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GMC Curricular content and structure

Content

The curriculum must be intellectually challenging and place greater demand on students as they progress. Students should have time for reflection and personal growth, to catch up on elements they have missed because of illness, or other good reasons, and to deal with difficulties in coming to terms with a particular part of the curriculum.

The following curricular themes set out the knowledge, skills, attitudes and behaviour expected of graduates. It is not a complete guide. Medical schools will need to add to them when they design curricula.

The scientific basis of practice

Graduates must have a knowledge and understanding of the clinical and basic sciences. They must also understand relevant parts of the behavioural and social sciences, and be able to integrate and critically evaluate evidence from all these sources to provide a firm foundation for medical practice.

They must know about and understand normal and abnormal structure and function, including the natural history of human diseases, the body's defence mechanisms, disease presentation and responses to illness. This will include an understanding of the genetic, social and environmental factors that determine disease and the response to treatment.

Graduates must know about biological variation, and have an understanding of scientific methods, including both the technical and ethical principles used when designing experiments.

Treatment

Graduates must know about and understand the principles of treatment including the following.

a. How to evaluate effectiveness against evidence.

b. How to take account of patients' own views and beliefs when suggesting treatment options.

c. The effective and safe use of medicines as a basis for prescribing, including side effects, harmful interactions, antibiotic resistance and genetic indicators of the appropriateness of drugs.

d. Providing surgical and perioperative care.

e. Recognising and managing acute illness.

f. The care of people with recurrent and chronic illnesses and people with mental or physical disabilities.

g. Rehabilitation, and care within institutions and the community.

h. Relieving pain and distress.

i. Palliative care, including care of the terminally ill.

They must also know about and understand the role that lifestyle, including diet and nutrition, can play in promoting health and preventing disease.

They must be aware that many patients are interested in and choose to use a range of alternative and complementary therapies. Graduates must be aware of the existence and range of such therapies, why some patients use them, and how these might affect other types of treatment that patients are receiving.

Clinical and practical skills

Graduates must be able to do the following safely and effectively.

a. Take and record a patient's history, including their family history.

b. Perform a full physical examination, and a mental-state examination.

c. Interpret the findings from the history, the physical examination, and the mental-state examination.

d. Interpret the results of commonly used investigations.

e. Make clinical decisions based on the evidence they have gathered.

f. Assess a patient's problems and form plans to investigate and manage these, involving patients in the planning process.

g. Work out drug dosage and record the outcome accurately.

h. Write safe prescriptions for different types of drugs.

i. Carry out the following procedures involving veins.

i. Venepuncture.

ii. Inserting a cannula into peripheral veins.

iii. Giving intravenous injections.

j. Give intramuscular and subcutaneous injections.

k. Carry out arterial blood sampling.

l. Perform suturing.

m. Demonstrate competence in cardiopulmonary resuscitation and advanced life-support skills.

n. Carry out basic respiratory function tests.

o. Administer oxygen therapy.

p. Use a nebuliser correctly.

q. Insert a nasogastric tube.

r. Perform bladder catheterisation.

Communication skills

Graduates must be able to communicate clearly, sensitively and effectively with patients and their relatives, and colleagues from a variety of health and social care professions. Clear communication will help them carry out their various roles, including clinician, team member, team leader and teacher.

Graduates must know that some individuals use different methods of communication, for example, Deafblind Manual and British Sign Language.

Graduates must be able to do the following.

a. Communicate effectively with individuals regardless of their social, cultural or ethnic backgrounds, or their disabilities.

b. Communicate with individuals who cannot speak English, including working with interpreters.

Students must have opportunities to practise communicating in different ways, including spoken, written and electronic methods. There should also be guidance about how to cope in difficult circumstances. Some examples are listed below.

a. Breaking bad news.

b. Dealing with difficult and violent patients.

c. Communicating with people with mental illness, including cases where patients have special difficulties in sharing how they feel and think with doctors.

d. Communicating with and treating patients with severe mental or physical disabilities.

e. Helping vulnerable patients.

Teaching skills

Graduates must understand the principles of education as they are applied to medicine. They will be familiar with a range of teaching and learning techniques and must recognise their obligation to teach colleagues. They must understand the importance of audit and appraisal in identifying learning needs for themselves and their colleagues.

Graduates must be able to do the following.

a. Identify their own learning needs.

b. Use different techniques to record, organise and present information, including computers and IT resources.

c. Use and evaluate a variety of teaching techniques to communicate information to colleagues.

