Colin Melville: What will covid-19 mean for the future of medical training?

How can we translate the flexibility we’ve learnt during covid-19 into better training for doctors, asks Colin Melville

For years there’s been talk of UK health services, and those who work in them, being under pressure “like never before.” Throw in a pandemic and you could be forgiven for assuming these services might collapse entirely. That they haven’t, and that healthcare staff continue to provide excellent and compassionate care to patients in the most difficult and distressing of circumstances, is testament to the dedication and skill of an amazing workforce.

Dedication to providing first rate care is largely inbuilt into those of us who seek a career in medicine. But the skills must be learnt, and that learning largely takes place on the job. Hospitals, GP surgeries, and other workplaces are live learning environments for thousands of doctors in training.

As the GMC’s director of education and standards, as well as its medical director, my role includes overseeing training. We ensure doctors receive the education and training they need to provide great care. That means, among other things, ensuring those live learning environments are suitable locations in which to learn while working.

The long lasting impact of coronavirus on education and training remains to be seen. But there’s little doubt, with some elective activities in specialties like surgery being suspended, that some trainees are missing the breadth of experience we’d ordinarily expect. But such unprecedented circumstances are a learning opportunity for us all. Trainees may not be learning all the skills they would expect right now, but what they are learning will be beneficial for their careers. They’re not alone either. Senior doctors, many of whom are trainers in more normal times, are also learning. The “live learning environments” in which doctors work don’t only train those who are officially “in training.” They never have. 

And I’m learning too, both as a doctor with a licence to practise and as a director at the GMC. The pandemic has presented the GMC with unique challenges, many of which don’t have easy solutions.

Our health services will be different post-covid, and that means training pathways will need to differ as well. Some fundamental assumptions we share may not hold anymore, and we will need to think about what the training pathway will look like for doctors.

The desire for greater flexibility in training isn’t new. To that end we have worked with the Academy of Medical Royal Colleges, who have recently published guidance for trainees who switch between specialties, ending the frustrating “snakes and ladders” effect of having to start again at the beginning.

That is a key part of our ongoing work to improve flexibility for trainees. But we must not take a rigid view of what flexibility means. It’s not just the way doctors train, it’s also the methods by which they are trained, how they work, and how they are judged to be competent in newly acquired skills as they progress.

A pandemic has made us act quickly, for example by granting temporary and early provisional registration to more than 30 000 doctors; and by approving around 550 additional training locations, so doctors working at them can count it towards their training progression. We moved fast to make sure trainees’ progression doesn’t suffer. Acting with such immediacy doesn’t come naturally to a regulator, but it was necessary. The situation made us reassess and look at things differently.

Flexibility and agility have been common themes in the responses of health services to coronavirus, whether it’s reorganising hospital layouts, redeploying staff, or rethinking how doctors interact with patients. The important thing now is not to lose sight of how organisations have been able to respond the way they have, and to translate the best of that into the way we train our doctors.

We must not lose the innovations and the resulting gains that this unprecedented situation has prompted. We’re working with medical schools, education bodies, royal colleges and faculties, and with medical students and doctors themselves, to build what we’ve all learnt into what we do in the future.

Medical education and training should continue to be just as flexible and responsive to events and to changing demands. Learning while working won’t always go to plan, but that doesn’t make the unplanned elements any less relevant or valued.

We will emerge from this pandemic, but our health services will be changed. And we as individuals, as well as institutions, will be changed. Medical education and training will be changed as well, and now is the time to be thinking about what those changes will mean.

None of this is a new direction for the GMC, but a change in ambition for how quickly we get to a point where medical education and training is truly flexible and responsive. That will benefit doctors and their patients, of course, but will also ensure the workforce can adapt to even the biggest of challenges.

Colin Melville is medical director and director of education and standards at the General Medical Council, UK. @drcolinm

Competing interests: None.