GMC consultation on the Medical Licensing Assessment - ends 30th April 2017

The GMC is consulting on the Medical Licensing Assessment which will apply to UK medical students, EEA and International graduates and aims “to create a single, objective demonstration that those applying for registration with a licence to practise medicine in the UK can meet a common threshold for safe practice.” (GMC-MLA consultation

The SHE network is drawing up a response to this consultation which is due to end on the 30th April. We would appreciate your comments on the draft set out below. We have focussed on the “scope” section but would value your views  on other questions. (Issues related to these are the: limitations of examination techniques for assessing competence; need for additional questions on sustainability and other emerging health and healthcare challenges). You can access the consultation document from the link to the website above.

DRAFT SHE RESPONSE:

Scope
The MLA blueprint will set out the knowledge and skills to be tested. It would draw on our Outcomes for graduates, taking account of the blueprints for the PLAB test and for the question bank developed by the MSCAA.
The MLA should test a wide range of the competencies necessary for doctors, including understanding patient safety, professionalism, ethics and the law relating to medical practice, prescribing and clinical practice in the UK. 

Q2. What should we consider when defining the areas of knowledge and skill to be tested in the MLA? 

Beyond being a test of core biomedical knowledge, the MLA must examine candidate’s attitudes, understanding of wider issues affecting health and healthcare, and skills including identification, analysis and application of evidence. 

Environmental change is an increasingly important determinant of health and the ability of societies and healthcare services to respond to ill health. Climate change has been recognized as the “biggest global health threat of the 21st Century”(2). Its effects on health are predicted to be overwhelmingly negative, impacting on the social and environmental determinants of health(3). Healthcare professionals have a great opportunity to improve the health of individuals and societies by promoting healthy, environmentally sustainable behaviours, such as active transport, gardening and healthy diets, and policies, such as creating green spaces in towns and cities. 

Furthermore, there is an imperative and a legal duty to reduce resource use, in particular carbon emissions. The NHS is committed to reducing its greenhouse gas emissions by 80% on 1990 levels by 2050(1). Environmental, social and financial resource constraints, risk impacting on the quality of healthcare services. Recognising this, the RCP has identified sustainability as a domain of quality(4). Doctors need to lead delivery of a sustainable health service. 

It is imperative that future doctors are equipped to be able to meet these challenges. Medical education is central to a sustainable future for healthcare and in September 2011 the General Medical Council asked the Sustainable Healthcare Education (SHE) Network to make recommendations on the priority learning outcomes for sustainability, to inform the on-going development of undergraduate and postgraduate medical curricula. The resulting Priority Learning Outcomes have been referenced in the GMC’s Outcomes for Graduates' appendix.

We recommend that the scope of the MLA should include sustainability and that the priority sustainability learning objectives (see below) are assessed within the MLA. 

Priority Sustainability Learning Outcomes:

1.    Describe how the environment and human health interact at different levels.

GMC’s Outcomes for graduates (5), 
•    “The graduate will be able to:recognize the role of environmental and occupational hazards in ill-health and discuss ways to mitigate their effects”

Draft generic professional capabilities document (6) outlines responsibilities that professionals must:

•    “be aware of and understand ..the relationship of the physical, economic and and cultural environment to health; basic principles of public health; basic principles of global health; global and multicultural aspects of delivering evidence-based, sustainable healthcare” 
•    “demonstrate that they can recognize where…environmental exposure…issues are contributing to ill health and act on this information”


2.    Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems

GMC’s outcomes for graduates (5)
•    “The graduate will be able to: demonstrate awareness of the role of doctors as managers, including seeking ways to continually improve the use and prioritisation of resources”.

Good Medical Practice (7) states that doctors:
•    “must take part in systems of …quality improvement” 

Draft generic professional capabilities document (6) outlines responsibilities that professionals must:
•    “manage time and resources effectively”
•    “demonstrate that they can participate in and promote activity to improve the quality and safety of patient care and clinical outcomes.

