are new doctors safe to practise?

Transcription

1 Be prepared: are ew doctors safe to practise?

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3 Cotets What we foud 02 Why we ve writte this report 04 What is preparedess ad how ca it be measured? 06 How well prepared are medical graduates? 08 How has preparedess chaged? 14 Does preparedess vary betwee medical schools? 18 I what ways are ew doctors poorly prepared? 24 What makes a ew doctor prepared? 36 What could happe ext? 46 Evidece used for this report 47 Refereces 49 Geeral Medical Coucil 01

4 What we foud The good ews is that very few graduates from UK medical schools are very poor at medical practice. But there are low-level cocers about a sizeable umber of ew doctors ad aroud oe i te feels poorly prepared for begiig their medical career. I some respects, the problem is wider tha this. Oe i te ew UK medical graduates feels poorly prepared. 02 Geeral Medical Coucil

5 More graduates are prepared for begiig their medical careers Positively, there are some idicatios that preparedess is improvig. This follows major chages i medical educatio some of them liked to our 2009 publicatio Tomorrow s Doctors, which sets out what is expected of ew graduates ad the stadards of teachig, learig ad assessmet i UK medical schools. Preparedess varies betwee medical schools ad aspects of practice There are major differeces betwee medical schools i the preparedess ad subsequet progressio of their graduates. Variatio is t ecessarily a bad thig, as log as it does t compromise the care patiets receive, but substadard pockets of medical educatio must be improved. The root causes are various. The level of preparedess is affected by the characteristics of the studets that medical schools select, by udergraduate curricula icludig the opportuities for gaiig cliical experiece, by the supervisio ad support give to ew graduates ad by the cliical eviromets i which they fid themselves. How we ll tackle the issue We will work with medical schools, postgraduate traiig bodies, employers ad idividual doctors, both ew ad well established, to address the shortcomigs ad make sure that patiets get the doctors they eed. Preparedess is ofte poor i certai aspects of practice. We eed to improve the competece of ew doctors i prescribig; the early maagemet of emergecy patiets (especially whe o call); some practical procedures; ad, loosely, resiliece, professioalism ad employability. Graduates sometimes acquire specific skills i the abstract, but ca t put them ito practice while uder the pressures of the day-to-day cliical eviromet. Geeral Medical Coucil 03

6 Why we ve writte this report We regulate medical educatio ad set the outcomes ad competecies that ew graduates eed to show. We also quality assure medical educatio to see how our requiremets are beig met we do this by collectig iformatio from doctors i traiig ad from the orgaisatios ivolved, ad by visitig the sites where educatio is delivered. I 2009 we published the latest versio of Tomorrow s Doctors, which icludes the outcomes for graduates ad the stadards that medical schools eed to achieve. This followed a major review, which icluded research we commissioed 1 ad full cosultatio with medical schools, employers ad others. 04 Geeral Medical Coucil

7 Assessig the impact of Tomorrow s Doctors We have ow reviewed the impact of Tomorrow s Doctors to see what we ca lear. The review gives us a base of evidece for future work to make sure that our regulatio is effective ad focused. It gives us a startig poit for reviewig the outcomes for graduates. It also helps us to cosider the case for fudametal chages to regulatio, which icludes a proposal to abolish the year of provisioal registratio after graduatio. Also, should we itroduce a licesig examiatio for doctors wishig to practise i the UK? I reality, it is hard to reach firm coclusios about the impact of Tomorrow s Doctors. It did t come ito force util the academic year , so ew graduates received much of their medical educatio uder the previous versio. Also, other major chages have bee itroduced, so it is t possible to sigle out the ifluece of Tomorrow s Doctors cofidetly. Therefore, this report focuses o how well prepared medical graduates are to become safe doctors i traiig. We cosider how preparedess has chaged, how it varies betwee medical schools ad i what respects graduates have appeared particularly well or poorly prepared. We also make some suggestios about factors that may ifluece preparedess, icludig the impact of Tomorrow s Doctors. Our ew stadards for medical educatio Separately, we have bee reviewig our stadards for the delivery of educatio ad traiig, coverig both udergraduate ad postgraduate stages. Iformatio has bee shared betwee the two complemetary reviews. Tomorrow s Doctors will be replaced by a ew set of stadards for the delivery of educatio ad traiig, alogside a stad-aloe set of curricular outcomes to be achieved by graduates. Geeral Medical Coucil 05

