Graduate attributes in the disciplines of Medicine, Dentistry and Veterinary Medicine: a survey of expert opinions

The study reported here was part of a project funded by the Quality Assurance Agency (QAA) Scotland Enhancement theme programme investigating 'Research teaching linkages: enhancing graduate attributes' in the disciplines of Medicine, Dentistry and Veterinary Medicine [1]. One component of the project investigated research related graduate attributes and aimed to determine and define what attributes were desirable in graduates from these three professional degrees.

There has been debate regarding the shortfall in graduates from professional degrees who opt to include research in their career plans. The Selborne Report raised concerns over the future of Veterinary Medicine research [2], whilst the new draft version of the General Medical Councils (GMC) Tomorrow's Doctors guidelines includes the high level outcome of 'The doctor as a scholar and scientist' under which fall research skills such as 'Formulate simple relevant research questions in biomedical science, psychosocial science or population science and design appropriate studies or experiments to address the questions' [3]. Therefore there are concerns over the potential of future professional graduates to carry out research relating to their careers. Part of this concern focuses on the lack of experience and training during the undergraduate years. The difficulty lies in ensuring that appropriate training is given during degree programs to equip interested students with the skills required whilst not specifically training all undergraduates for this career. The 'product' of a vocational degree course such as Medicine, Dentistry or Veterinary Medicine should be a competent professional equipped for their first day in practice, therefore research skills may not be necessary. So should these crowded curricula be pressured further to 'fit in' research as well as professional attributes? Would ensuring that research related graduate attributes are covered exert further pressure on curricula?

Professional attributes should already be covered within the curriculum as required by the governing bodies the General Medical Council (GMC) [4], the General Dental Council (GDC) [5] and the Royal College of Veterinary Surgeons (RCVS) [6] but what research attributes are desirable of such graduates? Identification of these attributes would enable curriculum designers to map them onto current teaching and recognise gaps in coverage.

Also of interest is the opinion of students graduating from such professional/vocational programs as to whether the courses do cover the attributes discovered. The BSc in Medical Sciences at St Andrews is a three year Honours degree program, after which graduates move on to their clinical years at other Medical Schools. The program itself is designed to provide 'an excellent scientific foundation for clinical practice' [7] and therefore should cover both professional and research practice. But would students completing such a course agree? A major component of the course, similar to other Honours degree programs, is the completion of a final year project. We investigated whether the degree program, and the final year project in particular, helped to equip graduates from the BSC Medical Sciences with the attributes that experts in the field thought were vital for a successful professional and research career.

The first aim of this study was to identify what research related graduate attributes were desirable in graduates from Medical, Dental or Veterinary degrees. A secondary aim was to determine whether such research related attributes can be covered in a curriculum whose content is governed by regulating bodies. The third and final aim was to investigate student opinion as to whether a course designed to provide a scientific foundation in Medicine would equip graduates with the identified attributes.

Interviews with faculty members with responsibility for curriculum design from all three disciplines and ranking by further experts in the area resulted in two lists of attributes, one desirable in a graduate pursuing a professional career, the second in a graduate pursuing a research career. The definitions agreed in the study (Table 2) provide a useful focus for debate amongst curriculum designers as to whether the opportunity to develop such attributes, are available within their program. The definitions may also help the developers of teaching sessions to design elements to foster and encourage these attributes amongst their undergraduates.

Interestingly the top seven attributes in both lists were the same, although not ranked in exactly the same order of preference. This suggests that such graduate attributes are high level skills which would be applicable to both research and professional situations. This finding has implications for curricula design in Medical, Dental and Veterinary degree programs. Curricula in all three disciplines are prescribed by guidelines issued by the governing bodies, the GMC [4], GDC [5] and RCVS [6] which are focussed towards the production of graduates competent to pursue a professional career, although they do suggest graduates be aware of the evidence base for practice and have an understanding of research methods. This study suggests that the two career aims (professional and research) are not mutually exclusive in terms of curriculum design and opportunities for learning within the curriculum. Indeed it may be the context in which the attributes are taught/encouraged which results in the student perceiving the session as being professional or research related [1]. This means that designing courses which cover research related skills can be accomplished without adding further pressure to already crowded curricula. This does raise further questions as to how graduates can be encouraged to consider incorporating research into their careers, especially within veterinary research where the Selbourne report noted there was a lack of such people [2].

