Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Graduate Medical Education in the European Region I. J. T. Davies To cite this article: I. J. T. Davies (1979) Graduate Medical Education in the European Region, Medical Teacher, 1:3, 117-119 To link to this article: http://dx.doi.org/10.3109/01421597909023824
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 14
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [University of Florida]
Date: 14 November 2015, At: 13:53
Editorial Director: Dr Abraham Marcus Editor: Dr Katherine Hope Editorial Adviser: Dr Michael A. Simpson Managing Editor: Anne Patterson
Staff Editor: Cathy Peck Advertisement Director: Mike Fulton
Downloaded by [University of Florida] at 13:53 14 November 2015
Advertisement Manager: Sally Benson
Editorial Department: Update Publications Ltd 33/34 Alfred Place London WClE 7DP, England Tel: 01-637 4544 Subscription Departments: Update Publications Ltd 33/34 Alfred Place London WClE 7DP, England Tel: 01 -637 4544 Update Publishing International Inc. 44 Engle Street Englewood New Jersey 07631, USA Tel: (201) 5697477 Subscription Rates: Annual Subscription UK: 213.00 (post free) All other countries: US $32.00 (post free including air freight to N . America)
Contributions: Contributions are invited in the form of original papers, articles of discussion and comment on all aspects of health sciences education. Prospective contributors should write to the Managing Editor, Medical Teacher, Update Publications Ltd, 33/34 Alfred Place, London WClE 7DP, England, before submitting manuscripts . Medical Teacher is published bi-monthly.
@Update Publications Ltd, 1979 Medical Teacher Vol 1 No 3 1979
Graduate Medical Education in the European Region A commendable effort to bring together information about postgraduate medical education throughout Europe and the Soviet Union has been made by the World Health Organization. In 1974, WHO published a report on graduate medical education in the European Region (WHO 1974). In 1978 it produced its first supplementary report (WHO 1978), bringing up to date and revising the data in the original report. The supplement is based on information obtained by means of a short questionnaire distributed to countries of the European Region using English, during 1976, and to those using French and Russian, during 1977. The report is divided into three parts: the first gives basic information about undergraduate training, internship, specialist training and assessment in each country; the second part gives the training requirements for each specialty in individual countries; and the third part gives the same information, but allows convenient comparison of individual specialty training in different countries. There is a brief introduction which, unfortunately, does not indulge in any speculation or suggestions as to how the information may be useful. The compilers’ collecting zeal cannot be questioned, but the reader could have been vouchsafed some message, lessons or hopes that the compiler had permitted himself to formulate. Difficulty of Making Comparisons Comparisons of the postgraduate training requirements of different countries must be interpreted carefully when the systems of health care delivery and definition of specialties are so variable (Parry 1976). Apart from the UK, only the USSR seems to have developed a concept of primary medical care with structured training, during or following which formal examination is encouraged or mandatory. Throughout Europe the majority of doctors are in private practice (usually with differing systems of State or private insurance schemes), and patients refer themselves to a doctor of their own choice, depending on their own assessment of the specialty appropriate for their symptoms. Inevitably, this means that most specialists cannot be regarded as equivalent to National Health Service (NHS) consultants, who generally deal only with the appropriate problems beyond the competence of the referring general practitioner. Indeed, this is reflected in the length of training programmes; only in the UK is the average length of specialty training nine or ten years -nearly twice the length of time required in France, Germany or Italy. No doubt in these countries some clinical work done by specialists would be done in the UK by general practitioners. One of the benefits of the NHS system seems to be the consultant appointment system, by which candidates for consultant appoint ments have to satisfy representatives of the appropriate Royal College 117
or Faculty of their competence and experience in the discipline. The Colleges exist largely to maintain high standards of professional competence and they have an essential role in ensuring that candidates for consultant appointments in shortage specialties fulfil the same high standards required for candidates in the more competitive disciplines. In most European countries specialist standards vary within each discipline in different regions, and according to which body is governing the specialty standards. There are no equivalent bodies to the UK Royal Colleges, and specialty standards are not coordinated nationally. Furthermore, in Europe possession of a specialist qualification is not generally a condition of practice in that specialty, and unlike the UK there is no attempt to regulate the numbers being trained in each discipline with the anticipated number of future vacancies.