8 What is preparedess ad how ca it be measured? We take a wide view o what makes a ew graduate prepared for medical practice. I this report, we use preparedess to cover all the attributes that we should expect of ew graduates which iclude: professioalism employability competece readiess fitess for purpose fitess to practise. There are tesios to bear i mid. O oe had, it is importat to be reasoably precise about the skills we expect ew graduates to demostrate; o the other had, we must ot overlook their overall capability. O oe had, ew graduates eed to be able to cotribute to patiet care from day oe; o the other had, they eed to be istilled with the values ad habits to sustai a career over decades. O oe had, they still have much to lear ad are eterig a ew stage of traiig i which they should be properly supervised ad supported; o the other had, they are ow employees ad their patiets are waitig ad eed safe treatmet. Usurprisigly, it is particularly difficult to defie a precise boudary betwee beig prepared ad ot. Employers may say substatial umbers of ew graduates have ot bee properly prepared for their resposibilities. A smaller proportio of graduates may agree that they do ot have all the skills they eed to cope with the demads upo them this may be atural ad reasoable, or reflect poor support ad supervisio. Much smaller umbers will be idetified formally as doctors i difficulty ad will be carefully moitored through the Foudatio Programme. Eve smaller umbers will be referred to us, ad could have their registratio erased or compromised as a result. These differet thresholds reflect the rage of expectatios that face graduates, but do t stop us idetifyig areas of cocer that eed to be addressed. 06 Geeral Medical Coucil

9 Various mechaisms cast light o graduate preparedess Surveys of ew doctors ad their traiers These ca be large-scale ad methodologically soud, but ca be iflueced by factors such as respodets age, sex ad workig eviromets. Where there are differeces betwee the perceptios of the ew doctors ad their traiers, the ew doctors ted to have a more positive view of their ow preparedess. Other assessmets ad moitorig These should be robust, but i some cases are restricted to small umbers of graduates. Direct evidece o the safety or quality of patiet care delivered by ew doctors This is very valuable, but ca be very limited. By combiig sources ad types of evidece, we ca build up a picture of graduate preparedess. Feedback from employers ad other orgaisatios This gives a importat perspective, but may ot be scietifically robust. Examiatios Exam results should be reliable ad valid, but focus o limited competecies at a specific poit. Geeral Medical Coucil 07

10 How well prepared are medical graduates? A log-ruig study ito preparedess by Goldacre ad colleagues foud that 53% of 2008 graduates ad 49% of 2009 graduates agreed that their medical school had prepared them well. 2 Several idicators are available from more recet surveys of traiers ad doctors i their first year of foudatio traiig (F1 doctors or F1s). What do F1 doctors thik? 69.9 % 74.4 % agree or strogly agree that they are adequately prepared for my first foudatio post. 9.2% disagree or strogly disagree. agree or strogly agree the skills I leared at medical school set me up well for workig as a foudatio doctor. 8.5% disagree or strogly disagree % 24.5 % feel forced to cope with cliical problems beyod your competece or experiece o a daily or weekly basis. say they sometimes or defiitely get very frighteed or paic feeligs for apparetly o reaso at all. 08 Geeral Medical Coucil

11 92.2 % of F1s uderstad what is expected of them. 7.8% do ot. What do traiers thik? Clare va Hamel has surveyed traiers to fid out what they thik about the preparedess of the F1 doctors they trai. They thik % of F1s ever fail to cope with the trasitio from medical school; 23.9% sometimes fail; 4.4% defiitely fail % 66.8 % of F1s uderstad what is expected of them. 7.8% do ot. of F1s ever seem overly axious; 28.6% sometimes seem overly axious; 4.6% defiitely seem overly axious % of F1s ever fail to cope with the trasitio from medical school; 23.9% sometimes fail; 4.4% defiitely fail % Geeral Medical Coucil 09

