Flexibility or Rigidity in Specialist Training
Medical education in a specialty is customarily and conveniently divided into four stages: the undergraduate course, leading to qualification; around 3 years of general professional training, during which a postgraduate diploma may be acquired; some 4 years of specialist training; and continuing education for the established consultant. In this country, ultimate responsibility for the entire educational process rests with the General Medical Council. The agents of undergraduate education are the universities and their associated hospitals and general practices. The agents of postgraduate training are again universities and the hospitals, but with central standards maintained by the colleges. The dichotomy between undergraduate and postgraduate education, with the university influence predominantly in the former, and the hospital influence in the latter, seems to me justifiable. The many possible courses open to a doctor on qualification require that he (or increasingly she) be a broadly educated man or woman; and the university environment permits, even if it may not compel, a breadth of interest. On the other hand, when a course has been firmly set in one direction, the public interest requires an assurance of adequate training, such as is most appropriately certified by a professional body. During its much longer association with undergraduate than with postgraduate training, the General Medical Council has moved away from rigid specification of time spent on different subjects towards general guidelines; and in my view the increased flexibility thus permitted in the undergraduate course has been wholly beneficial.
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