Downloaded by [University of Florida] at 13:53 14 November 2015
Specialist Accreditation The Treaty of Rome allows for the mutual recognition of professional qualifications. This is already in force, but so different are the systems of postgraduate training and medical practice that a UK medical graduate can be given specialist accreditation by the General Medical Council indicating specialist status, as understood in the EEC countries, after only three to four years’ postregistration training in the UK. Uniform System Unlikely There seems to be no great desire to create a more uniform system for organizing, purveying and monitoring postgraduate medical education in different countries. Indeed the systems of health care delivery and clinical organization are so different in Europe and the UK that entirely different organizations are inevitable. As the NHS is the employer of the majority of doctors in the UK there have to be strong and independent bodies to monitor professional standards; and as the NHS now accepts its responsibilities to encourage and finance the postgraduate medical education of its doctors, there must also be independent bodies to provide high standards of training and continuing postgraduate education. If this were not so, professional standards would be in danger of being subordinated to service exigencies. Although medical educators in Europe often admire our Royal Colleges, Councils for Postgraduate Medical Education, Postgraduate Centres and Clinical Tutor organization, they are unlikely to copy them. These bodies exist in their present form because the State, either directly or indirectly, employs the majority of doctors in the UK. Nevertheless, nothing but good can follow a closer understanding of the systems of postgraduate medical training and continuing education which have developed in other countries. Comparisons between each other’s ways should be welcomed. I. J. T. Davies Regional Director of Postgraduate Medical Education, Raigmore Hospital Invemess, Scotland.
118
References
Parry, K. M . , Medical education in France, Germany, Italy and the United Kingdom compared, Medical Education, 1976, 10,59-66. World Health Organization, Graduate Medical Education in the European Region, Copenhagen, 1974. World Health Organization, Graduate Medical Education in the European Region: First Supplementary Report, Copenhagen, 1978.
Shotgun Marriages: Todd in Retrospect Over 10 years have passed now since the publication of the Todd Report (Royal Commission on Medical Education 1968), and it is worth examining the Report in the light of subsequent developments. It has been said that most Royal Commissions are devices for postponing a major issue until after the next election, and Todd certainly fulfilled that function most successfully. For a long time, little was changed as we awaited the Report; and then we had to wait until everyone had read it, thought about it and consulted everyone else, before embarking on action. Although it largely ignored the existence of relevant research and other sources of data, many of its recommendations were broadly in line with the best of current thought on the subject. Combined with the more permissive and imaginative approach the General Medical Council was developing, British medical education surely benefited on the whole. Twinning Preclinical Schools But there was one extraordinarily silly set of proposals in the Todd Report, which has wasted enormous amounts of time and not negligible amounts of money in the last decade. It was proposed that the London medical schools should pair, or otherwise group themselves, sharing a common preclinical school, and in close relation to other science faculties of the University. There have never been any good reasons for supporting these bizarre proposals; they have never made any sort of educational sense. In fact, the results of such action, had anyone been foolish enough to follow the advice, would have directly contradicted many of the other suggestions of the Royal Commission. A preclinical course isolated from the clinical school both geographically and psychologically, and linked to powerful general sciepce faculties, could never provide proper training for future doctors; it could not fail to exaggerate the existing problems of relevance, factual overload and lack of curricular co-ordination. Integration of preclinical and clinical training, as repeatedly stressed elsewhere in the Commission’s Report (and by every other authority on the subject) would have been made impossible by the implementation of these Medical Teacher Vol 1 No 3 1979
Downloaded by [University of Florida] at 13:53 14 November 2015
shotgun marriages (welcomed by neither of the very reluctant spouses). Over the intervening years, most of the schools have managed to avoid acting on the advice of this gross and inept educational computer dating error. In most cases the scheme is now well and truly dead and buried. It is curious how quickly, completely and quietly most twinning schemes were abandoned. Only with regard to the London Hospital and St Bartholomew’s has some degree of formal collaboration appeared to be even partially successful. The development of the medical schools of the Royal Free and University College Hospitals has been retarded by repeated attempts to force them into an unnatural and unworkable combination with a joint preclinical school that would be unable properly to meet the needs of either school. The changes in medical education, the University and the NHS have been ignored by the few who still seek to force what one Dean has called “this albatross of the Todd proposals” on the schools. It is devoutly to be hoped that everyone concerned will accept what most people already see clearly: the twinning of the London medical schools was a foolish idea, ill-conceived, ill-thought out and increasingly unworkable. Rationalization of Medical Education That said, some rationalization of medical education in the capital is certain to follow from the deliberations of the working party established by Lord Annan, the ViceChancellor of the University of London, to examine the current situation. The reason for the enquiry is the serious financial position in which the London medical schools find themselves. The DHSS indirectly funds the London schools, in that much of the teaching is done by NHS staff. With the reallocation of money for medical services to other parts of the country, it is this contribution which is progressively being cut and which the University is unable to make good. Among the steps the working party may consider is whether to phase out one or more of the schools. The working party is seeking evidence in writing from interested parties, and is expected to report after March of next year.