12 Preparedess ad employmet A 2009 survey of employers foud that: iterviewees were kee to say that some juior doctors are excellet ad some respodets thought that stadards were geerally improvig. The message from may respodets was, however, that juior doctors are geerally ot meetig the eeds ad expectatios of the curret NHS. 3 A similar picture was reported more recetly i the idepedet Shape of Traiig review. We heard from some employers that they were cocered that may doctors whe leavig medical school are ot fit to take up their Foudatio Programme posts. 4 As stressed by the ew qualitative research by Morouxe ad colleagues, which we commissioed, difficulties i perceived preparedess ofte relate to aspects of the workig eviromet, icludig: How may graduates formally cause cocer? The umbers of graduates who are formally recogised as causig particular cocer are much smaller tha you might expect from the reports of employer opiio. We refuse provisioal registratio to very few UK graduates: four i 2010 two i 2011 four i 2012 two i Some applied agai ad were the awarded provisioal registratio. the challeges of a high-volume time pressured workload, ofte with iadequate levels of staff. Traiees may feel prepared for situatios whe all goes to pla, but uprepared whe exposed to high volumes of work which demad prioritizatio ad multi-taskig; or ucertai thresholds (ot kowig whe to refer to seiors); iadequate team-workig; or whe seiors are ot easily accessible. 10 Geeral Medical Coucil

13 There were doctors i the Foudatio Programme i 2012/13 14,975 was the total of doctors o the programme i Foudatio Programme doctors did ot complete their year of traiig i F1 doctors (3.2%) ad 296 doctors i the secod year of traiig (F2 doctors or F2s) (3.0%). Amog the F1 doctors, 0.7% were i less tha full-time traiig, 0.8% had more tha four weeks absece, 0.9% wet ito exteded or remedial traiig, 0.1% were dismissed, 0.6% resiged ad 0.2% did ot complete for some other reaso doctors did t complete Foudatio Programme traiig 235 doctors did t complete foudatio year 1 There were 378 Foudatio Programme doctors i difficulty i F1 doctors (2.6%) ad 185 F2 doctors (2.4%). Of the 378, 135 were siged off as fit to cotiue traiig i the ormal way, but 187 were forced to repeat at least some of their Foudatio Programme traiig, 36 resiged or were released, ad there were 20 others doctors did t complete foudatio year 2 Geeral Medical Coucil 11

14 18 F1 doctors ad 13 F2 doctors were referred to us that year. 2.5% of UK graduates from 2012 were still provisioally registered i March 2014 (97.5% had secured full registratio). Graduates ca retai provisioal registratio loger tha the ormal year for a rage of reasos. 1.1% of F1 doctors ad 1.0% of F2 doctors received a usatisfactory outcome i their Aual Review of Competece Progressio (ARCP) i % The rate of usatisfactory ARCP outcomes icreases i later stages of traiig, where the impact of udergraduate educatio will be less up to 25.1% i core traiig ad 14.0% i higher traiig. of doctors who graduated i 2012 were fully registrated by March Geeral Medical Coucil

