Tomorrow’s Doctors
LondonRegent’s Place, 350 Euston Road, London NW1 3JNManchesterSt James’s Buildings, 79 Oxford Street, Manchester M1 6FQEducationScotlandNapier House, 35 Thistle Street, Edinburgh EH2 1DYWalesRegus House, Falcon Drive, Cardiff Bay CF10 4RUNorthern Ireland20 Adelaide Street, Belfast BT2 8GBTelephone: 0845 357 3456Facsimile: 0845 357 8001Website: www.gmc-uk.orgOutside the UK telephone: 44(0)161 923 6602Tomorrow’sdoctors
Tomorrow’s doctorsTomorrow’s doctorsTomorrow’s doctorsTomorrow’s doctorsThe duties of a doctor registered with theGeneral Medical CouncilPatients must be able to trust doctors with their lives and well-being. To justifythat trust, we as a profession have a duty to maintain a good standard of practiceand care and to show respect for human life. In particular as a doctor you must:make the care of your patient your first concerntreat every patient politely and consideratelyrespect patients’ dignity and privacylisten to patients and respect their viewsgive patients information in a way they can understandrespect the rights of patients to be fully involved in decisions about their carekeep your professional knowledge and skills up to daterecognise the limits of your professional competencebe honest and trustworthyrespect and protect confidential informationmake sure that your personal beliefs do not prejudice your patients’ careact quickly to protect patients from risk if you have good reason to believe thatyou or a colleague may not be fit to practiseavoid abusing your position as a doctorwork with colleagues in the ways that best serve patients’ interests.In all these matters you must never discriminate unfairly against your patients orcolleagues. And you must always be prepared to justify your actions to them.Approved January 2003Published February 2003General Medical Council 01
Tomorrow’s doctorsTomorrow’s doctorsContentsIntroductionPage5The main recommendations5Curricular outcomesThe principles of professional practiceOutcomes778Curricular content, structure and deliveryContentThe scientific basis of practiceTreatmentClinical and practical skillsCommunication skillsTeaching skillsGeneral skillsThe working environmentMedico-legal and ethical issuesDisability and rehabilitationThe health of the publicThe individual in societyStructureDelivering the curriculumSupervisory structuresTeaching and learningLearning resources and facilitiesStudent selectionStudent support, guidance and sessing student performance and competenceThe principles of assessmentAssessment proceduresAppraisalStudent progress222223232402 General Medical CouncilStudent health and conductGeneral principlesConfidentiality for medical studentsThe responsibility of medical students to protect patientsThe responsibility of other doctors to protect patientsThe responsibility of universities to protect patientsPage252525262627Putting the recommendations into practiceWhat the law says about undergraduate educationUK lawEuropean Union lawResponsibility for undergraduate education in the UKThe GMCThe medical schoolsThe UK Health DepartmentsThe responsibilities of doctorsThe responsibilities of l GMC contacts39General Medical Council 03
Tomorrow’s doctorsTomorrow’s doctorsIntroductionThe main recommendationsThe undergraduate curriculum is the first stage of medical education. It provides a foundation forfuture learning and practice as a pre-registration house officer (PRHO) and beyond. Graduates whohave gone through this process must be aware of, and meet, the principles of professional practiceset out in our publication Good medical practice (published in May 2001). These principles makeclear to the public the standards of practice and care they should expect.Attitudes and behaviour that are suitable for a doctor must be developed. Students must developqualities that are appropriate to their future responsibilities to patients, colleagues and society in general.We first published Tomorrow’s doctors in 1993. This signalled a significant change in the form of ourguidance. Our emphasis moved from gaining knowledge to a learning process that includes theability to evaluate data as well as to develop skills to interact with patients and colleagues.The core curriculum must be supported by a series of student-selected components that allow studentsto study, in depth, areas of particular interest to them.Medical schools welcomed our guidance and introduced new, ground-breaking curricula. We carriedout a series of informal visits to UK medical schools to monitor their progress in putting ourguidance into practice, highlight and share good practice, and identify areas causing difficulty orconcern. A valuable part in the process of developing and delivering undergraduate curricula hasbeen the ongoing and developing partnerships between medical schools and the NHS.We carried out a second round of informal visits between autumn 1998 and spring 2001. We thenreviewed progress, considering the strengths and weaknesses of our guidance. This review tookaccount of developments in educational theory and research, and professional practice.These recommendations, which replace those published in 1993, identify the knowledge, skills,attitudes and behaviour expected of new graduates. They:put the principles set out in Good medical practice at the centre of undergraduate education;make it clear what students will study and be assessed on during undergraduate education;make it necessary for all medical schools to set appropriate standards; andmake necessary rigorous assessments that lead to the award of a primary medicalqualification (PMQ).The