Training of medics and other health care profesionals

Editor - I think that a common "medical foundation course" for doctors, nurses, physiotherapists, dentists, and pharmacists would be a better training. Graduates of this course could then undertake vocational training of an extra one or two years to become a nurse and three to be a doctor. Such a course could be a three year medical sciences degree with compulsory modules in physiology and anatomy, but with choice in some more tailored modules-perhaps a module in nursing skills for aspiring nurses, pharmacology for pharmacists, etc. Students could do modules designed for several different professions, allowing their options to be kept open. Tomorrow's orthopaedic surgeons and physiotherapists may have a greater mutual respect and insight into each other's roles if, for example, they had studied a module in limb anatomy together as undergraduates. Nursing and medicine are different jobs, but much of the knowledge required is the same. I expect nurses feel very patronised by the assumption that they do not want to be taught to the same depth as doctors or that it would be too difficult for them.

Such a course would give students more time in which to make a better informed decision about their choice of occupation. Students who decide a career in patient care is not for them will still gain a worthwhile science degree, rather than dropping out with nothing. If the numbers on the course were not restricted, then the entry requirements would be lower, thus reducing the stress of the intense competition at 18. In addition, by the age of 21 there would be a much more level playing field for the applicants to medical training, due to candidates having had a longer time in which to reach their full potential academically and due to a decrease in the effect of the wide differences in the standard of schooling. Many sixth formers feel that they would like a career in something medically related but are put off medicine itself by the tough competition and entry requirements, but view entering nursing after school as being unacademic and "low status." The foundation degree could be an attractive option to them. Because of increasing financial pressures, people from ordinary families may soon not be able to afford a medical education. Local colleges of further education as well as universities could run the course, thus allowing more students to save money by living at home.

With a more highly skilled NHS workforce, job descriptions could overlap to a greater extent, which is surely desirable in the light of a shortage of doctors. At a general practitioner practice I have observed the role of a nurse practitioner. I have noticed no differences in quality between the consultations by the doctors and those by the nurse practitioner, except that it is inconvenient to require the doctor's signature on the prescriptions that the nurse writes out. If we desire to increase the skills of all health care professionals in order to improve the quality of patient care we must not defensively guard our elite training and status.

Victoria Kerry, third year medical student, Medical Students' Representative Council 1999-2000, University of Manchester


studentBMJ 2000;08:303-346 September ISSN 0966-6494