15 How does preparedess affect patiet safety? It is difficult to assess the impact of graduate preparedess o patiet care. However, oe study idetified a 6% icrease i deaths amog patiets admitted at the poit whe ew graduates eter the NHS ad most other doctors i traiig chage posts. Surveys by two medical royal colleges foud that more tha four i five respodets believed that patiet care suffers durig this chageover period. 7 The risks to patiet safety i the chageover period relate to the mass movemet of doctors i traiig ito ew roles, ot oly the itroductio of ew graduates. However, accordig to the report of the ew qualitative research by Morouxe ad colleagues: F1 doctors felt uprepared for the step chage i resposibility, the workload, the degree of multitaskig, decidig who ad whe to ask for help, uderstadig how the hospital works (which varied by hospital) ad dealig with uderperformace of other team members. Deaths icrease whe o cosultats are preset There is o doubt that patiets are more at risk whe cosultats are scarce or abset. May reviews have foud that patiets suffer whe there is a delay i ivolvig cosultats ad the icreased death rate for hospital patiets at weekeds has bee attributed to lower cosultat ivolvemet. 8 While this evidece demostrates the beefits of cosultat-delivered care, it also idicates the dagers that result from relyig upo doctors i traiig who are ot appropriately prepared for the practice they eed to deliver. Preparedess eeds to be improved The overall picture idicates that there is room for progress. Employers have cocers about the preparedess of ew graduates ad a small miority of ew graduates appear to regard themselves as geerally poorly prepared. Their traiers share a similar view. All but a tiy umber of UK graduates obtai GMC registratio, ad aroud 3% have formally recogised difficulties while they are i the Foudatio Programme, or do ot make progress at the usual rate. But the picture looks more worryig whe we look at particular aspects of preparedess ad variatios betwee medical schools. Geeral Medical Coucil 13

16 How has preparedess chaged? Past research The research by Goldacre ad colleagues shows that ew doctors reported a geeral tred of improvig preparedess before the 2009 versio of Tomorrow s Doctors. The percetage of graduates who agreed that they had bee well prepared icreased from 36% for 1999/2000 to 50% for 2002 ad 58% for 2005, before fallig back to 49% for Those who disagreed fell i each of those cohorts from 41% to 31%, 21% ad 16% respectively. 9 A 2012 literature review by Talletire ad colleagues reported a less clear-cut picture. They foud that sice 1993, graduates perceptio of their ow preparedess: Research we commissioed The rapid review by Morouxe ad colleagues did t fid strog evidece of chage followig the publicatio of Tomorrow s Doctors i However, more recet cohorts of graduates were better prepared tha previous cohorts. The ew qualitative research idicates areas of possible improvemet. Some iterviewees, icludig other healthcare professioals ad patiet represetatives, oted a improvemet i the commuicatio skills of F1s. Iterviewees also felt that recet graduates were more orieted towards multi-professioal team workig. improved for practical procedures ad team workig showed little chage for acute care, commuicatio ad ethics declied for prescribig. Other professioals saw little chage i preparedess i commuicatio, ethics, prescribig ad practical procedures, but a declie i preparedess for acute care Geeral Medical Coucil

17 Results from aual surveys of doctors i traiig Recet quatitative surveys of ew doctors suggest a cotiuatio of the improvemet reported by Goldacre ad colleagues. I our 2009 atioal traiig survey, ew doctors were asked: Do you feel that you were adequately prepared for your first F1 post? 54.3% of UK F1 doctors said they were, but 33.0% disagreed. UK graduates who say they felt prepared for their first F1 posts % 58.8% 61.8% I 2012, F1 doctors were asked to respod to the statemet: Before commecig my first foudatio post I felt prepared for the role. For 2013 ad 2014, the statemet was tweaked to: I was adequately prepared for my first foudatio post. I 2014, 69.9% agreed ad 9.2% disagreed. Possibly the much lower percetage i 2012 relates to our ot usig the qualified phrase adequately prepared that year ad askig how the graduates felt before their first post % 70.2% 69.9% Geeral Medical Coucil 15

18 New doctors were also asked: I this post how ofte did you feel forced to cope with cliical problems beyod your competece or experiece? The same questio has bee used each year from 2009 ad shows a cosistet patter of major improvemet up to 2012 ad a less clear picture sice the. A further survey of F1 doctors by Clare va Hamel idicates improvemet i their overall preparedess betwee 2012 ad However, sigificat chages were ot foud i the proportio of F1 doctors with serious axiety or i relatio to prescribig ability. How ofte have F1 doctors felt forced to cope with cliical problems beyod their competece or experiece? Never Rarely Mothly Weekly Daily % 41.1% 20.9% 26.0% 4.4% % 44.2% 20.2% 22.8% 3.9% % 47.8% 18.8% 18.4% 2.9% % 49.0% 17.8% 11.2% 1.3% % 47.6% 18.3% 12.1% 1.7% % 46.4% 17.5% 11.5% 2.1% 16 Geeral Medical Coucil

