Journal of Public Health Advance Access published June 4, 2015 Journal of Public Health | pp. 1–4 | doi:10.1093/pubmed/fdv069
Public health education in UK medical schools—towards consensus Stephen Gillam1, Veena Rodrigues2, Puja Myles3 1
Public Health and Primary Care, Institute of Public Health, Cambridge, UK Norwich Medical School, University of East Anglia, Norwich, UK Epidemiology and Public Health, University of Nottingham, Nottingham, UK Address correspondence to Stephen Gillam, E-mail: [email protected] 2 3
With the support of the Faculty of Public Health, public health educators from medical schools have produced a consensus statement on ‘core’ content of learning in public health that a graduate should achieve in any UK medical school, irrespective of curriculum design. The document updates previous statements on public health education in medical schools. It compares key learning outcomes/curricular content in different medical schools (the ‘what’); considers the processes and resources required for effective delivery of teaching programmes (the ‘how’); and considers examples of ‘best practice’. It provides a basis for the furtherance of educational development in medical schools.
Why it matters The role of a clinical doctor effectively spans all three domains of public health: health improvement, health protection and healthcare public health. An understanding of the natural history of diseases underpins prevention and health promotion with individual patients. Knowledge and application of the principles of communicable disease control and the role of environmental factors in health and disease are crucial in protecting the populations’ health. An awareness of the delivery of health care in different settings and understanding of the wider determinants of health can enable doctors to work in partnership with local agencies in the community to advocate for interventions that will help reduce health inequalities. Doctors with a clear understanding of their role within the health and social care systems can significantly influence the planning and organization of services. They can ensure that the development and delivery of health care will benefit patients and can promote the fair allocation of resources. Doctors can practise medicine more effectively by applying critical appraisal skills to their decision-making.1 In other words, learning about the sciences and disciplines underpinning public health should bring significant benefits both to the practice of clinical medicine and to the health of
the population. Medical postgraduates have a leadership role in promoting and protecting the health of the population and preventing ill-health. Royal Colleges suggest that doctors should work collaboratively across all sectors to develop systems to reduce health inequalities.2,3
Struggling to deliver The General Medical Council’s Tomorrow’s Doctors sets out the standards for knowledge, skills and behaviours that medical students should acquire. It strongly underlines the importance of public health.4 However, the interpretation and implementation of public health-related learning outcomes are highly variable. Many medical schools have difficulty finding teachers and staffing levels have deteriorated.5 The UK Public Health Educators in Medical Schools (PHEMS) is a voluntary network of UK-based public health educators involved in undergraduate medical teaching that offers a peer support network and forum for sharing good practice in public health education. The PHEMS network has been meeting annually for this purpose since 2004. In 2012, PHEMS was approached by the Faculty of Public Health (FPH), the standard setting body for specialists in public health in the UK, to develop a consensus statement on the undergraduate public health curriculum for UK medical schools.
Consultation process Initial consultation discussions involved 30 participants representing 18 medical schools and the FPH. Participants included public health academics, one clinical academic from another medical specialty and two public health specialty
Stephen Gillam, Public Health Teaching Lead, General Practitioner Veena Rodrigues, Head, Department of Medical Education Puja Myles, Associate Professor, Health Protection & Epidemiology
# The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected].
1
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
Introduction
2
J O U R NA L O F P U B L IC H E A LT H
registrars. A report summarizing the workshop output was circulated to all PHEMS members and a core group of FPH representatives. The resulting material informed an initial draft guidance document which went through three further e-mail consultation rounds and included wider stakeholders including clinical academics from other specialties and the
Medical Schools Council, before final review and approval by the FPH Board. Responses to further e-mail consultations were from Public Health academics and FPH members. Despite our best efforts, the consultation might not adequately reflect the perspectives of stakeholders who did not contribute to the consultations.
Box 1 Overview of the consensus statement Brief description
Introduction
Rationale underpinning the consensus statement and aim.
Developing the curriculum
Overview of the links between the consensus statement and undergraduate
A core curriculum for public health
Mapping of TD09 learning outcomes to core curricular aims in public health and Faculty of
medical training, foundation medical training and public health specialty training in the UK. Public Health domains; lists relevant GMC TD09 learning outcomes and includes suggestions on how these can be implemented in practice (indicative content). Learning and assessment
Suggestions on teaching, experiential learning and assessment methods for public
Who is a public health educator?