Oxford Medical Publications An Introduction to Human Biochemistry C. A. Pasternak This book presents in one volume the biochemistry and cell biology necessary for an understanding of the molecular basis of medicine. In so far as human biochemistry is studied in order to relate it t o human disease, the book explains in molecular terms the basis of that relationship, thus providing a useful introduction to the subject for all preclinical medical students, nurses, and biology students taking courses in biochemistry. Illustrated paper covers
f4.95
Community Care for the Mentally Disabled Edited by J. K. Wing and
R. Olsen
Since the war, there has been a gradual recognition that segregating the mentally disabled in institutions is not an adequate solution for the sufferers or their families. However, if the trend towards community care is to continue, it must be undertaken in the presence of adequate services. This book on the subject will be of particular interest to psychiatric nurses, psychiatrists, and social workers. f10 paper covers f4.50
An Introduction to the Psychotherapies Edited by Sidney Bloch This introductory textbook has been written for trainees in the mental health profession: psychiatrists, psychiatric nurses, clinical psychologists, and social workers. It describes eight types of psychotherapy, including behaviour therapy, group psychotherapy, crisis intervention, marital, family, and sex therapy, at a level which will give a firm basis for future study and practice. f8.50 paper covers
f3.95 Reference
Royal Commission on Medical Educalion 1965-68 Report, HMSO. London. 1968.
The Mechanics of the Circulation C. G. Caro, T. J. Pedley, and W. A. Seed
R. C. Schroter,
This book, first published in 1978,sets out t o explain in physical terms many aspects of circulatory function, both normal and abnormal. ‘A well-compiled production; the diagrams and photographs are superb and easy to follow.. . It will be useful to undergraduates in physiology.. .’ British Medical Journal. Illustrated paper covers fl 1
Oxford University Press Medical Teacher Vol 1 No 3 1979
119
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Graduate Medical Education in the European Region I. J. T. Davies To cite this article: I. J. T. Davies (1979) Graduate Medical Education in the European Region, Medical Teacher, 1:3, 117-119 To link to this article: http://dx.doi.org/10.3109/01421597909023824
Published online: 03 Jul 2009.
Submit your article to this journal
Article views: 14
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [University of Florida]
Date: 14 November 2015, At: 13:53
Editorial Director: Dr Abraham Marcus Editor: Dr Katherine Hope Editorial Adviser: Dr Michael A. Simpson Managing Editor: Anne Patterson
Staff Editor: Cathy Peck Advertisement Director: Mike Fulton
Downloaded by [University of Florida] at 13:53 14 November 2015
Advertisement Manager: Sally Benson
Editorial Department: Update Publications Ltd 33/34 Alfred Place London WClE 7DP, England Tel: 01-637 4544 Subscription Departments: Update Publications Ltd 33/34 Alfred Place London WClE 7DP, England Tel: 01 -637 4544 Update Publishing International Inc. 44 Engle Street Englewood New Jersey 07631, USA Tel: (201) 5697477 Subscription Rates: Annual Subscription UK: 213.00 (post free) All other countries: US $32.00 (post free including air freight to N . America)
Contributions: Contributions are invited in the form of original papers, articles of discussion and comment on all aspects of health sciences education. Prospective contributors should write to the Managing Editor, Medical Teacher, Update Publications Ltd, 33/34 Alfred Place, London WClE 7DP, England, before submitting manuscripts . Medical Teacher is published bi-monthly.