General skills

Graduates must be able to do the following.

a. Manage their own time and that of others.

b. Prioritise tasks effectively.

c. Reflect on practice, be self-critical and carry out an audit of their own work and that of others.

d. Use research skills to develop greater understanding and to influence their practice.

e. Follow the principles of risk management when they practise.

f. Solve problems.

g. Analyse and use numerical data.

h. Take account of medical ethics when making decisions.

The working environment

Graduates must understand the working, organisational and economic framework in which medicine is practised in the UK, including:

a. the organisation, management, provision and regulation of healthcare; and

b. the structures and functions of the NHS.

Graduates must be aware of current developments and guiding principles in the NHS, for example:

a. patient-centred care;

b. systems of quality assurance such as clinical governance;

c. clinical audit;

d. the significance of health and safety issues in the healthcare setting;

e. risk assessment and management strategies for healthcare professionals; and

f. the importance of working as a team within a multi-professional environment.

Medico-legal and ethical issues

Graduates must know about and understand the main ethical and legal issues they will come across. For example, how to:

a. make sure that patients' rights are protected;

b. maintain confidentiality;

c. deal with issues such as withholding or withdrawing life-prolonging treatment;

d. provide appropriate care for vulnerable patients;

e. respond to patients' complaints about their care;

f. deal appropriately, effectively, and in patients' interests, with problems in the performance, conduct or health of colleagues; and

g. consider the practice of medicine within the context of limited financial resources.

Graduates must understand the principles of good practice set out in our publication Seeking patients' consent: the ethical considerations. These include:

a. providing enough information about conditions and possible treatments to allow patients to make informed decisions about their care;

b. responding to questions;

c. knowing who is the most appropriate person to ask for consent;

d. finding out about a patient's ability to make their own decisions and to give their consent; and

e. statutory requirements that may need to be taken into account.

Disability and rehabilitation

Graduates must know about the following.

a. The rights of people with mental or physical disabilities.

b. How the opportunities available to disabled people can be affected by society's view of them.

c. The potential strengths and contribution of such individuals.

They must also recognise the importance of responses to illness and providing help towards recovery, as well as managing chronic disease and relapse, and reducing or managing impairments, disabilities and handicaps. They must be aware of issues surrounding the needs of parents with children who have mental or physical disabilities.

The health of the public

Graduates must understand the issues and techniques involved in studying the effect of diseases on communities and individuals, including:

a. assessing community needs in relation to how services are provided;

b. genetic, environmental and social causes of, and influences on the prevention of, illness and disease; and

c. the principles of promoting health and preventing disease, including surveillance and screening.

The individual in society

Graduates must understand the social and cultural environment in which medicine is practised in the UK. They must understand human development and areas of psychology and sociology relevant to medicine, including:

They must understand a range of social and cultural values, and differing views about healthcare and illness. They must be aware of issues such as alcohol and drug abuse, domestic violence and abuse of the vulnerable patient. They must recognise the need to make sure that they are not prejudiced by patients' lifestyle, culture, beliefs, race, colour, gender, sexuality, age, mental or physical disability and social or economic status.

Graduates must take account of patients' understanding and experience of their condition, and be aware of the psychological effect that this can have on them and their families. This is particularly important when dealing with vulnerable patients, such as:

Exploring patients' fears and concerns can help them understand their condition and to take an active part in decisions about their treatment.

Structure

The curriculum must have a core and student-selected components (SSCs). The core curriculum must take up most curricular time. We expect that in a standard five-year curriculum between 25% and 33% would normally be available for SSCs.

Together the core curriculum and SSCs must allow students to meet the curricular outcomes. This will make sure that graduates have the necessary knowledge, skills and attitudes to practise as a PRHO. Medical schools must determine the way in which the curricular outcomes are met.

SSCs support the core curriculum and must allow students to do the following.

1. Learn about and begin to develop and use research skills.
2. Have greater control over their own learning and develop their self-directed learning skills.
3. Study, in depth, topics of particular interest outside the core curriculum.
4. Develop greater confidence in their own skills and abilities.
5. Present the results of their work verbally, visually or in writing.
6. Consider potential career paths.

At least two thirds of each student's SSCs must be in subjects related to medicine, whether laboratory-based or clinical, biological or behavioural, research-orientated or in humanities related to medicine.

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