So the GMC say that they want to introduce an exam that all doctors who want to work in the UK will need to pass. Lots of comments on the BMJ site, and of course twitchiness from medical school leaders, some of whom I suspect are nervous at the thought of yet more league tables. I don’t know what to think of it all. In general, I think an exam is a good idea, although this belief assumes the exam is meaningful, unlike many postgraduate medical exams. But there are lots of questions, and I wonder how much this is all about playing to the gallery: anything to conceal the failings of the GMC in other areas.
First, how does this fit into EU law and the single market? Would seem clear to me that given the need to open up professional services across Europe, any such exam must be independent of any monopoly employer, so the government / NHS — and hence the GMC — should not be involved. Second, it continues the pretence that the ‘day of graduation’ is the key time to assess clinical competence. In the UK of course, nobody at graduation can practice independently, so testing at this stage seems perverse. Surely better to assess when people join the specialist register / GP register? Third, what do we do with specialists who want to move over to the UK later in their career? Make them go back and learn the Krebs cycle?
There is no longer such a thing as a ‘standard’ or ‘qualified’ doctor, just a drifting current of competence, a continuous interaction between person and professional environment. I still think medical school is in large part about producing graduates who have the knowledge and abilities so that when they are put in a clinical environment, they can learn on the job to become a ‘proper doctor’. As for many other professions, you shouldn’t expect too much of your recent graduates, nor should you employ them in mission critical areas.
One silver lining of course is that if we move to serious summative assessment, we do not need the GMC to pretend that there is much meaningful quality assurance in medical education. Dylan Wiliam in one of his many brilliant contributions, pointed this out many years ago. You can have quality assurance, as for instance in the oft-quoted Toyota methodology. But in other areas (he quoted chip design) assurance doesn’t work, it just leads to the endless box ticking exercises that charactertise much of modern HigherEd and postgrad med ed (my words).
We cannot—anybody who’s been in a classroom more than a nanosecond actually knows this—we cannot predict what it is that children will learn as a result of our teaching. So we cannot have quality assurance in learning. We have to have quality control. We have to keep on checking on what it is the kids have actually learned, because we cannot predict it.
Well, putting to one side the cheap (but accurate) comment that those making the rules often have no background in education, let alone classroom experience, the point here is that for professional degrees like medicine, we have to use quality control, not quality assurance. And we can. Remember the ironic phrase, “our students turned out competent doctors despite the best intentions of their medical school”. So, if we must have an exam, can we dispense with all the inspection nonsense?