A BSc program in Medical Sciences may not have precisely the same aims as the standard five year MBChB and this is one limitation of this study, as graduates may have a slightly different focus in their careers. The course at the University of St Andrews provides the basis for entrance to the third year of an MBChB course, but also attempts to deliver an understanding of the scientific basis of Medicine and therefore should be equipping its graduates with the research related attributes determined in the previous part of the study. The results show that the final year students considered that the degree program as a whole, did provide them with the opportunity to develop all of the top seven attributes identified in this project as being common to both professional and research careers. The final year project component of the course was viewed as being particularly effective at equipping students with the ability to understand the importance of having an inquiring mind and developing their critical appraisal skills. Similar outcomes for research projects were shown in a qualitative study in science undergraduates and their faculty advisors by Seymour et al [9]. They noted that the research project increased application of knowledge and skills such as critical thinking, changed attitudes, behaviours (such as increasing curiosity and initiative) and personal/professional gains (such as increasing confidence in communicating their work to others) [9, 10]. Interestingly the final year project in the St Andrews curriculum was not thought to improve team working skills within the students as much as other attributes. This may be due to the library based nature of the project undertaken by many of our students, rather than being laboratory based, where they would be working alongside others such as post-doctoral researchers or PhD students. Overall though this project provides further evidence as to the benefits of undergraduates taking part in research projects, but extends the previous work in pure science degrees to a Medical Sciences degree which includes a vocational element. The research project therefore is an excellent example of a method that can link research and teaching in the minds of the undergraduate, a vital component of the research-teaching nexus [1]. As the new draft version of the GMCs Tomorrow's Doctors guidelines includes the high level outcome of 'The doctor as a scholar and scientist' [3], this may be one way to cover such areas within the medical curriculum.

Other limitations of this study include the sample of interviewees, which included individuals from all Scottish Medical, Dental and Veterinary schools and a selected sample from English schools. The English schools were selected for participation on the basis of achieving representatives from a wide range of curriculum types although it is not an exhaustive sample. We acknowledge that this may have impacted on the views that were obtained.

Data analysis employed both qualitative and quantitative methods. The development of the list of refined attributes from the interview suggestions utilised NVivo software which may have affected coding and clustering of data and therefore the emerging themes. The process was however carried out by two authors (AL and JS) who achieved consensus.

This study is timely as the Higher education sector becomes ever more globalised. Many Veterinary schools in the UK comply with European Association of Establishments for Veterinary Education curriculum guidelines [11]. The Tuning project [12] is also ongoing and has the expansive aim of tuning educational structures and courses in higher education across Europe. This includes agreeing generic graduate competencies which should be outcomes for all degree programs. The Thematic Network on Medical Education in Europe (MEDINE) is working within the Tuning project among others [13]. One piece of research carried out by the MEDINE group was an online survey investigating how vital medical educators viewed the generic Tuning competencies. Interestingly, of the 29 generic Tuning competencies, the 15 which were ranked most vital by medical educators across Europe were similar to the top seven attributes identified in this study [14]. The seven attributes defined in the current project are possibly higher level and therefore incorporate one or more of the Tuning project generic competencies. One of the Tuning project generic competencies is 'research skills': this study would argue that in fact all of the seven attributes identified in this project are, in fact 'research skills'. The results of this study add to the current discussions around identifying and agreeing a common range of graduate attributes in the wider context of European education in the disciplines of Medicine, Dentistry and Veterinary Medicine.

Curriculum designers in Medicine, Dentistry and Veterinary Medicine can utilise the seven graduate attributes identified in this study as a means of ensuring that they produce graduates who are equally well equipped for either a professional or research career. By mapping these core attributes to current learning activities they can ensure that there are opportunities within their curriculum for students to develop and practice these skills. The definitions of these attributes will allow a focus for discussion on the opportunities available within the different curricula.

Results of the student study confirmed the belief that involving students in a research project was an excellent way to equip them with many of the identified attributes. Students completing a BSc Medical Sciences reported that the final year project was particularly effective in developing an inquiring mind and the skills of critical appraisal.