core curriculum must set out the essential knowledge, skills and attitudes students must have bythe time they graduate.The core curriculum must be the responsibility of clinicians, basic scientists and medical educationalistsworking together to integrate their contributions and achieve a common purpose.Factual information must be kept to the essential minimum that students need at this stage ofmedical education.Learning opportunities must help students explore knowledge, and evaluate and integrate (bringtogether) evidence critically. The curriculum must motivate students and help them develop the skills forself-directed learning.The essential skills that graduates need must be gained under supervision. Medical schools must assessstudents’ competence in these skills.The curriculum must stress the importance of communication skills and the other essential skills ofmedical practice.The health and safety of the public must be an important part of the curriculum.Our recommendations provide the framework that UK medical schools use to design detailedcurricula and schemes of assessment. They also set out the standards that we will use to judge thequality of undergraduate teaching and assessments when we visit medical schools and ask forwritten information.04 General Medical CouncilGeneral Medical Council 05
Tomorrow’s doctorsTomorrow’s doctorsCurricular outcomesClinical education must reflect the changing patterns of healthcare and provide experience in a varietyof clinical settings.The principles of professional practice1Teaching and learning systems must take account of modern educational theory and research, andmake use of modern technologies where evidence shows that these are effective.The principles of professional practice set out in Good medical practice must form the basisof medical education.Good clinical careSchemes of assessment must take account of best practice, support the curriculum, make sure that theintended curricular outcomes are assessed and reward performance appropriately.Doctors must practise good standards of clinical care, practise within the limits of theircompetence, and make sure that patients are not put at unnecessary risk.When designing a curriculum, putting it into practice and continually reviewing it, medical schools mustset up effective supervisory structures which use an appropriate range of expertise and knowledge.Maintaining good medical practiceSelection, teaching and assessment must be free from unfair discrimination.Relationships with patientsDoctors must keep up to date with developments in their field and maintain their skills.Doctors must develop and maintain successful relationships with their patients.Working with colleaguesDoctors must work effectively with colleagues.Teaching and trainingIf doctors have teaching responsibilities, they must develop the skills, attitudes and practicesof a competent teacher.ProbityDoctors must be honest.HealthDoctors must not allow their own health or condition to put patients and others at risk.206 General Medical CouncilThe following curricular outcomes are based on these principles. They set out what isexpected of graduates. All curricula must include outcomes that are consistent with those setout over the following pages.General Medical Council 07
Tomorrow’s doctorsTomorrow’s doctorsOutcomes63Graduates must be able to show that they can meet the following outcomes.4Good clinical careKnow about and understand the following:(a) Our guidance on the principles of good medical practice and the standards ofcompetence, care and conduct expected of doctors in the UK.(b) The environment in which medicine is practised in the UK.(c) How errors can happen in practice and the principles of managing risks.Know about, understand and be able to apply and integrate the clinical, basic, behaviouraland social sciences on which medical practice is basedBe able to perform clinical and practical skills safelyDemonstrate the following attitudes and behaviour:(a) Recognise personal and professional limits, and be willing to ask for help whennecessary.(b) Recognise the duty to protect patients and others by taking action if a colleague’shealth, performance or conduct is putting patients at risk.5Relationships with patientsKnow about and understand the rights of patientsBe able to communicate effectively with individuals and groupsDemonstrate the following attitudes and behaviour:(a) Accept the moral and ethical responsibilities involved in providing care to individualpatients and communities.(b) Respect patients regardless of their lifestyle, culture, beliefs, race, colour, gender,sexuality, disability, age, or social or economic status.(c) Respect the right of patients to be fully involved in decisions about their care, includingthe right to refuse treatment or to refuse to take part in teaching or research.(d) Recognise their obligation to understand and deal with patients’ healthcare needs byconsulting them and, where appropriate, their relatives or carers.7 Working with colleaguesKnow about, understand and respect the roles and expertise of other health and socialcare professionalsBe able to demonstrate effective teamworking and leadership skillsBe willing to lead when faced with uncertainty and change.Maintaining good medical practice8Be able to gain, assess, apply and integrate new knowledge and have the ability to adaptto changing circumstances throughout their professional lifeBe willing to take part in continuing professional development to make sure that theymaintain high levels of clinical competence and knowledgeUnderstand the principles of audit and the importance of using the results of auditto improve practiceBe willing to respond constructively to the outcome of appraisal, performance reviewand assessment.Teaching and trainingBe able to demonstrate appropriate teaching skillsBe willing to teach colleagues and to develop their own teaching skills.9ProbityGraduates must demonstrate honesty.10HealthGraduates must be aware of the health hazards of medical practice, the importance oftheir own health and the effect that their health has on their ability to practise safely andeffectively as a doctor.08 General Medical CouncilGeneral Medical Council 09