@Update Publications Ltd, 1979 Medical Teacher Vol 1 No 3 1979
Graduate Medical Education in the European Region A commendable effort to bring together information about postgraduate medical education throughout Europe and the Soviet Union has been made by the World Health Organization. In 1974, WHO published a report on graduate medical education in the European Region (WHO 1974). In 1978 it produced its first supplementary report (WHO 1978), bringing up to date and revising the data in the original report. The supplement is based on information obtained by means of a short questionnaire distributed to countries of the European Region using English, during 1976, and to those using French and Russian, during 1977. The report is divided into three parts: the first gives basic information about undergraduate training, internship, specialist training and assessment in each country; the second part gives the training requirements for each specialty in individual countries; and the third part gives the same information, but allows convenient comparison of individual specialty training in different countries. There is a brief introduction which, unfortunately, does not indulge in any speculation or suggestions as to how the information may be useful. The compilers’ collecting zeal cannot be questioned, but the reader could have been vouchsafed some message, lessons or hopes that the compiler had permitted himself to formulate. Difficulty of Making Comparisons Comparisons of the postgraduate training requirements of different countries must be interpreted carefully when the systems of health care delivery and definition of specialties are so variable (Parry 1976). Apart from the UK, only the USSR seems to have developed a concept of primary medical care with structured training, during or following which formal examination is encouraged or mandatory. Throughout Europe the majority of doctors are in private practice (usually with differing systems of State or private insurance schemes), and patients refer themselves to a doctor of their own choice, depending on their own assessment of the specialty appropriate for their symptoms. Inevitably, this means that most specialists cannot be regarded as equivalent to National Health Service (NHS) consultants, who generally deal only with the appropriate problems beyond the competence of the referring general practitioner. Indeed, this is reflected in the length of training programmes; only in the UK is the average length of specialty training nine or ten years -nearly twice the length of time required in France, Germany or Italy. No doubt in these countries some clinical work done by specialists would be done in the UK by general practitioners. One of the benefits of the NHS system seems to be the consultant appointment system, by which candidates for consultant appoint ments have to satisfy representatives of the appropriate Royal College 117
or Faculty of their competence and experience in the discipline. The Colleges exist largely to maintain high standards of professional competence and they have an essential role in ensuring that candidates for consultant appointments in shortage specialties fulfil the same high standards required for candidates in the more competitive disciplines. In most European countries specialist standards vary within each discipline in different regions, and according to which body is governing the specialty standards. There are no equivalent bodies to the UK Royal Colleges, and specialty standards are not coordinated nationally. Furthermore, in Europe possession of a specialist qualification is not generally a condition of practice in that specialty, and unlike the UK there is no attempt to regulate the numbers being trained in each discipline with the anticipated number of future vacancies.
Downloaded by [University of Florida] at 13:53 14 November 2015
Specialist Accreditation The Treaty of Rome allows for the mutual recognition of professional qualifications. This is already in force, but so different are the systems of postgraduate training and medical practice that a UK medical graduate can be given specialist accreditation by the General Medical Council indicating specialist status, as understood in the EEC countries, after only three to four years’ postregistration training in the UK. Uniform System Unlikely There seems to be no great desire to create a more uniform system for organizing, purveying and monitoring postgraduate medical education in different countries. Indeed the systems of health care delivery and clinical organization are so different in Europe and the UK that entirely different organizations are inevitable. As the NHS is the employer of the majority of doctors in the UK there have to be strong and independent bodies to monitor professional standards; and as the NHS now accepts its responsibilities to encourage and finance the postgraduate medical education of its doctors, there must also be independent bodies to provide high standards of training and continuing postgraduate education. If this were not so, professional standards would be in danger of being subordinated to service exigencies. Although medical educators in Europe often admire our Royal Colleges, Councils for Postgraduate Medical Education, Postgraduate Centres and Clinical Tutor organization, they are unlikely to copy them. These bodies exist in their present form because the State, either directly or indirectly, employs the majority of doctors in the UK. Nevertheless, nothing but good can follow a closer understanding of the systems of postgraduate medical training and continuing education which have developed in other countries. Comparisons between each other’s ways should be welcomed. I. J. T. Davies Regional Director of Postgraduate Medical Education, Raigmore Hospital Invemess, Scotland.
118
References
Parry, K. M . , Medical education in France, Germany, Italy and the United Kingdom compared, Medical Education, 1976, 10,59-66. World Health Organization, Graduate Medical Education in the European Region, Copenhagen, 1974. World Health Organization, Graduate Medical Education in the European Region: First Supplementary Report, Copenhagen, 1978.
