Will four-year medical degrees solve the crisis in medical education?

The ongoing workforce crisis is also a crisis in medical education. The advance of technology and science are complicated by widening inequalities, shifting demographics, and escalating multimorbidities. These were challenges enough for budding doctors even before the rapid evolution of artificial intelligence, but the question now is how should medical training evolve in response?

Two issues dominate. First, is the medical workforce big enough? On international comparisons with European countries, the UK has fewer doctors per head of population. As demand rises and funds are squeezed – despite the sum awarded to the NHS in the UK government’s recent budget – doctors are inevitably overworked and dissatisfied. A simple example is the increased hospital activity from long COVID. ¹

Second, is the medical workforce being trained to the right level, with the right skill set? Here, dissatisfaction is further deepened by limited training opportunities and a loss of the team ethos ² that was at the heart of the “firm” system. The health system itself, by some accounts, is being Sovietised.^3,4

One policy response is to increase the workforce of health professionals, including doctors. Political leaders are clear in stating that the strategy is not to simply rely on international medical graduates, but it is to become more self-sufficient. New medical schools are opening, some of which offer accelerated four-year degrees.

However, just cutting the years of training isn’t a solution on its own. What doctors need to know is rapidly expanding. The concept of information overload was widely accepted over two decades ago. Since then information overload has only worsened. Similarly, the required skill set, both technical and compassionate, grows too.

And, yet, the thrill of the new cannot suffice without the foundations that any medical career must be built on. What is a doctor without the basic clinical skills of history and examination, without the deductive skills to consider appropriate differential diagnoses?

What, too, about the longstanding gaps in teaching critical appraisal, appreciating science, ⁵ and patient communication that even the oldest and grandest medical schools have neglected?

There is a way out of this complex misalignment but it doesn’t lie in short cuts to medical qualifications. It does, though, rest on understanding the multilayered role of today’s and tomorrow’s doctors, on redesigning medical education to meet those emerging needs while preserving the essence of the role, and daring to accept that the last workforce plan didn’t solve the problem.