Good communication skills can mask deficiencies

Dr Allan Cumming is associate dean of teaching at the University of Edinburgh

Are good doctors born or made?

The innate characteristics of a good doctor are beneficence and the capacity to engage with the knowledge necessary for informed practice. Beyond this basic level I believe that good doctors are made. Education should enable students to bridge the gaps between their ability and their "unconscious competence." The increasing emphasis on generic clinical skills in undergraduate curriculums is highly appropriate. But there is a risk that students who learn to communicate superbly are deficient in other respects that may not be detected. Bad communication can be immensely harmful. However, medical schools must also ensure that graduates are equipped to provide good, safe patient care across a broad range of competencies.

What do you look for when selecting medical students?

Equal weighting is given to academic and non-academic criteria. Academic criteria involve achieved or predicted grades and academic potential. Non-academic criteria are derived from the applicant's application and consider evidence of career exploration, appropriate work experience, and non-academic achievements and interests. The university takes the issue of widening access very seriously.

In what way do you think that medical education needs to be altered?

Future doctors in the new NHS should not be educated in isolation from other health professionals, and the clinical governance agenda must be reflected in undergraduate education. The continuing growth of complementary and alternative medicine and the demands of multicultural medical practice must also be appropriately recognised.

Accelerated medical degree courses for suitably qualified graduates may aid the process of matching future manpower needs.

How do you know that your methods of assessing students are the best ways to recognise potential good and bad doctors?

Practice related assessment has become part of the curriculum at Edinburgh. New ways of testing clinical skills, communication, attitudes, and core clinical understanding are being widely implemented, and their reliability and validity are currently being measured.

"Fitness to practise" committees have been established, although to date few students have been disqualified purely on non-academic grounds. Most medical schools, including Edinburgh, now ask students to maintain reflective diaries or portfolios, records of achievement, results of peer assessment, and other indicators of personal and professional development. These are incorporated into formative and summative assessments.