19 Fewer doctors i difficulty Also, the proportio of formally recogised doctors i difficulty i the Foudatio Programme has declied from 4.6% i 2010 to 2.6% i 2013 for F1 doctors. Ad from 4.2% i 2010 to 2.4% i 2013 for F2 doctors. 11 Proportio of doctors i traiig formally recogised as doctors i difficulty Idicatios of a overall improvemet i preparedess There has bee improvemet i the views ew doctors hold of their ow preparedess, both before ad sice the 2009 publicatio of Tomorrow s Doctors. This is probably due to a rage of factors, which could iclude chages i udergraduate educatio, i the Foudatio Programme or i the support available from employers F1 3.4% 4.6% 3.7% F2 4.2% Also, fewer ew graduates are formally recogised as havig difficulty, which suggests better preparedess at the weaker ed of the spectrum (assumig there has bee a reasoable cosistecy i the threshold for beig recogised as i difficulty) % 2.6% 2.4% 2.5% However, Talletire ad colleagues suggest decliig preparedess from I ay case, the evidece is partial ad we do t have cosistet data over time o the views of traiers ad employers, let aloe more objective evidece o chages i preparedess. Geeral Medical Coucil 17

20 Does preparedess vary betwee medical schools? Variatio betwee medical schools i the iterests, abilities ad career progressio of their graduates is ievitable ad ot i itself a cause for cocer. However, uderstadig the extet of variatio i some aspects of preparedess ca highlight problematic issues across medical educatio ad determie whether they are tied to particular locatios perhaps with causes that ca be idetified ad addressed. Evidece from surveys The rapid review by Morouxe ad colleagues foud six studies suggestig differeces betwee schools ad two suggestig o differeces. I particular, the reports from Goldacre ad colleagues have documeted a rage across schools i the perceptio ew doctors have of their preparedess. The rapid review cocludes: there is compellig evidece to suggest that medical school does make a differece i terms of self-reported preparedess. More recet survey evidece supports this coclusio, such as resposes to our 2014 atioal traiig survey. There was a wide variatio betwee medical schools i the ew doctors who cofirmed: I was adequately prepared for my first foudatio post. This agreemet raged from 60.7% to 85.0% (those disagreeig raged from 2.4% to 12.5%). There were five uiversities or medical schools where more tha 80% of graduates said they were adequately prepared; seve with 70 79% of graduates prepared; ad the other 17 with 60 69% of graduates prepared. 18 Geeral Medical Coucil

21 We ca also look at resposes to the questio: I this post how ofte have you felt forced to cope with cliical problems beyod your competece or experiece? At oe istitutio, 30.7% of graduates aswered ever. At the other extreme, there was oe school where that respose was give by oly 17.9% of graduates. How have perceptios of preparedess chaged over time? Usig resposes to our 2014 atioal traiig survey, we ca also cosider the variatio betwee schools i how their graduates perceived preparedess has chaged over time. O feelig they have obtaied the skills to set them up for practice, the percetage agreeig or strogly agreeig varied across schools from 61.8% to 96.6%. Statistical aalysis of the va Hamel survey of ew doctors i 2013 foud o sigificat differeces betwee medical schools i either the mea axiety score or the percetage with serious axiety. But for a overall preparatio questio ad for early all the specific preparatio domais, there were highly sigificat differeces betwee the medical schools. Also, there were sigificat differeces betwee the schools for all the measures of prescribig ability. At oe school, the umber of graduates regardig themselves as prepared icreased by 134.7% betwee 2009 ad 2014 (from 31.4% to 73.8%). There was also a school with a 75.2% icrease. At the other extreme were two schools with decreases i graduates declared preparedess, of 4.3% ad 10.8% (although chages i the questio asked may have cotributed to these treds). We ca also look at the chage i the graduates copig beyod their competece betwee 2009 ad If we look at those aswerig daily or weekly, all medical schools seem to have improved. The best improvemet was oe medical school with a fall of 79.6% (from 39.7% of graduates to 8.1% sayig they have to cope beyod their competece daily or weekly). At the other extreme was a school with a fall of 30.8% over that period. Geeral Medical Coucil 19

