Learning Outcomes for The Role of the Doctor within the Health Service

Learning Outcomes for The Role of the Doctor within the Health Service

Level 1 - The doctor as a professional

Level 2 - Outcomes for The Role of the Doctor within the Health Service

This is a rapidly changing area of medical education and practice, which is subject to many external influences including political, legal and economic. However, there are a number of key outcomes applicable to the new graduate, awareness of which should provide a firm basis for dealing with future developments and changes within the health service.

Level 3	This could include: Level 4
Healthcare systems	An outline of: the structure of the medical profession in the UK the professions allied to medicine roles and relationships of primary, secondary and tertiary care NHS organisation the origin and history of medical practice systems that impact on the NHS e.g. private medicine, EU, complementary therapies, etc. Other health care systems
The clinical responsibilities and role of a doctor	The "Duties of a Doctor" as defined by the General Medical Council. Appreciation of the medical profession as a voice in society and an agent of change. The importance of valuing and participating in professional audit. The doctor as an employee within a corporate organizational entity or as an independent contractor.
Code of conduct and required personal attributes	Duties of a Doctor (GMC) Local codes where applicable.
The doctor as researcher	Appreciation of the value of medical research and how this is organised and funded in UK and Europe. Outlining the potential role of research in career progression and the opportunities for research even as an undergraduate.
The doctor as mentor and teacher	The importance of reflecting on and analysing own experience of mentors and teachers identifying the "positive" and the" negative" and how to use this in one’s own practice as a teacher of others. The importance of adopting a culture of life-long learning and fostering this in the health service.
The doctor as manager	Managing people and resources e.g. financial.
The doctor as a member of a multi-professional team and the roles of other healthcare professionals	The opportunity to learn with and be taught by other healthcare professionals during undergraduate education with an understanding of the benefits to be gained by all concerned including patients. Working with other healthcare professionals in the context of patient care as an undergraduate in order to better develop team-working, leadership and facilitative skills.

Specific Issues

Modes of assessment for this outcome common to several schools already include:
MCQs, MEQs, OSCEs and Case Studies to assess knowledge
continuous assessment, OSCEs and portfolio reflective essays to assess professional attitudes and behaviour
in-course assignments, peer assessment and projects to assess research, self-learning and team-working skills
reflective essays, learning needs assessments, writing curriculum vitae to assess self-awareness and insights relevant to career choice
oral presentations, peer assessment of group work and SSMs on teaching to assess the student as a mentor and manager

Two fairly new assessment methods have been recommended for this outcome:

Portfolio case studies and reflective writing. These have the potential to assess the student’s understanding of some of the multi-faceted aspects of medical practice e.g. multi-disciplinary working, ethical decision making, resource management, the role of self-directed learning and research and the interplay between clinical experiences and personal health, relationships and career choice.
Educational mentoring, based on regular meetings with a tutor who will aim to assist the student’s personal and professional development through motivational appraisal. The student might bring some of the following personal information to the appraisal: the CV, academic record, feedback from tutors, peers, self and patients on academic work and personal and professional development, personal plans, learning needs assessments and critical incident analyses.

Research into the validity and reliability of the tools listed above is required. Although there is information for some of the more established tools e.g. MCQ, MEQ and OSCEs this may not be applicable in the context of this outcome. Further work is required to evaluate them.

Assessment of many of the Level 4 outcomes will be applied in an integrated fashion i.e. professional conduct and motivation can only be assessed within the context of observed clinical or project work and not alone. Many of the outcomes will be assessed together e.g. lateness at clinics may be a marker for poor motivation and/or poor organisational skills.

Compensation should no longer be permitted between academic content and personal/professional development to prevent information on students’ suitability for medical practice being ‘lost’ within assessment of academic ability. Separate tracking of personal and professional development is suggested to allow concerns about a student’s professional qualities to be identified and acted upon quickly to benefit students, patients and the profession.

Assessment methods and tools must be selected which will motivate medical students to adopt attitudes, skills and knowledge for professional practice and not merely for examinations. In particular we need to encourage specific strategies in medical students e.g. reflective practice, deep learning and skills in teamworking. Research on the effect of assessment on students’ personal and professional development will be very important in the new medical curricula.

These recommendations on continuous assessment, portfolios and educational mentoring are all tempered by the recognition that each requires significant resources. Staff development is necessary to ensure that teachers understand the purpose of these systems and how to make objective and fair assessments and give feedback.

These modes of assessment also require tutors to find more time to gather information about students on attachment and offer feedback on their performance; mark several pieces of written work for the portfolio, often including reflective writing where the tutor needs to be familiar with the whole portfolio; and to offer appraisal and mentoring to a few students perhaps twice in the academic year. These concerns about tutors’ time emphasise the need to introduce these modes of assessment cautiously and enquiringly and to review the acceptability by both staff and students as part of the evaluation.

Different methods of assessment are essential in a balanced assessment portfolio. This is to match assessment to outcomes, to provide a range of types of assessment so that students finding particular difficulty, for example with written assessment have an opportunity for compensation through excellence in other media, and to give students a wider experience. Direct and indirect methods should be used to give as complete and authentic a picture of the student as possible. It should be remembered that assessment is an integral part of the educational cycle and contributes not just to the student’s progress but also to course evaluation and revision.

The recommended assessment methods test attitudes and behaviour and depend on reflection and synthesis rather than reproduction of factual information, although this is not totally excluded. Tutors’ reports on attitudes, commitment, and motivation may be the most appropriate tool to use, if there is an opportunity for the tutor to get to know the student. Validated tools are available and there is the possibility of adopting the RITA scale which would provide a link with the postgraduate years. Many of these outcomes should be assessed in an integral way with other outcomes. For example, attitudes and professional behaviour can be specifically part of marking schedules for OSCE stations, and assessment topics within health care systems would be a specific part of guidance for, and marking schedules for, oral patient case studies, or written reports.

Recommended methods of assessment include:
Oral presentations
Short notes
Essays / written reports / project work
Case study presentations
MCQ
MEQ
OSCE
EMI
Peer assessment of team working
Ward simulation exercises

Potential new methods of assessment are:
Portfolios
Mentoring