Medical Apprenticeships. Explain it to me like I’m 5.

[W0tnow]

…because I don’t understand. According to this article, these apprentices will achieve a medical degree after 5 years of on the job training and academic study.

But the traditional route involves 5-6 years of study, (including supervised patient contact, but mostly study) and is, by all accounts, incredibly intense. How can you attend medical school, work in a hospital as an apprentice doctor, from day 1, and achieve the same qualifications in the same amount of time? How is that possible? Who is going to be supervising/ training these apprentices? The same staff who currently train first year doctors?

If I understand this correctly, (and I’m sure I don’t) the only difference between the two qualifications, is that one comes with a massive debt.

https://educationhub.blog.gov.uk/2023/06/30/nhs-doctor-apprenticeships-everything-you-need-to-know/

I think a lot of people are waiting with baited breath to see how this will work in practice.

Your summary is correct and as a doctor I'm horrified

Is it???

But….but…how??

What I don’t understand is how you could even be speaking to/examining a patient (completely supervised by a professional obviously) without a thorough knowledge if anatomy?

I mean, I’m pretty smart and I’m a fast learner but if you showed me your hand and said it hurts here and probably this and this has happened I’d still not even know how all the parts of the hand work together and what different systems of the body might be affecting it. Surely you can’t learn that on the job? And I’d not want to be seen by a trainee who didn’t have that knowledge. I’m a person, not a doll for practicing on 🤷‍♀️

I am also curious as to how this will work. Positives= zero debt , entry requirements will be the same ( I believe) , paid to train. Negatives= Ratio of practice hours vs academic study is unclear, there is a a lack of senior drs to train medical students / junior drs already. Time will tell, as it does with everything else.

It's a terrible idea.

The course is already long, intensive and packed.

There is already a shortage of doctors to train students.

It's not clear that the apprentice version will be internationally recognised which is probably why the government is keen as they will be stuck in the UK

I thought the apprenticeship was a way for nurses etc to train to be a doctor? I could be wrong on that one.

so who in the NHS aid organising this then ?

Are you saying no doctors have been involved in the scheme at all ?

Where I work the are proposing similar for other disciplines. The feeling among most people is that it is completely a political move and it is not remotely realistic.

@Unsure33 of course there will be doctors involved in this.

There are doctors that like getting on and doing the job, and doctors that like being on committees.

It will be the latter sort.

When I did medicine at uni 81-86 we did anatomy, physiology, biochemistry, microbiology pathology pharmacology and lots of other basic sciences in our first 3 years with patients being brought in from year 3. They are brought in earlier now which is good from a learning to communicate perspective but I know why things work, I understand why your bloods go abnormal because I understand the biochemistry of the kidney and liver etc, I understand pre load and after load on the heart and it's role in heart failure..(actually plumbers understand this too from understanding heating systems) I've learnt the basic science so I can question what I do and don't do. Even if I can't remember everything clearly I still know where to look things up to remind me about how the body actually works. Medicine is not easy and it is not an exact science. I really worry about the apprentice scheme. I'm retiring in 9 weeks and worry for my own health care.

This wouldn't be too bad. We used to have students who were science post grads who came in for years 2-5 if the course but they still knew a lot of basic science.

Surely they'll have to have a science degree or something, a few exams before they start? To show they know the science? Otherwise this sounds like a terrible idea.

I suspect it will be very similar to the clinical component of old-style medical degrees - the apprentice will be attached to a firm for a 12 week rotation, will do basic ward jobs (cannulas, bloods, writing in notes, discharge letters) and in exchange will pick up stuff as they go along. Lectures one day a week. They will need to do a fuck of a lot of reading in their own time.

Not sure how they will cover the non-clinical components - we had two years of solid 9-5 anatomy/physiology/pharmacology lectures before we were let loose on patients.

In order to be eligible for GMC recognition, the apprentice will need to sit the same exams, including OSCEs (practicals) as traditional medical students.

Not sure who is going to train them. Not enough capacity to train medical students already (many are turned away from placements as no one to teach). The idea of just shoving more students in is so stupid.
Nothing in that NHS plan helps with retention.

@Saschka but there aren't firms anymore. There is a constantly rotating workforce of doctors who are treated like dirt.

I was just going to say “firms” don’t really exist anymore in hospitals.
It’s a terrible idea and I doubt it will ever get off the ground. Will the GMC even agree to register them? And as pp pointed out an “apprenticeship “ will never be regarded the same as the current training.

“Ward team” then. I am a hospital consultant, even with people going on call and on zero days I can assure you there are still “small groups of 3-4 junior doctors attached to one or more consultants, who have responsibility for managing that consultant’s inpatients”, whatever you want to call them.

I have a medical degree. It cost me about £80,000 and the interest goes up every year.

It took me 5 years to complete, but some are 6 years long. 2 years "pre-clinical", with Mon-Fri 9-5 lectures, groupwork, full body cadaveric dissection and communication skills workshops. 3 years "clinical" rotating around different hospital specialties/GP practices with workplace based assessments and further lectures.

We were assessed by written exams, vivas and practicals (OSCEs). Some of these were traditional anatomy exams in the dissection lab, identifying structures on the dead bodies/parts of bodies and relating them to physiology and pathology.

It is one of the most challenging degrees you can complete. It is highly academic and requires an insane amount of private study to get through the exams, whilst also working on the wards.

You cannot replace the content of the pre-clinical years with on the job work. The thing that makes doctors unique is that we have an extensive academic grounding in general science of the human body that we apply to diagnosing and treating disease. Without that scientific basis, you cannot be a real doctor. The clinical skills and experience all builds on that pre-existing knowledge.

A lot of other healthcare professionals look at us and think it's pretty easy to just prescribe medication, give fluids and perform a straightforward operation, but what they don't see is the thought and understanding behind it.

Apprenticeships will just train students to follow algorithms, not to understand "why".

@Saschka can my DD come work for you ? As all her friends have yet to be in a 'team'. They seem to be on call at the mercy of rota gap filling, or on nights. V little actual teaching and just constant grunt work and being shouted at.
I dread DD starting in a few weeks 😞.

Agree, it is going to be very difficult/impossible to replicate the pre-clinical component.

The exams have to be the same - the qualification won’t be recognised otherwise.

So it will either end up being very watered-down, with the first two years basically being pre-clinical with maybe a bit of token ward work to justify the salary. Or the poor apprentices will basically be teaching themselves.

I definitely wouldn’t be volunteering to supervise them, and would steer people away from applying until it is very well established (10+ years in).

The cynical part of me says they will be easier to retain as they are very unlikely to be able to be employed abroad.

Not a doctor but given the recruitment and retention crisis in the NHS I can see why they’re trying to do something new. As long as patient safety can be guaranteed (a big ask) then I’m not automatically opposed to an apprenticeship option.

I know someone who completed first year of medical degree at university and then left - only had approx 5 hours of lectures per week and all the rest was online/ self study. Wasn’t what they expected at all so didn’t continue. This was 2021-22 so post covid. Has this improved now because tbh, 5 hours of actual face to face learning time weekly could probably be achieved via the apprenticeship route?

The problem is that the government is open to trying and throwing lots of money at literally every strategy besides paying doctors what they're worth and improving retention.

The amount of disrespect the government shows my profession by training up other people to replace us, instead of valuing us, is difficult to live with.