22 ARCP outcomes The ARCP outcomes data also reveal variatios betwee medical schools. For higher traiig, with a UK figure of 14.0%, the rage was from 5.8% (leavig aside some schools with very small umbers of graduates covered by our data) to 19.2%. I the first year of the Foudatio Programme (F1), usatisfactory outcomes raged from 0.0% amog graduates from some schools to 3.6% for graduates from oe school. The overall UK figure was 1.1%. I the secod year of the Foudatio Programme (F2), the rage was from 0.0% for some schools to 2.5% for oe school. The overall UK figure was 1.0%. For core traiig, with a overall UK figure of 25.1%, the rage was from oe school where 5.4% of graduates i the programme achieved usatisfactory outcomes, to aother where 36.7% received usatisfactory outcomes. I iterpretig these figures, it s importat to bear i mid: the impact of the educatio provided by the medical school is likely to be highest o Foudatio Programme outcomes ad lowest o higher specialty traiig traiig programmes vary hugely i their rate of usatisfactory outcomes, so a apparetly good result for a medical school may be largely due to its graduates eterig traiig programmes where it is relatively rare to receive a usatisfactory outcome. For example, some programmes tie ARCP outcomes to passes i examiatios. 20 Geeral Medical Coucil

23 medical schools vary i the time that their graduates spet i traiig programmes durig , the period covered by this data, ad the loger they were i programmes, the more opportuities they had to receive a usatisfactory outcome. It is possible to adjust the figures to take accout of the differeces betwee the schools i the atioal traiig programmes their graduates wet ito durig the period of our data. Takig this approach, oe school has 8.4% fewer usatisfactory outcomes tha you would expect give the spread of their graduates across the various traiig programmes. At the other extreme are three schools with 3.1% more usatisfactory outcomes tha you would expect. Foudatio Programme data We ca also cosider the spread of medical schools i relatio to the selectio of their graduates ito the Foudatio Programme i % of applicats were allocated oe of their top five choices. The rage across the medical schools was from 81.8% at oe school up to four schools all at more tha 99%. 12 Lookig at the results from the situatioal judgemet test, which is scored out of 50, the averages for the various UK schools raged from 37.3 to The average for EEA graduates was 33.3 ad for other iteratioal graduates So the average results for the UK medical schools i the situatioal judgemet test vary by less tha 8%. Nevertheless, variatios i idividuals performace are see as substatial eough to justify their beig used as a major compoet i rakig for etry to the Foudatio Programme. 13 We ca also look at the umbers of Foudatio Programme doctors i difficulty. At oe extreme is oe medical school with more tha 4% of its graduates i difficulty. There are also schools with fewer tha 1% of their graduates i that positio. Agai, this suggests oly a limited variatio betwee schools, give the small umbers of graduates officially i difficulty from ay oe school. The rage is arrower still if you oly cosider the doctors i difficulty who are ot siged off as fit to cotiue traiig i the ormal way. Geeral Medical Coucil 21