Delivery of public health education and the role of educators from various disciplines
health within the undergraduate medical curriculum. in contributing to a holistic and comprehensive curriculum.
Box 2 Organization of the core public health curricular aims within the undergraduate medical degree around Faculty of Public Health Domains Faculty of Public Health Domain
Core undergraduate public health curriculum aim
Public health knowledge 1. Health protection Specialty Training key area 6 2. Health Improvement Specialty Training key areas 3 and 5 3. Organization of health services
To protect the health of individual patients and populations against communicable disease and environmental hazards (a clinical and legal responsibility). To instil key principles of population health and prevention in managing and preventing clinical conditions. To understand the framework within which health care is delivered in the UK.
Specialty Training key areas 3 & 4 4. Improving the quality of health services Specialty Training key area 7
To improve the clinical effectiveness and quality of health services by applying the principles and methods of evaluation, audit, research and development, and standard setting.
Public health skills 5. Epidemiology—Practising evidence-based medicine Specialty Training key areas 2 & 9
To recognize epidemiology as the basic science underpinning public health and clinical medicine; to provide evidence to guide public health policy and clinical practice to protect, restore and promote health of individuals and populations; to think critically, challenge the status quo, evaluate and apply evidence, synthesize evidence of different types.
6. Using health information
To use, analyse and interpret health information to improve clinical practice.
Specialty Training key areas 1 & 8 Attitudes and values 7. Adopting public health attitudes and values Specialty Training key area 4 & Ethical management of self
To adopt a ‘population perspective’ in everyday clinical practice.
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
Section title
P U B L I C H E A LTH ED U CATI O N I N U K M ED I CA L S CH O O L S
3
Box 3 Excerpt from consensus statement illustrating mapping of the GMC Tomorrow’s Doctors 2009 learning outcomes to core curriculum aims and Faculty of Public Health Domains as well as suggestions for indicative content Faculty of
Core curriculum aim
GMC ‘Tomorrow’s Doctors’ 2009 learning
Public Health
outcomes *(Key: Doctor as scholar and
Domain
scientist; Doctor as practitioner; Doctor as
Indicative content
professional) Public health knowledge (11.e) Explain and apply the basic principles
1. What are the principles of infection
and populations against communicable
of communicable disease control in
prevention and control? (11e, 23h)
Specialty
disease and environmental hazards
hospital and community settings.
2. What are the best ways to prevent the
Training key
(a clinical and legal responsibility)
(11.g) Recognize the role of environmental
spread of communicable diseases? (11e, 23h)
and occupational hazards in ill-health and
3. What is individual risk? How can risks be
discuss ways to mitigate their effects.
prevented, ameliorated, controlled and
(23.h) Understand the importance of, and
communicated? (11e, 11g)
the need to keep to, measures to prevent
4. What are the causes and consequences of
the spread of infection, and apply the
accidents? How can they be prevented? (11g)
principles of infection prevention and
5. What should you do when you have a
control.
patient with a notifiable disease? (11e, 23h)
1. Health
area 6
6. What should you do in an outbreak situation? (11e, 23h) 7. How will you address environmental health concerns expressed by local communities or individual patients? (11g) 8. What is the relationship between occupation and various health risks (e.g. occupational cancers, respiratory diseases, musculoskeletal disorders and stress/ depression/addiction)? (11 g) 9. What is the association between environmental exposures and health inequalities? (11 g)
We adopted a pragmatic approach to consensus by defining consensus as ‘a position one could live with even if it was not one’s preferred position’ rather than a position of unreserved unanimity. Nevertheless, we attempted to explore and resolve any differences that emerged via discussion and compromise. On most aspects of the guidance such as core curriculum goals, approaches to learning and assessment, there was a clear consensus from the start. Any differences mainly related to the translation of the curriculum goals into indicative content but were resolved following discussion. There is no single best curriculum design, but each medical school should be able to show a coherent approach to learning and assessment.