Tomorrow’s doctorsTomorrow’s doctorsCurricular content, structure and deliveryContentTreatment161112The curriculum must be intellectually challenging and place greater demand on students asthey progress. Students should have time for reflection and personal growth, to catch up onelements they have missed because of illness, or other good reasons, and to deal withdifficulties in coming to terms with a particular part of the curriculum.how to evaluate effectiveness against evidencehow to take account of patients’ own views and beliefs when suggestingtreatment optionsthe effective and safe use of medicines as a basis for prescribing, including side effects,harmful interactions, antibiotic resistance and genetic indicators of the appropriatenessof drugsproviding surgical and perioperative carerecognising and managing acute illnessthe care of people with recurrent and chronic illnesses and people with mental orphysical disabilitiesrehabilitation, and care within institutions and the communityrelieving pain and distresspalliative care, including care of the terminally ill.The following curricular themes set out the knowledge, skills, attitudes and behaviourexpected of graduates. It is not a complete guide. Medical schools will need to add to themwhen they design curricula.The scientific basis of practice13Graduates must have a knowledge and understanding of the clinical and basic sciences. Theymust also understand relevant parts of the behavioural and social sciences, and be able tointegrate and critically evaluate evidence from all these sources to provide a firm foundationfor medical practice.14They must know about and understand normal and abnormal structure and function,including the natural history of human diseases, the body’s defence mechanisms, diseasepresentation and responses to illness. This will include an understanding of the genetic, socialand environmental factors that determine disease and the response to treatment.15Graduates must know about biological variation, and have an understanding ofscientific methods, including both the technical and ethical principles used whendesigning experiments.10 General Medical CouncilGraduates must know about and understand the principles of treatment includingthe following:17They must also know about and understand the role that lifestyle, including diet and nutrition,can play in promoting health and preventing disease.18They must be aware that many patients are interested in and choose to use a range ofalternative and complementary therapies. Graduates must be aware of the existence andrange of such therapies, why some patients use them, and how these might affect other typesof treatment that patients are receiving.General Medical Council 11
Tomorrow’s doctorsTomorrow’s doctorsClinical and practical skillsCommunication skills19Graduates must be able to do the following safely and effectively:take and record a patient’s history, including their family historyperform a full physical examination, and a mental-state examinationinterpret the findings from the history, the physical examination, and themental-state examinationinterpret the results of commonly used investigationsmake clinical decisions based on the evidence they have gatheredassess a patient’s problems and form plans to investigate and manage these, involvingpatients in the planning processwork out drug dosage and record the outcome accuratelywrite safe prescriptions for different types of drugscarry out the following procedures involving veins:(a) venepuncture(b) inserting a cannula into peripheral veins(c) giving intravenous injections.give intramuscular and subcutaneous injectionscarry out arterial blood samplingperform suturingdemonstrate competence in cardiopulmonary resuscitation and advancedlife-support skillscarry out basic respiratory function testsadminister oxygen therapyuse a nebuliser correctlyinsert a nasogastric tubeperform bladder catheterisation.12 General Medical Council20Graduates must be able to communicate clearly, sensitively and effectively with patients andtheir relatives, and colleagues from a variety of health and social care professions. Clearcommunication will help them carry out their various roles, including clinician, team member,team leader and teacher.21Graduates must know that some individuals use different methods of communication, forexample, Deafblind Manual and British Sign Language.22Graduates must be able to do the following:communicate effectively with individuals regardless of their social, cultural or ethnicbackgrounds, or their disabilitiescommunicate with individuals who cannot speak English, including workingwith interpreters.23Students must have opportunities to practise communicating in different ways, includingspoken, written and electronic methods. There should also be guidance about how to cope indifficult circumstances. Some examples are listed below:breaking bad newsdealing with difficult and violent patientscommunicating with people with mental illness, including cases where patients havespecial difficulties in sharing how they feel and think with doctorscommunicating with and treating patients with severe mental or physical disabilitieshelping vulnerable patients.General Medical Council 13