Shotgun Marriages: Todd in Retrospect Over 10 years have passed now since the publication of the Todd Report (Royal Commission on Medical Education 1968), and it is worth examining the Report in the light of subsequent developments. It has been said that most Royal Commissions are devices for postponing a major issue until after the next election, and Todd certainly fulfilled that function most successfully. For a long time, little was changed as we awaited the Report; and then we had to wait until everyone had read it, thought about it and consulted everyone else, before embarking on action. Although it largely ignored the existence of relevant research and other sources of data, many of its recommendations were broadly in line with the best of current thought on the subject. Combined with the more permissive and imaginative approach the General Medical Council was developing, British medical education surely benefited on the whole. Twinning Preclinical Schools But there was one extraordinarily silly set of proposals in the Todd Report, which has wasted enormous amounts of time and not negligible amounts of money in the last decade. It was proposed that the London medical schools should pair, or otherwise group themselves, sharing a common preclinical school, and in close relation to other science faculties of the University. There have never been any good reasons for supporting these bizarre proposals; they have never made any sort of educational sense. In fact, the results of such action, had anyone been foolish enough to follow the advice, would have directly contradicted many of the other suggestions of the Royal Commission. A preclinical course isolated from the clinical school both geographically and psychologically, and linked to powerful general sciepce faculties, could never provide proper training for future doctors; it could not fail to exaggerate the existing problems of relevance, factual overload and lack of curricular co-ordination. Integration of preclinical and clinical training, as repeatedly stressed elsewhere in the Commission’s Report (and by every other authority on the subject) would have been made impossible by the implementation of these Medical Teacher Vol 1 No 3 1979
Downloaded by [University of Florida] at 13:53 14 November 2015
shotgun marriages (welcomed by neither of the very reluctant spouses). Over the intervening years, most of the schools have managed to avoid acting on the advice of this gross and inept educational computer dating error. In most cases the scheme is now well and truly dead and buried. It is curious how quickly, completely and quietly most twinning schemes were abandoned. Only with regard to the London Hospital and St Bartholomew’s has some degree of formal collaboration appeared to be even partially successful. The development of the medical schools of the Royal Free and University College Hospitals has been retarded by repeated attempts to force them into an unnatural and unworkable combination with a joint preclinical school that would be unable properly to meet the needs of either school. The changes in medical education, the University and the NHS have been ignored by the few who still seek to force what one Dean has called “this albatross of the Todd proposals” on the schools. It is devoutly to be hoped that everyone concerned will accept what most people already see clearly: the twinning of the London medical schools was a foolish idea, ill-conceived, ill-thought out and increasingly unworkable. Rationalization of Medical Education That said, some rationalization of medical education in the capital is certain to follow from the deliberations of the working party established by Lord Annan, the ViceChancellor of the University of London, to examine the current situation. The reason for the enquiry is the serious financial position in which the London medical schools find themselves. The DHSS indirectly funds the London schools, in that much of the teaching is done by NHS staff. With the reallocation of money for medical services to other parts of the country, it is this contribution which is progressively being cut and which the University is unable to make good. Among the steps the working party may consider is whether to phase out one or more of the schools. The working party is seeking evidence in writing from interested parties, and is expected to report after March of next year.
Oxford Medical Publications An Introduction to Human Biochemistry C. A. Pasternak This book presents in one volume the biochemistry and cell biology necessary for an understanding of the molecular basis of medicine. In so far as human biochemistry is studied in order to relate it t o human disease, the book explains in molecular terms the basis of that relationship, thus providing a useful introduction to the subject for all preclinical medical students, nurses, and biology students taking courses in biochemistry. Illustrated paper covers
f4.95
Community Care for the Mentally Disabled Edited by J. K. Wing and
R. Olsen
Since the war, there has been a gradual recognition that segregating the mentally disabled in institutions is not an adequate solution for the sufferers or their families. However, if the trend towards community care is to continue, it must be undertaken in the presence of adequate services. This book on the subject will be of particular interest to psychiatric nurses, psychiatrists, and social workers. f10 paper covers f4.50
An Introduction to the Psychotherapies Edited by Sidney Bloch This introductory textbook has been written for trainees in the mental health profession: psychiatrists, psychiatric nurses, clinical psychologists, and social workers. It describes eight types of psychotherapy, including behaviour therapy, group psychotherapy, crisis intervention, marital, family, and sex therapy, at a level which will give a firm basis for future study and practice. f8.50 paper covers
f3.95 Reference
Royal Commission on Medical Educalion 1965-68 Report, HMSO. London. 1968.
The Mechanics of the Circulation C. G. Caro, T. J. Pedley, and W. A. Seed
R. C. Schroter,
This book, first published in 1978,sets out t o explain in physical terms many aspects of circulatory function, both normal and abnormal. ‘A well-compiled production; the diagrams and photographs are superb and easy to follow.. . It will be useful to undergraduates in physiology.. .’ British Medical Journal. Illustrated paper covers fl 1
Oxford University Press Medical Teacher Vol 1 No 3 1979
119
