1、The state of medical education and practice in the UK 2020 The state of medical education and practice in the UK 2020 Published by: General Medical Council Regents Place 350 Euston Road London NW1 3JN Telephone: 0161 923 6602 Website: gmc-uk.org Published November 2020 2020 General Medical Council T

2、he text of this document may be reproduced free of charge in any format or medium providing it is reproduced accurately and not in a misleading context. The material must be acknowledged as GMC copyright and the document title specified. Read the report at gmc-uk.org/stateofmed Join the conversation

3、 using #stateofmed To ask for this publication in another format or language, please call us on 0161 923 6602 or email us at publicationsgmc-uk.org General Medical Council 01 Foreword 04 An information resource 06 Executive summary 08 Chapter 1 The state of medical practice 09 Chapter 2 The state of

4、 medical education 10 Chapter 3 The changing medical workforce 11 Chapter 4 Learning from 2020 12 Introduction 13 The human tragedy of the pandemic 13 A catalyst for change 13 Sharing and sustaining positive changes can improve doctors wellbeing and patient care 14 Workloads remain a critical issue

5、14 Supporting an increasingly diverse workforce is essential 15 Disruption to medical education and training 15 An urgent need to sustain positive new ways of working 16 Contents Contents Contents 02 General Medical Council Our response to the pandemic 17 Temporary and provisional registration 17 Re

6、suming the Professional and Linguistic Assessments Board (PLAB) tests 17 Postponing revalidation 17 Changes to medical education and training 17 National training survey 18 Supporting doctors 18 Chapter 1: The state of medical practice 19 Chapter summary 20 Introduction 21 The impact of the pandemic

7、 on doctors working lives 23 New ways of working during the pandemic 31 Doctors workloads during the pandemic 37 The impact of the pandemic on doctors health and wellbeing 40 The impact of the pandemic on safe and supportive healthcare environments 49 The impact of the pandemic on patient care and s

8、afety 52 Chapter 2: The state of medical education 57 Chapter summary 58 Introduction 59 The major changes to education and training 61 The impact on the quality of training and patient safety 75 The effect on trainee and trainer wellbeing 84 Contents General Medical Council 03 Chapter 3: The changi

9、ng medical workforce 93 Chapter summary 94 The UK workforce 95 The supply of UK-trained doctors 106 Doctors who leave the profession 114 Doctors future intentions 121 Chapter 4: Learning from 2020 127 Chapter summary 128 Introduction 129 Supporting doctors wellbeing and ability to deliver high-quali

10、ty care 130 Developing visible leadership, autonomy, and a listening culture 131 Strengthening teamwork and a sense of belonging 136 Helping doctors to build and maintain competence 140 Attracting and retaining a high-quality medical workforce 143 Conclusion 150 Glossary 151 A note on research and d

11、ata 152 References 162 Acknowledgements 168 Foreword 04 General Medical Council Foreword 2020 has tested the resilience of the health system and those who work in it. The fortitude of the workforce has been rightly lauded, with remarkable levels of public support. Experiences of this time have not b

12、een uniform, for patients or for the profession. But clinicians, system leaders and policymakers can all agree that coronavirus (COVID-19) has left its mark, and will continue to do so. The picture is complex, and were only part-way through this pandemic. But clear lessons have already emerged, and

13、we owe it to doctors and the patients they care for to apply them. Central amongst them must be the inequalities that persist in medicine and across society, lent a new urgency by the disproportionate toll of COVID-19 on BME health and social care workers. This is no longer a question of gathering e

14、vidence, but of committing to action. We know that the experiences of doctors from a BME background can be sharply different from those of their white colleagues. It is now a question of what we do about it. This work is critical not only in the interests of justice and fairness, but because BME doc

15、tors make up a growing part of the workforce. 61% of joiners this year identify as BME, compared with 44% in 2017. Meanwhile, more international medical graduates joined the workforce this year than UK and EEA graduates combined. This growing diversity must be accompanied by genuine inclusivity. To

