Blythe and Hancock pose an interesting question, but their article does not highlight three important issues.1 First, that an undergraduate curriculum results in a generic ‘product’, whose nascent knowledge and competency must relate to patient care regardless of their subsequent specialisation. Second, that these competencies will be attained in different ways in different settings, and often are and should be practised in more than one undergraduate setting or speciality, both prescribing and consultation skills are exemplars. Third, the fact that a specific speciality does or does not lead on a specific component may not mean that the graduate fails to achieve that competency. So, let’s pretend that medical school (a) makes prescribing tasks a core learning activity of its final year GP placement, but medical school (b) signs off this competency at the end of year 4 in the medicine for the elderly placement, and uses its final year GP placement to focus on the applied skills of acute diagnosis of undifferentiated problems. From the primary care curriculum in each school this will look different, but both sets of graduates should be able to succeed in relevant work-based and ‘objective structured clinical examination’ type assessments.
The idea in this article, therefore, needs further refinement to ensure it will provide useful information that will act as a driver for relevant change, as trying to map entry competencies for MRCGP onto GP departmental teaching alone would not reflect such legitimate variation. A national comparative mapping of current use of primary care placements,2 and the learning objectives they prioritise, might well be more informative, particularly because there are clear differences in long-term career impacts that may relate to the nature and status of GP-teachers in different UK medical schools.3 Links between GP teaching leads at different medical schools are actually already established in the Society for Academic Primary Care’s ‘Heads of Teaching’ network, and the Royal College of General Practitioners is, and will remain, a champion of exposing medical students and postgraduates to our discipline. Giving students the building blocks for MRCGP is only part of what we should seek to achieve, we need to show that all graduates leave medical school having learned to respect and aspire to the value of good generalist medical practice for patients, and seen its potential as an inspiring career choice.
- © British Journal of General Practice 2011
