Medical education standards in Scotland are being put at “serious risk” because of surging class sizes, which are forcing students to sit on the floor of lecture theatres and resulting in overcrowded ward rounds, a new report has found.

In its “Beyond Capacity” report, published today, BMA Scotland has warned there has been a sharp rise in the number of medical students in the past decade in Scotland, but without the necessary equivalent growth in teaching staff, clinical placements, training posts, or employment opportunities.

The lack of capacity in the system is putting educational standards at “serious risk”, with a survey finding 85% of respondents believe there are too many medical students at their university, and nearly three-quarters (72.8%) believe that current numbers are not compatible with high quality education and training.

One final year student at Dundee University said: “Sometimes people have to sit on the floor in lectures, there have sometimes been upwards of 8-12 students on one ward at a time.”

The report has also highlighted a shortage of training posts and worrying implications for Scotland’s future medical workforce. Almost one third (32.3%) of respondents said they plan to leave the UK or leave medicine altogether, with the vast majority (94.3%) citing the current employment crisis as a contributing factor.

A second-year student at the University of Glasgow said: “All my family are from Scotland and I’m worried I’m going to have to leave the UK just so I can have a job.”

Today’s report highlights survey results, carried out by BMA Scotland’s medical students committee (SMSC), which also found:

• More than three-quarters (75.5%) report reduced access to teaching and learning resources and more than six in ten (62.6%) have been turned away from scheduled clinical placements.
• More than four in five (80.3%) students report that large numbers of students have negatively affected their placements, with overcrowded wards and clinics limiting hands on experience and patient engagement.
• 99% of respondents are worried about unemployment after foundation training, and 97% believe current intake levels will limit access to specialty training.

Joe Payne, chair of BMA SMSC, said:

“We recognise that Scotland does not have enough doctors to meet demand and many patients are currently struggling to access care in a timely manner. But the alarming findings in our report makes it absolutely clear the answer to this crisis is not simply recruiting more medical students while at the same time failing to increase opportunities for training and employment.

“Since 2015, the number of medical students in Scotland has increased from 3,928 to 6,761, representing a 72 per cent rise. Current estimates suggest Scotland now has almost twice as many medical students per head of population as England – but unlike in other UK nations, these increases have largely been absorbed within existing medical schools rather than through the establishment of new institutions and without considering training capacity. This rapid expansion, which was intended to strengthen the workforce, is now instead actively undermining confidence, retention, and long-term sustainability.

“Our survey has revealed the shocking consequences of surging class sizes, with students being forced to sit on the floor of lecture theatres to avoid missing out and anatomy laboratories full to the brim. Concerns have also been raised about situations where large groups of students are present for consultations or ward rounds, making patients feel uncomfortable and potentially limiting learning opportunities.

“At the moment, high quality education is still being provided and high quality graduates produced, but that does appear to be in spite of the circumstances they train in and not because of them. The system is currently being held together only by the goodwill of academics and doctors, which is being stretched to the limit and cannot last indefinitely.

“The stresses don’t stop at graduation – our survey found anxiety surrounding job security amongst students is exceptionally high. Without plans to expand training jobs or reassess student intakes, this crisis in medical education will only worsen and we must act quickly to protect the education of students and their future prospects. While new legislation to prioritise UK medical graduates for speciality training will certainly help, it will not change the fact that medical student intakes outnumber training jobs by two to one.  The choice now facing policymakers is clear: restore balance to the system, or allow erosion of education quality, workforce confidence, and patient care.

“BMA Scotland is firstly calling for an urgent reassessment of student numbers to ensure class sizes support high-quality education. Second, we must invest in pre-clinical and clinical training capacity, including medical academics, to properly support students. Third, we must align training positions with intake levels to restore confidence in Scotland’s training pipeline and reduce the unemployment anxiety shadowing every medical student’s journey.

“Without urgent action to align student intake with teaching capacity, clinical placements, training posts, and employment opportunities, Scotland is at serious risk of degrading the quality of medical education, worsening workforce attrition, and squandering a major public investment in training future doctors, with the real prospect many will choose to work elsewhere or be forced to leave the profession altogether.

“Today’s medical students are the future of the NHS – they will be tomorrow’s doctors delivering care to patients across Scotland. To enable that, they need to be able to access the best opportunities in education, support, and training pathways. We owe it to them, and our patients, to make that happen.”

Dr Jonathan Gibb, Co-Chair, of the BMA’s Medical Academic Staff Committee (MASC), said:

“The Beyond Capacity Report raises important questions about the sustainability behind the rise in medical student places in Scotland that can’t be ignored. Despite significant increases in student numbers, the number of doctors working in medical schools (medical academics) across Scotland has remained stagnant over the past two decades due to a lack of funding, threatening the future of doctors being at the forefront of leading the education of tomorrow’s doctors.

“In this environment, medical academics and clinical educators across Scotland have been working above capacity to ensure graduates are equipped with the high-quality standards required to join the medical profession. However, the report findings clearly highlight that the current system is not sustainable, and we need urgent investment in the workforce with alignment across undergraduate and postgraduate training capacity.”

 

Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives. 

The BMA Scotland report ‘Beyond Capacity: The Impact of Increased Medical Student Intake in Scotland’ presents the findings of a national survey of 549 medical students across all Scottish medical schools and all stages of training.