Editorials |
Medical education—the need for change
In November 2006 the Prime Minister said:‘A stable economy is the foundation of a fair and prosperous society. My Government will continue to maintain low inflation, sound public finances, and high employment’ [1].
The economy of virtually every country in the world depends on the majority of the working age population being employed. The fruit of this labour helps to drive a country's gross domestic product and hence its standard of living. Work can fuel improvements in the health of populations but it is also very important to the individual in terms of their perception of self-worth and health.
A productive population requires a healthy workforce but at the same time work can help to maintain mental and physical health, includes people in society and helps prevent poverty. While work is not the only issue for well-being [2], the negative consequences of worklessness due to unemployment, ill-health, disability or injury are well-known. They include, increasing abnormal health-related behaviour, loss of contact with the labour market and reduced or fixed income leading to loss of social contact [3].
There is increasing evidence that for most of the common medical problems for which people claim an unemployment or incapacity benefit, the right kind of work is beneficial to their health [4]—work is therapeutic! Supporting people to remain in, or move back into, work is therefore a key element of public health strategy.
It is important that all health care professionals are aware of the importance of work to the individual, their family and society.
There have been attempts to ‘mainstream’ occupational safety and health into education with the aim of making ‘risk management ... an intrinsic part of the way decisions are made and actions are taken in the workplace’ [5]. But despite the prominence given to occupational health issues in recent UK government policy, there appears to be a declining commitment to integrate training in occupational medicine into UK medical schools and into postgraduate training [6].
Consequently, many clinicians are not aware of the relationship between work and health and unless they are personally interested in occupational medicine will not see these issues as relevant to their day-to-day practice.
So what could be done?
The General Medical Council (GMC) has responsibilities encompassing both undergraduate and postgraduate education [7]. In 1993, the GMC issued guidance for undergraduate medical education in ‘Tomorrow's Doctors’ [8], designed to ensure that medical undergraduates are provided with appropriate knowledge, skills, attitudes and behaviour. Recently, it has suggested that all doctors should be revalidated periodically to ensure that they have maintained their skills and knowledge to a satisfactory standard.
At postgraduate level, the competent authorities for the Foundation Programme are the GMC for the first year before registration and the Postgraduate Medical Education and Training Board (PMETB) for the second year of the programme after full registration; the two organizations have separate but linked responsibilities for medical education and training and for registration.
In 2005, the GMC and PMETB jointly published ‘Principles of Good Medical Education and Training’ [9] which provides an underpinning framework for the development of undergraduate and postgraduate medical education and training including the provision, design and delivery of the curriculum.
An understanding of the positive and negative effects of work on the individual would seem to be an essential element of this curriculum. Modern medical practise is no longer concerned solely with curing diseases—it has a much wider remit including supporting people with health conditions and disabilities in work because this is the ‘healthy option’.
How often have we experienced health care professionals giving unduly negative messages about their patients' ability to work? The expectations about a return to work following illness or injury can be overly pessimistic. Clinical outcome measures of advice and treatment rarely include ‘return to work’ as an objective [10].
Unless there is a recognition within medical education of the importance of the interrelationship between health and work, many clinicians will continue to view work as potentially ‘toxic’ for their patients and inappropriately advocate leave or early retirement on health grounds.
We therefore need recognition from the GMC, the Council of Heads of Medical Schools and other influential bodies that safe work is an important contributor to health and to develop a uniform system for the delivery of teaching about the importance of work and occupational medicine in our medical schools and in postgraduate training.
Without such a change, too many patients will spend a part of their life economically inactive and unnecessarily excluded from mainstream society.
e-mail: nick{at}niven-jenkins.co.uk
References
- Prime Minister's Speech Economic Stability, Growth and Prosperity. http://www.primeminister.gov.uk/files/pdf/economic%20stability%20growth%20and%20prosperity.pdf (2 January 2007, date last accessed).
- Wealth, Poverty and Welfare. Economic and Social Research Council A-level briefing. http://www.esrc.ac.uk/ESRCInfoCentre/Images/wealth_a-level_tcm6-11453.pdf (12 December 2006, date last accessed).
- Acheson D. Independent Inquiry into Inequalities in Health Report. (1998) London: The Stationery Office.
- Waddell G, Burton A. Is Work Good for your Health and Well-being? (2006) London: The Stationery Office.
- Learning about Occupational Safety and Health. Summary of a seminar organised in Bilbao. http://osha.europa.eu/publications/forum/8/index.htm?set_language=en (12 December 2006, date last accessed).
- Wynn P, Aw T, Williams N, Harrington M. Teaching of occupational medicine to undergraduates in UK schools of medicine. Occup Med (2003) 53:349–353.[Abstract]
- GeneralMedical Council. Strategic Options for Undergraduate Medical Education. General Medical Council Education Committee Consultation July–October. http://www.gmc-uk.org/education (12 December 2006, date last accessed).
- GeneralMedical Council. Tomorrows Doctors. http://www.gmc-uk.org/education/undergraduate/tomdoc.pdf (12 December 2006, date last accessed).
- GeneralMedical Council and The Postgraduate Medical Education and Training Board. Principles of Good Medical Education and Training. http://www.gmc-uk.org/education/publications/gui_principles_final_1.0.pdf (29 January 2007, date last accessed).
- Quality and Outcomes Framework Information. http://www.ic.nhs.uk/services/qof (1 January 2007, date last accessed).
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