Many hands make heavyworkNicholas Jones, Fourth Year Medical Student, Newcastle University, Newcastle upon Tyne, UK

Parry J, Mathers J, Thomas H, Lilford R,

Stevens A, Spurgeon P. More students,

less capacity? An assessment of the

competing demands on academic medi-

cal staff. Med Educ 2008; 42: 1155–1165.

The quality of medical educa-tion may be suffering under thestrain of increasing numbers ofmedical students, and thecompeting interests of researchand clinical medicine.

The number of medicalstudents in the UK has grown by60 per cent since 1998; at thesame time undergraduate educa-tion has become more resource-intensive, focusing on small-group teaching and early clinicalcontact. Researchers aimed toassess the impact of this andcompeting commitments for aca-demic medical staff.

A mixed methods study wasundertaken, encompassing quan-titative work across all UK medicalschools, combined with compre-hensive qualitative investigations

into three case-study schools.These were purposively sampledto reflect different types of med-ical school expansion, and in-cluded a new school, a new schoolshared between two universitiesand an expanded existing school.

Results showed that schoolsfound it difficult to create andmaintain faculties of sufficientsize and diversity to providehigh-quality education to the

expanded number of students.Although extra funding had beenprovided, some felt that this hadactually been used to boost theschool’s performance in the Re-search Assessment Exercise. Thenew researchers were often reluc-tant to teach undergraduates, andso the additional funding did notgreatly improve the number ofteaching staff. Much of the pres-tige and funding of medicalschools is determined by theirresearch work, making it moreprofitable to invest in this aspectrather than educational perfor-mance, where there is no agreed

method of evaluation, and so noperformance-related funding. Thisreinforces the primacy of researchand diminishes teaching capacity.

This research–education ten-sion is exacerbated by clinicalcommitments, and by the explicitdemands made on clinicians bythe UK’s National Health Service(NHS) agreements and perfor-mance management frameworks.Meeting national service targetsbrings in more money than edu-cation does, and so tends to beprioritised. Other NHS policieshave reduced the available timeconsultants have for teachingundergraduates, as has condens-ing specialist training.

In principle, governmentmonies, termed the ServiceIncrement for Teaching (SIFT),fund the extra costs of clinicalplacements and teaching facili-ties. This should allow NHS or-ganisations to ‘backfill’ aconsultant’s time spent teachingusing another clinician. However,the money allocated rarely meetscosts, and it is difficult to reallo-cate funds tied up in old teachinghospitals to those increasing theirteaching commitments. Hospitalsmay need to ‘backfill’ across arange of specialties, and it can bedifficult to find employees forunpopular posts. Nor is there asufficient pool of clinical andresearch staff to teach the in-creased number of students.

Finally, because of the over-subscription of applicants tostudy medicine, all schools knowthey will fill their course as longas completion of the course leadsto a career in medicine. This

Undergraduateeducation hasbecome moreresource-intensive,focusing onsmall-groupteaching andearly clinicalcontact

� Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 59–62 61

removes the pressure for innova-tion and improvement, and merely

drives schools to ensure that theypass the General Medical Council

inspection process, often involv-ing papering over any cracks inthe course.

Without any external qualityassurance or competition betweenmedical schools, it appears thatundergraduate teaching is beingundermined by the rewards ofresearch and clinical activity. Anational policy review is needed,or it may become untenable forschools to pursue research excel-lence and deliver high-qualityeducation to the increasedstudent population.

Meetingnational service

targets bringsin more moneythan education

does, and sotends to beprioritised

62 � Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 59–62