Tomorrow’s doctorsTomorrow’s doctorsTeaching skillsThe working environment2425Graduates must understand the principles of education as they are applied to medicine. Theywill be familiar with a range of teaching and learning techniques and must recognise theirobligation to teach colleagues. They must understand the importance of audit and appraisal inidentifying learning needs for themselves and their colleagues.27the organisation, management, provision and regulation of healthcare; andthe structures and functions of the NHS.Graduates must be able to do the following:28identify their own learning needsuse different techniques to record, organise and present information, including computersand IT resourcesuse and evaluate a variety of teaching techniques to communicate informationto colleagues.Graduates must be able to do the following:manage their own time and that of othersprioritise tasks effectivelyreflect on practice, be self-critical and carry out an audit of their own work and thatof othersuse research skills to develop greater understanding and to influence their practicefollow the principles of risk management when they practisesolve problemsanalyse and use numerical datatake account of medical ethics when making decisions.14 General Medical CouncilGraduates must be aware of current developments and guiding principles in the NHS,for example:patient-centred caresystems of quality assurance such as clinical governanceclinical auditthe significance of health and safety issues in the healthcare settingrisk assessment and management strategies for healthcare professionalsthe importance of working as a team within a multi-professional environment.General skills26Graduates must understand the working, organisational and economic framework in whichmedicine is practised in the UK, including:Medico-legal and ethical issues29Graduates must know about and understand the main ethical and legal issues they will comeacross. For example, how to:make sure that patients’ rights are protectedmaintain confidentialitydeal with issues such as withholding or withdrawing life-prolonging treatmentprovide appropriate care for vulnerable patientsrespond to patients’ complaints about their caredeal appropriately, effectively, and in patients’ interests, with problems in the performance,conduct or health of colleaguesconsider the practice of medicine within the context of limited financial resources.General Medical Council 15
Tomorrow’s doctors30Graduates must understand the principles of good practice set out in our publicationSeeking patients’ consent: the ethical considerations. These include:Tomorrow’s doctorsThe individual in society34providing enough information about conditions and possible treatments to allow patientsto make informed decisions about
doctors London Regent’s Place, 350 Euston Road, London NW1 3JN Manchester St James’s Buildings, 79 Oxford Street, Manchester M1 6FQ Scotland Napier House, 35 Thistle Street, Edinburgh EH2 1DY Wales Regus House, Falcon Drive, Cardiff Bay CF10 4RU NorthernIreland 20 Adelaide Street, Belfast BT2 8GB
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Sydney Sheldon - If Tomorrow Comes If Tomorrow Comes Sydney Sheldon Hmmm, looks like another genie got out of the bottle Me Fiction Scanned and fully proofed by nihua, 2002-03-24 v4.1 CR/LFs removed and formatting tidied. pdb conversion by bigjoe. IF TOMORROW COMES by Sidney Sheldon, 1985 BOOK ONE Chapter 01 New Orleans THURSDAY, FEBRUARY 20 .
Advantages to NHS Trusts of helping junior doctors — a supplement to the clinical audit and QI workforce 12 Responsibilities to junior doctors to support their training 12 Relationship of involving junior doctors in clinical audit and QI to external requirements of NHS Trusts 13
Locums and doctors in short-term placements are an essential part of the work force, contributing to patient care and safety. There is no evidence available to suggest that locums or doctors in short-term placements put patients more at risk compared to other doctors in more substantive posts.
foreign-trained doctors are not U.S. citizens—meaning that the majority are foreign-born.1 These doctors play a key role in providing healthcare for millions of Americans. This report builds upon other studies that have looked at the critical role foreign-trained doctors play regionally, in underserved communities, in rural areas, and
Most doctors at China's urban hospitals received at least four years of post-secondary medical education, but the average education level of rural doctors is considerably lower.8 As of 2014, only 11.9 percent of rural doctors had received a bachelor's degree. By contrast, 65.7 percent of doctors in urban hospitals had a bachelor's degree.9
Lower CPE requirements are for doctors who are in reduced practice. Doctors in reduced practice: may prescribe medication for himself and his family members (spouse, child, adopted child, stepchild, grandchild, sibling, parent, step-parent and grandparent); and the above condition applies to doctors who are residing locally or overseas. .
Independent Personal Pronouns Personal Pronouns in Hebrew Person, Gender, Number Singular Person, Gender, Number Plural 3ms (he, it) א ִוה 3mp (they) Sֵה ,הַָּ֫ ֵה 3fs (she, it) א O ה 3fp (they) Uֵה , הַָּ֫ ֵה 2ms (you) הָּ תַא2mp (you all) Sֶּ תַא 2fs (you) ְ תַא 2fp (you
