Helen Salisbury: Shortening the medical degree

NHS England has just announced that it will be piloting four year undergraduate medical courses from 2026, and the General Medical Council seems ready to play its part.12 This idea was aired in the long term workforce plan published a year ago,3 but a consultation with the profession was widely expected, so many commentators have been surprised by this announcement.45

One of the professed reasons for a compressed degree is that students accumulate a lot of debt over the course of five years of study, which is unattractive to candidates from less advantaged backgrounds. A shorter degree would mean less debt and an opportunity to start earning sooner. Current graduate entry courses mostly last four years, so it’s clearly possible to cover the medical curriculum in this time, and the GMC promises no lowering of standards or of requirements for doctors qualifying from these shorter undergraduate courses.2

There are clearly some problems with this argument. For a primary medical qualification to be recognised in Europe, students need to do “a minimum of 5500 hours of theoretical and practical training provided by, or under the supervision of, a university.”6 Current four year graduate entry courses are tough and achieve the required number of hours by sacrificing holidays. But many students on undergraduate courses—particularly the people this plan is meant to be helping—use those holidays to earn the money needed to keep themselves afloat. It’s hard to have a part time job as a medical student, partly because of the amount of studying required outside formal teaching but also because clinical placements may be distant from the medical school.

So, if we’re to stick to the internationally agreed minimum standards, it’s not clear how this will help less advantaged students; indeed, it may be that the option of a shorter degree will be taken up preferentially by students who don’t need to earn money to pay their way through medical school. It’s interesting that the pilot scheme is taking place at Buckingham Medical School, which is part of a private university currently charging tuition fees of £40 000 a year to home students, so there are unlikely to be many students from the target group taking part.7

What other reasons could there be for shortening medical studies? Medicine hasn’t become conceptually easier or noticeably less complicated in the past few decades. It’s easier to look things up than it was 20 years ago, so perhaps we need to memorise less—but an internet search can’t replace the grounding in science and critical thinking required to understand current medical practice and prepare for future advances. We need more doctors, and as soon as possible, but it would be short sighted to sacrifice quality for speed. As noted by Oliver and Vaughan in The BMJ in March, “the sad conclusion is that this is really about bums on seats, producing the next generation of doctors as quickly and cheaply as possible. This comes at the cost of less education, less training, less experience, and less expertise—which in the long run can only lead to poorer and less safe care for patients.”8

A cynic might even suggest that the qualification is being shortened deliberately so that it won’t be recognised overseas, thus limiting career choices and ensuring that the recipients remain working here. And if NHS England is sincere in its wish to widen participation, there are simpler ways to achieve this than cramming five years’ learning into four. Providing funds for fees and living costs might be a good place to start.