Content Box 1 provides an overview of the consensus statement that was launched in May 2014 and is available online via the FPH
website.6 Its primary aim is to support public health educators in interpreting the GMC’s Tomorrow’s Doctors 2009 (TD09) guidance. The consensus statement outlines core content of undergraduate public health curriculum in UK medical schools mapped against the Faculty of Public Health domains (see Box 2) and provides guidance on curriculum design by listing nationally agreed ‘public health-related’ learning outcomes that could be used as a standard reference framework for future GMC audits. In addition to indicative public health topics (see Box 3 for example), it provides pedagogical suggestions for educators. Some concepts relating to public health practice are best taught via experiential learning through scenario-based teaching (table-top pandemic influenza outbreak exercises or prioritization roleplays). Community placements offer a valuable learning experience even though they can be difficult to arrange because of the range of organizations involved in the planning, commissioning and delivery of community interventions in public health, lack of
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
To protect the health of individual patients
protection
4
J O U R NA L O F P U B L IC H E A LT H
Canada. This heightens the need for an agreed syllabus for undergraduate medical education.9 The development of the consensus statement has been a collaborative exercise: sharing knowledge to define curricular goals for public health underpinned by appropriate pedagogical principles. Differences in organization and capacity across medical schools are acknowledged, but this consensus statement should help strengthen the teaching of public health and related disciplines.
Moving forward
Acknowledgements
One aim of the consensus statement is to support educators in developing an effective learning environment for public health. There is no equivalent to the clinical rotation in public health, and it can be difficult to gain experience of this specialty as an undergraduate. Barriers to clinical rotations include the difficulty of integrating a public health rotation within course structures, the move of public health departments to local authorities (where there is no precedent for medical student attachments) and a reduction in training capacity within public health service settings in general following the last NHS reforms. Additional pressures caused by already full curricula, current student perceptions of the subject, variable presence in summative assessments, the challenges of teaching and assessing behaviour change, and generic pedagogical issues can make public health seem abstract to students and irrelevant to clinical practice. Medical students in many countries graduate without feeling energized by their social purpose. They articulate a desire to help address health inequalities.7 There is a growing recognition of the need for medical schools to demonstrate social accountability with some schools doing this through community-based learning opportunities, student selected study and electives.8 The consensus statement suggests ways in which public health teaching can form an underpinning theme across all clinical training to address these issues. The GMC recently announced the likely development of a national licensing examination for UK medical graduates in line with current practice in other countries like USA and
Premila Webster, Lyndsay Davies, Russell Ampofo and colleagues from the PHEMS network.
References 1 Gillam S, Maudsley G. Public health education for medical students: rising to the professional challenge. J Public Health 2010;32:125– 31. 2 Royal College of Physicians. How Doctors Can Close the Gap: Tackling the Social Determinants of Health Through Culture Change, Advocacy and Education. London: Royal College of Physicians, 2010. 3 Royal College of General Practitioners. A Core Curriculum for Learning About Health Inequalities in UK Undergraduate Medicine. London: Royal College of General Practitioners, 2013. 4 General Medical Council. Tomorrow’s Doctors. Outcomes and standards for undergraduate medical education. London: General Medical Council, 2009. 5 Gillam S, Bagade A. Undergraduate public health education in UK medical schools – struggling to deliver. Med Educ 2006;40:430 – 6. 6 Myles P, Barna S, Maudsley G et al. Undergraduate Public Health Curriculum for UK Medical Schools: Consensus Statement 2014. 2014. http://www.fph.org.uk/uploads/PHEMS%20booklet.pdf (26 September 2014, date last accessed). 7 Misˇe J. Impatience of health professions students for health equity – can a new definition help? J Public Health Policy 2014;35:411 – 3. 8 McCrea ML, Murdoch-Eaton D. How do undergraduate medical students perceive social accountability? Med Teach 2014;36(10):867– 75. 9 General Medical Council. GMC Gives Green Light to ‘Passport to Practise’; Press Release 26th September 2014. http://www.gmc-uk. org/news/25493.asp (8 October 2014, date last accessed).
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
capacity to supervise students within such settings or timetabling constraints presented by the existing medical course structure. The consensus statement includes guidance on appropriate forms of assessment for different learning outcomes. Ongoing work by the PHEMS network following the launch of this statement includes developing a shared assessment bank including short answer questions, multiple choice answer questions, single best answer questions and objective structured clinical examination scenarios.