24 There s some variatio i graduates who remai provisioally registered There is also variatio i the umbers of graduates from each school who take loger tha usual to obtai full registratio. Lookig at the 2012 graduates who were still provisioally registered i March 2014, there were five medical schools with fewer tha 1% provisioally registered, icludig two with oe at all. There were six schools with more tha 4% of their graduates still provisioally registered, icludig oe with 8%. This ca be for a rage of reasos, ot all liked to the doctors preparedess. Choice of specialty varies betwee medical schools Medical schools also vary substatially i the specialties that their graduates apply to. For example, lookig at first roud applicatios i 2012 ad 2013, o average 24.3% of doctors i the Foudatio Programme made a applicatio to Core Medical Traiig. However, the UK medical schools raged from oe where 16.1% of graduates i the Foudatio Programme applied to Core Medical Traiig to aother where 53.0% did so. O average, 37.0% of doctors o the Foudatio Programme applied for GP traiig, varyig from 17.4% of graduates from oe school to 48.0% at the high ed. We ca also look at our data o specialist ad GP registratio. It takes several years to complete traiig as a GP or a specialist ad the period of traiig varies substatially. So we eed to go back a few years to obtai figures that give a true compariso i relatio to the fial destiatios of graduates. 22 Geeral Medical Coucil

25 We have chose to look here at the destiatios of graduates from the five years For example: The percetage of medical graduates becomig GPs raged from 17.1% at oe uiversity to 46.8% at aother. The rage for aaesthesia was from 3.7% of graduates from oe uiversity up to 9.9% at aother. For the physicias, the uiversities raged from 9.0% of medical graduates up to 29.2%. Ad for the surgeos, the rage was from 5.1% up to 13.8%. Clearly, this is takig us some way from preparedess at the poit of graduatio. But we ca see the substatial variatios betwee medical schools i relatio to specialisatio of their graduates, whether or ot this is desirable. O the oe had, the patter ca be see as resultig from competitio for places i specialty traiig ad as reflectig the relevat ad relative stregths of the graduates applyig ad progressig. O the other had, the medical schools producig large umbers of GPs are helpig to address a key area of cocer i medical staffig. The specialties most valued by studets or doctors i traiig may ot be the most valuable to the NHS. Are some medical schools better tha others? There are major differeces betwee medical schools i the preparedess ad subsequet careers of their graduates. Clearly, evets later i a doctor s career will ted to be less closely attributable to their udergraduate educatio. I ay case, this iformatio is ot sufficiet to demostrate that some schools are better tha others. That depeds o the criteria you use, ad ot least whether it is relevat to cosider the value added by the medical school takig ito accout the potetial of the studets they erol. Also, there is room to debate whether the variatio betwee schools i graduate preparedess is a problem ad, if so, how it could be tackled. For example, a atioal licesig examiatio might reduce variatio i preparedess by prevetig some very poor graduates from practisig ad possibly by ecouragig more uiformity i udergraduate curricula. Geeral Medical Coucil 23

26 I what ways are ew doctors poorly prepared? The research we commissioed Morouxe ad colleagues rapid review of the academic literature sice 2009 foud: research suggestig that ew doctors are reasoably well prepared for history-takig ad performig full physical examiatios, but less so for prescribig, cliical reasoig ad diagosis, ad the early maagemet of emergecy patiets variatio reported o competece i practical procedures mixed fidigs o team-workig ad commuicatio with colleagues ad patiets some evidece that ew doctors are poorly prepared for dealig with error ad safety icidets ad that they lack uderstadig of the cliical eviromet Morouxe ad colleagues also carried out ew, origial research. I this, data from iterviews with ew doctors ad others, ad from diaries kept by ew doctors, were mapped agaist the outcomes of graduates set out i Tomorrow s Doctors. The researchers foud that some ew doctors fid traslatig scietific kowledge ito cliical practice challegig, but uderstadig huma structure, fuctio ad pathological mechaisms provides cofidece for decisio makig. Others thought that they are geerally poorly prepared to look beyod the biomedical aspects of a patiet s coditio. The research also shows that graduates are cofidet i speakig with patiets for history takig, to summarise patiets histories, to explai examiatio fidigs, ad to commuicate these to seior staff. But they are less prepared for the high umber of patiets to examie. mixed evidece o professioalism. 24 Geeral Medical Coucil