3.    Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment

Draft generic professional capabilities document (6) outlines responsibilities that professionals must:
•    “doctors must be aware of their legal responsibilities….any other legislation relevant to medical practice

 

[added this para as taken from above but not sure if we need to say this - These learning objectives have been validated in the USA (Tehrani et al). Other guidelines and frameworks have been developed in Australia (Maxwell et al.) and internationally (Walpole et al). Other frameworks support the findings of the UK consultation and are in line with the content in the UK Priority Sustainability Learning Objectives.]

Sustainability is primarily a perspective through which to approach existing topics, such as public health and health inequalities, quality improvement and medical leadership and ethics. 

Sustainable clinical practice should also be examined in the Prescribing Safety Assessment. In line with the learning objective “Identify ways to improve the environmental sustainability of health systems - in individual practice, in health service management, and in the design of care systems”, candidates can demonstrate their knowledge of the need for rational prescribing and communication with a patient about this.

We provide below the expanded priority sustainability learning outcomes, and we believe that these should all be examinable in the MLA.

We recommend that the Priority learning outcomes are used to guide the assessment of the knowledge and skills of graduates/doctors in sustainability. The expanded versions of the  learning outcomes provide suggestions in more detail.


1. Describe how the environment and human health interact at different levels
Doctor as scholar and scientist
•    Outline the dependence of human health on global and local ecological systems, which supply essentials such as air, water and a stable climate.
•    Discuss the contribution of human activity and population size to global environmental changes such as climate change, biodiversity loss and resource depletion.
•    Describe the mechanisms by which human health is affected by environmental change, for example through changes in disease vectors, exposure to extreme weather, migration and reduced food security.
•    Describe features of a health-promoting local environment, in community and healthcare settings, to include access to green spaces, clean air and an active travel infrastructure. 


2. Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems
Doctor as practitioner
•    Define the concept of environmental sustainability. 
•    Explain how trends in demographics, technology, climate and resource availability may affect our ability to provide healthcare into the future. 
•    Describe, with examples, the different types of environmental impact resulting from healthcare provision, and how these may be measured. 
•    Identify ways to improve the environmental sustainability of health systems - in individual practice, in health service management, and in the design of care systems. 
•    Identify potential synergies between policies and practices that promote environmental sustainability and those that promote health.

 

3. Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment. 
Doctor as professional
•    Explain how the health impacts of environmental change are distributed unequally within and between populations and the disparity between those most responsible and those most affected by change. 
•    Recognise and articulate personal values concerning environmental sustainability, given the relationship between the environment and the health of current and future generations. 
•    Discuss ethical tensions between allocating resources to individual patients and protecting the environment upon which the health of the wider community depends.  
•    Demonstrate awareness of organisational sustainability policies and the legal frameworks for reducing carbon emissions. 

 


References:
(1)UK Parliament. Climate Change Act. London: UK Government; 2008
(2)Managing the health effects of climate change. Costello, Anthony et al. The Lancet , Volume 373 , Issue 9676 , 1693 – 1733
(3)"Climate Change And Health". World Health Organization. 2017. Web. 13 Mar. 2017
(4)A Strategy for quality: 2011 and beyond. Royal College of Physicians (2011)
(5)General Medical Council,. Outcomes For Graduates (Tomorrow’s Doctors). London: GMC, 2015. Print.
(6)"GMC | Development Of Generic Professional Capabilities". Gmc-uk.org.2017. Web. 14 Mar. 2017
(7)"GMC | Good Medical Practice (2013)". Gmc-uk.org. N.p., 2017. Web. 14 Mar. 2017

Appendix - 
Report on consultation -Educating for Sustainable Healthcare – Priority Learning Outcomes.

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Comments

Responding to the MLA consultation

Sarah Walpole's picture

I would echo Emily's comment that it would be really valuable to have your contribution (however, small or large) to our response to the MLA consultation. This is a consultation about an exam that all medical students (and doctors coming from abroad) will have to take to enter practice in the UK, so it will have an impact.

You can also just add a comment if you don't want to edit the wiki document.

I've made a few suggestions about organisation of the response. I think we also need to establish whether GMC want to talk about outcomes or objectives or capabilities (I think the later is the new term), and make sure we are consistent.

There were some other questions within the consultation that have some weak relevance to SHE, but i think these are the most important ones.

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