Public health education in UK medical schools—towards consensus Stephen Gillam1, Veena Rodrigues2, Puja Myles3 1
Public Health and Primary Care, Institute of Public Health, Cambridge, UK Norwich Medical School, University of East Anglia, Norwich, UK Epidemiology and Public Health, University of Nottingham, Nottingham, UK Address correspondence to Stephen Gillam, E-mail: [email protected] 2 3
With the support of the Faculty of Public Health, public health educators from medical schools have produced a consensus statement on ‘core’ content of learning in public health that a graduate should achieve in any UK medical school, irrespective of curriculum design. The document updates previous statements on public health education in medical schools. It compares key learning outcomes/curricular content in different medical schools (the ‘what’); considers the processes and resources required for effective delivery of teaching programmes (the ‘how’); and considers examples of ‘best practice’. It provides a basis for the furtherance of educational development in medical schools.
Why it matters The role of a clinical doctor effectively spans all three domains of public health: health improvement, health protection and healthcare public health. An understanding of the natural history of diseases underpins prevention and health promotion with individual patients. Knowledge and application of the principles of communicable disease control and the role of environmental factors in health and disease are crucial in protecting the populations’ health. An awareness of the delivery of health care in different settings and understanding of the wider determinants of health can enable doctors to work in partnership with local agencies in the community to advocate for interventions that will help reduce health inequalities. Doctors with a clear understanding of their role within the health and social care systems can significantly influence the planning and organization of services. They can ensure that the development and delivery of health care will benefit patients and can promote the fair allocation of resources. Doctors can practise medicine more effectively by applying critical appraisal skills to their decision-making.1 In other words, learning about the sciences and disciplines underpinning public health should bring significant benefits both to the practice of clinical medicine and to the health of
the population. Medical postgraduates have a leadership role in promoting and protecting the health of the population and preventing ill-health. Royal Colleges suggest that doctors should work collaboratively across all sectors to develop systems to reduce health inequalities.2,3
Struggling to deliver The General Medical Council’s Tomorrow’s Doctors sets out the standards for knowledge, skills and behaviours that medical students should acquire. It strongly underlines the importance of public health.4 However, the interpretation and implementation of public health-related learning outcomes are highly variable. Many medical schools have difficulty finding teachers and staffing levels have deteriorated.5 The UK Public Health Educators in Medical Schools (PHEMS) is a voluntary network of UK-based public health educators involved in undergraduate medical teaching that offers a peer support network and forum for sharing good practice in public health education. The PHEMS network has been meeting annually for this purpose since 2004. In 2012, PHEMS was approached by the Faculty of Public Health (FPH), the standard setting body for specialists in public health in the UK, to develop a consensus statement on the undergraduate public health curriculum for UK medical schools.
Consultation process Initial consultation discussions involved 30 participants representing 18 medical schools and the FPH. Participants included public health academics, one clinical academic from another medical specialty and two public health specialty
Stephen Gillam, Public Health Teaching Lead, General Practitioner Veena Rodrigues, Head, Department of Medical Education Puja Myles, Associate Professor, Health Protection & Epidemiology
# The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected].
1
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
Introduction
2
J O U R NA L O F P U B L IC H E A LT H
registrars. A report summarizing the workshop output was circulated to all PHEMS members and a core group of FPH representatives. The resulting material informed an initial draft guidance document which went through three further e-mail consultation rounds and included wider stakeholders including clinical academics from other specialties and the
Medical Schools Council, before final review and approval by the FPH Board. Responses to further e-mail consultations were from Public Health academics and FPH members. Despite our best efforts, the consultation might not adequately reflect the perspectives of stakeholders who did not contribute to the consultations.
Box 1 Overview of the consensus statement Brief description
Introduction
Rationale underpinning the consensus statement and aim.
Developing the curriculum
Overview of the links between the consensus statement and undergraduate
A core curriculum for public health
Mapping of TD09 learning outcomes to core curricular aims in public health and Faculty of
medical training, foundation medical training and public health specialty training in the UK. Public Health domains; lists relevant GMC TD09 learning outcomes and includes suggestions on how these can be implemented in practice (indicative content). Learning and assessment
Suggestions on teaching, experiential learning and assessment methods for public
Who is a public health educator?
