical school assessment. "We want to see a change in England before it starts," he said.

Medics were also concerned that the assessors would not properly appreciate the changing face of medical education, where students were no longer taught in discrete subject modules, but instead as part of an integrated programme over five years. "The agency's assessment mechanisms are not designed to deal with this," he said. "They are used to visiting discrete subjects."

A spokeswoman for the QAA said it recognised the scale and importance of clinical teaching that would be reviewed by academic and professional peers. The assessors would be asked to evaluate the quality of education in relation to the curriculum, including the emphasis on integration.

"Each medical school will be asked to agree a programme of clinical observations," she said. "Each team will comprise between eight and ten reviewers who are professionally qualified and able to review clinical teaching."

* The General Medical Council and the QAA may combine some of their visits to medical schools over the next three years in order to streamline demands on institutions. Both the GMC and the QAA have responsibility for monitoring the quality of medical degrees. They are suggesting working in partnership, sharing some documentation and coinciding their visits so as to reduce the burden on medical schools.