Back to contents page
C
Career choice
Following graduation, there are over 50 main specialty areas in which doctors can practice [9]. There are a number of factors that can influence a doctor's career choice, including length of training, desire for variety in work, demand for flexible training and working, and the impact of workforce planning. There is intense competition for some specialties. Doctors normally make their career choice within the first few years after completion of undergraduate studies. In order to make the appropriate specialty choice, it is important to talk to specialists and college advisors working in the fields that interest you.
Whilst it is possible to change specialty, current arrangements mean that this will involve completing the period of specialist training again – this will involve a period of four to six years further specialist training. More information on making career choices is available in the BMA publication Medical specialties: the way forward. This guide is free to members and can be found on the BMA’s website. It can also be purchased by non-members for £10 from the BMJ Bookshop or by emailing the Department of Science and Education.
Certificate of completion of specialist training (CCST)
The Certificate of Completion of Training (CCT) is awarded by the Postgraduate Medical Education and Training Board (PMETB) to specialist registrars and GP registrars once they have successfully completed training. The award of the CCT allows doctors entry onto the specialist or GP registers in order for them to apply for consultant or GP principal posts.
Clinical governance
The clinical governance programme was implemented in April 1999. It is normally defined as "a system through which chief executives of NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish” [10].
Clinical governance is intended to raise the quality of NHS services for patients and ensure early identification of doctors who may be performing poorly [11]. At a local level, it should help plan services and ensure that clinical staff take an active part in reviewing the quality of services provided.
All health organisations have a statutory duty to seek quality improvement through clinical governance. The implementation of clinical governance by individuals, teams and organisations is supported by The Clinical Governance Support Team. Updates on issues of clinical governance can be found on the Department of Health website.
Clinical tutors
Clinical tutors are responsible for the organisation of postgraduate medical education within their hospitals and they are also involved with the organisation of continuing medical education (CME) for hospital doctors and general practitioners. There is a clinical tutor in each of the main hospitals in the United Kingdom. The role of the clinical tutor is wide. It encompasses the overall management of the education of doctors in training, together with the provision of appropriate career counselling and support.
Clinical tutors are representatives for postgraduate deans and are responsible for ensuring that the postgraduate deans’ educational contracts are fulfilled. They provide an important link between the postgraduate dean, the university and the NHS. Clinical tutors are responsible for the overall management of the postgraduate education centre and for the study leave budget. They should also ensure that all trainees are given access to career advice. For further information, please refer to the National Association of Clinical Tutors (NACT). Information is also available from the local postgraduate deans whose contact details are available on the Conference of Postgraduate Medical Deans (COPMeD) website.
Committee of General Practice Education Directors (COGPED)
The Committee of General Practice Education Directors (COGPED) is a forum that performs a similar role to the Conference of Postgraduate Medical Deans COPMeD, but focuses on general practice. Responsibility for postgraduate training for general practice is delegated from postgraduate deans to directors of postgraduate general practice education.
Communication skills
Communication skills are essential for healthcare teams in order to work effectively and provide good patient care [12]. Communication skills for doctors should encompass the ability to communicate with patients from different social, cultural and ethnic backgrounds as well as with those with disabilities or those who cannot speak English. It is important that doctors are trained to communicate bad news and to communicate in a wide variety of situations.
The General Medical Council (GMC) makes recommendations on communication skills in the context of undergraduate medical education in Tomorrow’s doctors. It states that “graduates must be able to communicate clearly, sensitively and effectively with patients and their relatives, and colleagues from a variety of health and social care professions. Clear communication will help them carry out their various roles, including clinician, team member, team leader and teacher”.
The BMA has produced a publication on communication skills called Communication skills education for doctors: a discussion paper. This recommends that communication skills training should be available to all medical students and doctors in practice as part of undergraduate education through to continuing professional development (CPD). At postgraduate level, development of effective communication skills training and assessment could be facilitated by encouraging patient feedback on doctors’ communication skills.
Information about access to communication skills courses for postgraduates can be obtained from administrators of postgraduate centres and advertisements in professional journals [13].
Competence
Competence is a collective noun encompassing a range of abilities and skills contained principally in the three domains of skill, knowledge, and attitude [14]. The competency-based approach to medical education is endorsed by the BMA and is now used as part of examining a doctor’s performance by the General Medical Council (GMC). In addition, it underpins observed structured clinical examinations (OSCE) and records of in-training assessment (RITAs). This approach is an analysis of occupational roles, the translation of these roles (in other words competencies) into outcomes, and then the assessment of a doctor’s progress in meeting these outcomes. The main focus of assessment is on whether or not the doctor has met the clearly-defined outcomes. The use of competency based education has become a feature of most stages of undergraduate and postgraduate medical training.