Delivery of public health education and the role of educators from various disciplines
health within the undergraduate medical curriculum. in contributing to a holistic and comprehensive curriculum.
Box 2 Organization of the core public health curricular aims within the undergraduate medical degree around Faculty of Public Health Domains Faculty of Public Health Domain
Core undergraduate public health curriculum aim
Public health knowledge 1. Health protection Specialty Training key area 6 2. Health Improvement Specialty Training key areas 3 and 5 3. Organization of health services
To protect the health of individual patients and populations against communicable disease and environmental hazards (a clinical and legal responsibility). To instil key principles of population health and prevention in managing and preventing clinical conditions. To understand the framework within which health care is delivered in the UK.
Specialty Training key areas 3 & 4 4. Improving the quality of health services Specialty Training key area 7
To improve the clinical effectiveness and quality of health services by applying the principles and methods of evaluation, audit, research and development, and standard setting.
Public health skills 5. Epidemiology—Practising evidence-based medicine Specialty Training key areas 2 & 9
To recognize epidemiology as the basic science underpinning public health and clinical medicine; to provide evidence to guide public health policy and clinical practice to protect, restore and promote health of individuals and populations; to think critically, challenge the status quo, evaluate and apply evidence, synthesize evidence of different types.
6. Using health information
To use, analyse and interpret health information to improve clinical practice.
Specialty Training key areas 1 & 8 Attitudes and values 7. Adopting public health attitudes and values Specialty Training key area 4 & Ethical management of self
To adopt a ‘population perspective’ in everyday clinical practice.
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
Section title
P U B L I C H E A LTH ED U CATI O N I N U K M ED I CA L S CH O O L S
3
Box 3 Excerpt from consensus statement illustrating mapping of the GMC Tomorrow’s Doctors 2009 learning outcomes to core curriculum aims and Faculty of Public Health Domains as well as suggestions for indicative content Faculty of
Core curriculum aim
GMC ‘Tomorrow’s Doctors’ 2009 learning
Public Health
outcomes *(Key: Doctor as scholar and
Domain
scientist; Doctor as practitioner; Doctor as
Indicative content
professional) Public health knowledge (11.e) Explain and apply the basic principles
1. What are the principles of infection
and populations against communicable
of communicable disease control in
prevention and control? (11e, 23h)
Specialty
disease and environmental hazards
hospital and community settings.
2. What are the best ways to prevent the
Training key
(a clinical and legal responsibility)
(11.g) Recognize the role of environmental
spread of communicable diseases? (11e, 23h)
and occupational hazards in ill-health and
3. What is individual risk? How can risks be
discuss ways to mitigate their effects.
prevented, ameliorated, controlled and
(23.h) Understand the importance of, and
communicated? (11e, 11g)
the need to keep to, measures to prevent
4. What are the causes and consequences of
the spread of infection, and apply the
accidents? How can they be prevented? (11g)
principles of infection prevention and
5. What should you do when you have a
control.
patient with a notifiable disease? (11e, 23h)
1. Health
area 6
6. What should you do in an outbreak situation? (11e, 23h) 7. How will you address environmental health concerns expressed by local communities or individual patients? (11g) 8. What is the relationship between occupation and various health risks (e.g. occupational cancers, respiratory diseases, musculoskeletal disorders and stress/ depression/addiction)? (11 g) 9. What is the association between environmental exposures and health inequalities? (11 g)
We adopted a pragmatic approach to consensus by defining consensus as ‘a position one could live with even if it was not one’s preferred position’ rather than a position of unreserved unanimity. Nevertheless, we attempted to explore and resolve any differences that emerged via discussion and compromise. On most aspects of the guidance such as core curriculum goals, approaches to learning and assessment, there was a clear consensus from the start. Any differences mainly related to the translation of the curriculum goals into indicative content but were resolved following discussion. There is no single best curriculum design, but each medical school should be able to show a coherent approach to learning and assessment.
