National examination would benefit medics

“Are universities losing control of what they teach to medical students?” asks John Cookson (“Sleepwalking into a crisis”, Opinion, 7 May). It is a legitimate question. However, his analysis omits some important considerations.

First, he says that “the General Medical Council has…decided to introduce a national examination for those seeking to practise as doctors”. This is not correct. The council of the GMC decided to consider the feasibility of a UK licensing exam, but the decision on whether or not to enact it has yet to be made.

Second, no decision has been made about the format or timing of a UK licensing exam. It could be at the end of medical school, but it could also be a year later, corresponding to the end of the first year of the foundation programme. Indeed, theoretically, a licensing exam or assessment could be taken at different stages. So it should not be assumed that university degree finals will disappear, nor should it be assumed that university teaching would be focused on a UK examination.

Third, Cookson claims a distinction between “scholarship” and “training”, alleging that the former resides only in universities and the latter teaches postgraduates how to follow a protocol rather than when to deviate from a guideline. In reality, doctors have to make differential diagnoses in unselected patients. Thus, they must be accepting of ambiguity and comfortable with complexity, skills that they begin to appreciate as undergraduates but do not really start to acquire proficiency in until the transitions to foundation doctor, registrar and consultant.

Within medical schools, there is a recognition of the value of a UK examination. In an increasingly mobile world, the setting of a clear and respected standard for entry to British medicine could have huge advantages for medical education and practice in this country, and its reputation internationally.

The development of a UK assessment will enable universities to produce doctors who are heterogeneous, adaptable and flexible. They can be educated in different ways, bringing in school-leavers and graduates; they will use practice-based learning and more traditional approaches; some will have more emphasis on care in the community, others will devote more time to “high-tech” interventions. But I think that the public would like to be reassured that, in terms of core knowledge, skills and competencies, all doctors meet the same standards.

Terence Stephenson
Chair
General Medical Council