Five decades of medical education

Thursday, 05 December 2013

From 1900 to 2100

Medico-Chirurgical Hall

It's all about the learner, now let's find a place for the person.

Prof. Gillian Needham - Postgraduate Dean - North of Scotland NES


Minute of meeting of Aberdeen Medico-Chirurgical society held in the Society's Hall, Foresterhill on Thursday 5th December 2013.

The President, Dr Colin Hunter, presided.

The President introduced the evening's speaker, Professor Gillian Needham, Postgraduate Dean for the North of Scotland. The title of her talk was Five Decades of Medical Education: its all about the learner, now let's find a place for the person.

Professor Needham had previously asked some members of the Society for their memories of their training and five members present read out sample comments from the survey - one from each decade of training. She had specifically asked about first week memories, positive and negative role models, why medicine had been chosen as a career and whether the profession had met these expectations.

The first commented that the concept of a family doctor had gone with resultant lack of continuity.

From the 50s, the comments were similar with a major change coming to general practice with the 'new contact' and the 'family doctor ' becoming lost in the increased work load.

Somebody who trained in the 60s said that his/her training had been unstructured but there was a team whom you knew. The culture has now changed but perhaps had not been well analyses.

A 70s trainee has learned that cure was not always possible so compassion was important.

From the 80s the comment was that his/her training had given income, education and social status, all to be welcomed.

A 90s trainee had enjoyed the training and especially the support of nurses and colleagues but training was now harder because of the shift system.

Prof Needham commented upon the similarity of all these statements and went on to speak about these 5 decades of training, the subsequent two decades and then the future. She mentioned various significant reports including those by Abraham Fletcher, Ken Calman, John Tooke, John Temple and most recently David Greenaway. She drew attention to the changing demographics of our society with the 'baby boomers' now nearing old age. Whilst many nations spend a lot of their personal income on health care, in Britain we need a flourishing workforce to pay for our health services which may be challenging due to changing demographics.

She then spoke briefly about leadership styles, noting the change over time from 'command and control' of older traditionalists to 'everybody is the same', but trainees always complain that they do not get enough feedback.

Taking an overview of Scottish medical training, Prof Needham said that from 1st April 2014, there will be one Scottish Deanery supporting training. There will still be two Foundation years before specialty training and she talked about selection for specialist training, saying that some specialties were oversubscribed. Selection has become quite refined and seems to work well. Referring to specialties which have more vacancies than applicants, she felt that it may be better to leave vacancies rather than fill the places with unsuitable candidates. Deaneries now have lots of data which is being analysed to show various aspects of training in different locations.

Change in the NHS is the norm and should be seen as presenting opportunities but people may need support. Other industries may provide useful models.

Turning to professionalism and excellence, Prof Needham paid tribute to the work of Sir Lewis Ritchie who was one of the members present. Although clinical competence may be taken as a given, trainees need specific coaching in professional leadership and all now have a compulsory programme on leadership which teaches managers and clinicians together and there is one scheme which takes trainees out for a whole year for more intensive management training.

Finally talking about the future shape of training, Prof Needham talked with regret about the major changes which occurred in 2007 and which had seriously disrupted some peoples' careers. There is likely to be a change in registration which will mean that full registration will be granted to new graduates but the foundation years will continue before more broad based specialty training lasting 4 to 6 years leading to a certificate of specialist training.

Prof Needham had hoped to show a video of David Greenaway taking to a trainee but time did not allow. It can be seen at

During an extensive question period, others agreed that the quality and aspirations of trainees had not changes but the system had, with a loss of team working and the risk of poorer personal patient care.

The President closed the meeting with an invitation for those present to join him in the Council Chamber for mulled wine and Christmas mince pies.

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