16、meet todays needs, it is not enough to recruit doctors, we also have to retain them. That means making the UK a place where doctors can develop their career and stay for the long term. For all doctors, more must be done to make compassionate cultures a lived reality. Weve seen encouraging signs, wit

17、h 54% reporting that the response to the pandemic had a positive impact on sharing knowledge. But these benefits havent been felt equally. While 68% of white doctors said there had been a positive impact on teamwork between doctors, this figure dropped to 55% for BME doctors. This period has also re

18、affirmed the power of the presence of leadership. 38% of doctors said there had been a positive impact on the visibility of leaders, rising to 58% for trainees. One clear positive cited across all levels was a sense of being all in it together. We know theres a direct correlation between the environ

19、ment in which a doctor works and the care their patient receives. Collaboration, communication and accessible leadership make a material difference. General Medical Council 05 Foreword In this time of uncertainty, these qualities are more important than ever. With a third of doctors reporting that t

20、he pandemic has adversely impacted their mental health, compassionate leadership must come to the fore. The emphasis on wellbeing weve seen during the pandemic must be maintained and built upon. When we look back at 2020, there is much to be proud of. In the face of acute need, healthcare workers an

21、d system leaders have responded with innovation and resolve. Lets seize the opportunity now to sustain and embed the good work thats been done, so were ready for the challenges to come. Dame Clare Marx Chair Charlie Massey Chief Executive and Registrar 06 General Medical Council An information resou

22、rce Alongside this report, we publish a range of data and information resources, which underpin many of the analyses and findings that follow. This includes a set of reference tables, GMC Data Explorer and GMC education data reporting tool. GMC Data Explorer is an interactive data sharing tool, whic

23、h allows external users to access our registration, revalidation, fitness to practise and education data directly. It provides access to data on: the number of UK graduate doctors, which can be broken down by the body that awarded their primary medical qualification (PMQ), or by the doctors register

24、 type, eg specialist register or GP register the current location of registered doctors, where they graduated from and their deanery or local education providers education the number of doctors with open cases and active sanctions at each designated body what allegations are made about doctors over

25、time. Reference tables The reference tables are published on our website.* These data cover five areas. 1 Who is on the register of medical practitioners? Who is on the temporary register (emergency) (TRE)? Who is a 2020 UK graduate? 2 How does the makeup of the register differ by country and region

26、? 3 Who are doctors in training and what are their training programmes? 4 Who are medical students? 5 Fitness to practise data. An information resource Accessing our data through GMC Data Explorer . . * See gmc-uk.org/stateofmed General Medical Council 07 An information resource How can users access

27、 GMC Data Explorer? GMC Data Explorer can be accessed through: https:/data.gmc-uk.org/gmcdata/home/#/ The GMC education data reporting tool Our education data reporting tool allows the public to access a wide range of information regarding medical education in the UK. The tool is commonly used by de

28、aneries, royal colleges, trusts, and local education providers to quality-assure medical education. The tool contains: national training survey results, viewable at different organisation, programme and specialty levels, including: 1 individual question-level results from the 2020 trainee and traine

29、r surveys, as tables or graphs 1 comparisons between full-time and less than full-time trainees 1 results of burnout questions an enhanced monitoring dashboard, displaying the number of current cases in each UK country or region. progression reports on key stages in doctors training, such as: 1 spec

30、ialty examinations 1 annual review of competency progression (ARCP) 1 application and entry into specialty training 1 foundation doctors preparedness for postgraduate training a summary dashboard showing a snapshot of data for any geographic location. How can users access the GMC education data repo

31、rting tool? The tool can be accessed through: www.gmc-uk.org/about/what-we-do-and-why/ data-and-research/national-training-surveys- reports 08 General Medical Council Doctors and healthcare professionals caring for patients with COVID-19 live with the constant fear of contracting the virus and trans

32、mitting it to their families. This risk has been starkly illustrated by the many healthcare professionals who have sadly lost their lives. The pandemic has also caused significant disruption to medical education and training, with the closure of universities and cancellation of planned clinical rota