Content Box 1 provides an overview of the consensus statement that was launched in May 2014 and is available online via the FPH
website.6 Its primary aim is to support public health educators in interpreting the GMC’s Tomorrow’s Doctors 2009 (TD09) guidance. The consensus statement outlines core content of undergraduate public health curriculum in UK medical schools mapped against the Faculty of Public Health domains (see Box 2) and provides guidance on curriculum design by listing nationally agreed ‘public health-related’ learning outcomes that could be used as a standard reference framework for future GMC audits. In addition to indicative public health topics (see Box 3 for example), it provides pedagogical suggestions for educators. Some concepts relating to public health practice are best taught via experiential learning through scenario-based teaching (table-top pandemic influenza outbreak exercises or prioritization roleplays). Community placements offer a valuable learning experience even though they can be difficult to arrange because of the range of organizations involved in the planning, commissioning and delivery of community interventions in public health, lack of
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
To protect the health of individual patients
protection
4
J O U R NA L O F P U B L IC H E A LT H
Canada. This heightens the need for an agreed syllabus for undergraduate medical education.9 The development of the consensus statement has been a collaborative exercise: sharing knowledge to define curricular goals for public health underpinned by appropriate pedagogical principles. Differences in organization and capacity across medical schools are acknowledged, but this consensus statement should help strengthen the teaching of public health and related disciplines.
Moving forward
Acknowledgements
One aim of the consensus statement is to support educators in developing an effective learning environment for public health. There is no equivalent to the clinical rotation in public health, and it can be difficult to gain experience of this specialty as an undergraduate. Barriers to clinical rotations include the difficulty of integrating a public health rotation within course structures, the move of public health departments to local authorities (where there is no precedent for medical student attachments) and a reduction in training capacity within public health service settings in general following the last NHS reforms. Additional pressures caused by already full curricula, current student perceptions of the subject, variable presence in summative assessments, the challenges of teaching and assessing behaviour change, and generic pedagogical issues can make public health seem abstract to students and irrelevant to clinical practice. Medical students in many countries graduate without feeling energized by their social purpose. They articulate a desire to help address health inequalities.7 There is a growing recognition of the need for medical schools to demonstrate social accountability with some schools doing this through community-based learning opportunities, student selected study and electives.8 The consensus statement suggests ways in which public health teaching can form an underpinning theme across all clinical training to address these issues. The GMC recently announced the likely development of a national licensing examination for UK medical graduates in line with current practice in other countries like USA and
Premila Webster, Lyndsay Davies, Russell Ampofo and colleagues from the PHEMS network.
References 1 Gillam S, Maudsley G. Public health education for medical students: rising to the professional challenge. J Public Health 2010;32:125– 31. 2 Royal College of Physicians. How Doctors Can Close the Gap: Tackling the Social Determinants of Health Through Culture Change, Advocacy and Education. London: Royal College of Physicians, 2010. 3 Royal College of General Practitioners. A Core Curriculum for Learning About Health Inequalities in UK Undergraduate Medicine. London: Royal College of General Practitioners, 2013. 4 General Medical Council. Tomorrow’s Doctors. Outcomes and standards for undergraduate medical education. London: General Medical Council, 2009. 5 Gillam S, Bagade A. Undergraduate public health education in UK medical schools – struggling to deliver. Med Educ 2006;40:430 – 6. 6 Myles P, Barna S, Maudsley G et al. Undergraduate Public Health Curriculum for UK Medical Schools: Consensus Statement 2014. 2014. http://www.fph.org.uk/uploads/PHEMS%20booklet.pdf (26 September 2014, date last accessed). 7 Misˇe J. Impatience of health professions students for health equity – can a new definition help? J Public Health Policy 2014;35:411 – 3. 8 McCrea ML, Murdoch-Eaton D. How do undergraduate medical students perceive social accountability? Med Teach 2014;36(10):867– 75. 9 General Medical Council. GMC Gives Green Light to ‘Passport to Practise’; Press Release 26th September 2014. http://www.gmc-uk. org/news/25493.asp (8 October 2014, date last accessed).
Downloaded from http://jpubhealth.oxfordjournals.org/ at University of Western Australia on December 17, 2015
capacity to supervise students within such settings or timetabling constraints presented by the existing medical course structure. The consensus statement includes guidance on appropriate forms of assessment for different learning outcomes. Ongoing work by the PHEMS network following the launch of this statement includes developing a shared assessment bank including short answer questions, multiple choice answer questions, single best answer questions and objective structured clinical examination scenarios.