Computer assisted learning (CAL)
Computer assisted learning is an alternative teaching model, which has been developed due to the practical difficulties doctors experience in attending traditional external courses. This method aims to provide flexible and time efficient methods of learning and training. It allows doctors to learn or update practical or theoretical skills. This method has recently been used by medical schools as students now work with computer simulated patients to test their skills of diagnosis and treatment. The simulation software enables the student to manage simulated patients whose condition deteriorates in real time until the correct tests and procedures are performed. An example is the website for Organising Medical Networked Information (OMNI) which was created by experts based at the University of Nottingham.
Conference of Postgraduate Medical Deans (COPMeD)
The Conference of Postgraduate Medical Deans (COPMeD) promotes the development of excellence in postgraduate medical education through relationships with universities, promotion of quality research and development of a seamless continuum from undergraduate, through postgraduate to continuing education. COPMeD provides a forum in which its postgraduate dean members can discuss current issues, share best practice and agree an approach to training in all deaneries.
Continuing medical education (CME)
Continuing medical education (CME) is a formal scheme operated by the medical royal colleges in the UK. The purpose is to keep doctors up to date with their medical knowledge, including new diseases and treatment methods. Through CME, doctors are able to attend conferences and courses to update their knowledge and skills throughout all stages of their careers [15]. In recognition of this continuing education, doctors are awarded accreditation points towards the CPD schemes of Royal Colleges. All doctors who attend CME events are expected to maintain a record of their activities, including the accreditation points awarded.
Continuing professional development (CPD)
Continuing professional development (CPD), is a process of lifelong learning for individuals and teams, which enables them to meet the needs of patients, deliver healthcare outcomes and at the same time maintain, expand and fulfil their own potential. It aims to ensure doctors are lifelong learners by identifying what their educational needs are and finding a way of meeting them. Strategies of meeting learning needs can include reflective practice, audit, portfolio development and multidisciplinary cooperation [16]. The goal of CPD is the promotion of a culture in which doctors retain a curiosity about their subject. Ideally CPD should also provide recharging of the batteries, by allowing doctors time to discover and fulfil learning needs, increase job satisfaction, improve performance and increase self-esteem [16]. Evidence of CPD may form the basis of revalidation. In its publication Tomorrow’s Doctors, the General Medical Council recommends that undergraduate curricula should foster the knowledge and understanding, attitudes and skills that will promote effective lifelong learning and support professional development.
Council of Heads of Medical Schools (CHMS)
The Council of Heads of Medical Schools [17] (CHMS) was established to act as a principal source for informed opinion and advice on all matters concerning basic medical education and medical school research in the UK. It also provides a link between medical schools and the NHS as well as being a point of reference for the media.
Curriculum
The word curriculum has its roots in the Latin word for track or racecourse. From there it came to mean course of study or syllabus. Today the definition is much wider and includes all the planned learning experiences of a school or educational institution [18]. A curriculum is therefore defined more widely than a syllabus and includes: content; teaching and learning strategies; assessment processes and evaluation processes.
A curriculum exists at three levels: what is planned for the students, what is delivered to the students, and what the students experience. It is always underpinned by a set of values and beliefs about what students should know and how they come to know it. In medical education, curricula are often designed around ‘outcomes’. However, it is important that an exclusive concern with specific competencies or precisely-defined knowledge and skills to be acquired do not result in the exclusion of other content that is important in preparing doctors [18].
Curricula must be responsive to changing values and expectations in education if they are to remain useful [18]. The General Medical Council (GMC) makes key
recommendations on undergraduate curricula in Tomorrow’s doctors (2003). The core curriculum for undergraduate medics must set out the essential knowledge, skills and attitudes students need to have by the time they graduate. It must be the responsibility of clinicians, basic scientists and medical educationalists working together to integrate their contributions to a common purpose. The core curriculum is supported by a series of special study modules or student-selected components that allow students to study, in depth, areas of particular interest to them. Other skills included in the curriculum are communication and the health and safety of the public. All these skills are gained under supervision and medical schools must assess the students’ competence in these skills.
Since the first publication of Tomorrow’s Doctors in 1993, new approaches have been introduced to the undergraduate curriculum, such as integrated courses and teaching methods such as problem-based learning.
Back to contents page