33、tions. Against this background, doctors have had diverse working experiences some positive, some negative. This report presents a range of original data, research and case studies that explore these experiences throughout the first peak of the pandemic. The cumulative impact of the ongoing pandemic

34、will take time to quantify and understand. But this immediate insight helps us highlight long-term risks and emerging opportunities that need to be considered now. Executive summary Executive summary As we publish our 2020 edition of The state of medical education and practice in the UK, the course

35、of the coronavirus (COVID-19) pandemic remains uncertain. It continues to be a human tragedy one of devastating loss of life, as well as physical and psychological trauma for many patients and their families. General Medical Council 09 Chapter 1 The state of medical practice Doctors have experienced

36、 significant and rapid changes to their personal and professional lives as a result of the pandemic. The Barometer survey 2020 uncovered the widespread impact that the early stages of the pandemic had on doctors day-to-day working lives. Four out of five (81%) doctors experienced significant changes

37、 to their work and over two fifths (42%) were redeployed. As well, healthcare professionals implemented many changes to practice to enable them to continue to provide high-quality care to patients. Doctors reported some positive changes namely to teamwork and knowledge sharing that they felt could b

38、e sustained beyond the pandemic. Compared with 2019, the first six months of 2020 saw a greater proportion of doctors being able to cope with their workload and a smaller proportion at high risk of burnout. This is likely to be linked to some doctors having reduced workloads because elective procedu

39、res were postponed or cancelled. Amid these positive signs, the pandemic brought to the fore some existing challenges. Workloads were still an issue for many. A third (32%) of doctors also indicated that the initial phase of the pandemic had a negative impact on their mental health and wellbeing. An

40、d a relatively high proportion of doctors said they experienced situations where doctor (43%) or patient safety (26%) was compromised. Executive summary 10 General Medical Council Chapter 2 The state of medical education The pandemic has had a significant impact on formal medical education. In respo

41、nse, April rotations were cancelled for all doctors in training and a new post (FiY1) was created for some 2020 medical school graduates to join the workforce early. We approved around 550 additional training locations, so doctors redeployed to them could count this experience towards their training

42、 progression. Its likely that the lessons learned during the pandemic will have a profound impact on the delivery of training in the future. During the spring peak of the pandemic, almost all trainees and trainers experienced changes in their day-to-day roles. In the national training survey (NTS) 2

43、020, over half (57%) of trainees and over three quarters (78%) of trainers reported that their day-to-day work was significantly affected. As part of this change, around two fifths of trainees (41%) said their workload increased, while roughly the same proportion (39%) said it became lighter. Just 1

44、7% of trainees and 11% of trainers experienced no change in their workload. Even in difficult circumstances, trainees still rated key aspects of their education positively. Nearly nine out of ten (86%) trainees described their clinical supervision as good or very good. However, as expected, formal t

45、raining and learning opportunities were significantly affected by the pandemic. Around three quarters of trainees (74%) and trainers (78%) said their training, or their role as a trainer, was disrupted. This had negative consequences for most trainees, especially in terms of limiting their opportuni

46、ties to gain required curriculum competencies. Over half (52%) of all trainees were concerned about their personal safety, or that of their colleagues, during the spring peak of the pandemic. A quarter (24%) felt their concerns were only partially addressed and 3% reported that they werent addressed

47、 at all. We continue to work with partners to ensure that all trainee doctors have safe working environments. Executive summary General Medical Council 11 Chapter 3 The changing medical workforce The medical workforce continues to grow, with a record rise in the number of licensed doctors between 20

48、19 and 2020 (5%). From 2012 to 2020, the number of licensed doctors grew by more than 14%. The UK medical workforce is increasingly ethnically diverse. More than half (54%) of the doctors joining the register in 2020 identified as black and minority ethnic (BME). The number of international medical graduates (IMGs) joining the UK medical workforce continues to increase. Between July 2019 and June 2020, over 10,000 IMGs joined more than UK and European Economic Area graduates combined. Medical school numbers are also up. Overall, the number of students starting medical school