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/

Nor cynical, just realistic.

As everyone's aware, there is a negative impact on current medical training from these experiments, and little apparent interest in what will survive or be damaged by these experiments.

@AgnesX it means the qualified doctors will head out the airport to countries that treat them better. And offer training as that's a whole other problem, not enough places for existing foundation doctors.
All of DDs incoming year are looking at possible alternatives and when they can leave. Already getting recruitment emails from abroad.
It scares me too. And makes me v v sad as DD will likely be the other side of the world in a few years.

@BadNomad really ? I'll need to change my spreadsheet as used to only be one. Wonder how many actually get in with an English degree though. Although Newcastle do the same for Undergraduate medicine.

That is the government plan. Make practicing medicine in the NHS so unappealing that consultants will be a thing of the past. Replace them with cheaper, less qualified non-doctors.

The painful part is that they're paying our replacements more than they pay our junior doctors.

Unfortunately those who are being flattered into taking up these roles are complicit in endangering patient safety and watering down the quality of care provided by the NHS.

As a vet who did similar training only with patients who bite, scratch and kick on a more regular basis. The problem is the lack of science when the non- standard patient comes along. The science enables the problem solving unpicking of a complex case that won't fit an algorithm.
The science also helps you understand new drugs when they come along as you know about receptors, cytokines, tumour necrosis factor and the such like.

@Lonecatwithkitten exactly. Medicine (and veterinary medicine) is only getting more complicated as our understanding deepens, not less so.

I'm a 4th mature medical student and think this could be extremely viable.

We had 2 pre clinical years with only patient volunteers brought in occasionally and GP placements. The time the knowledge really sticks in an applicable way is when it is illustrated by seeing real patients and performing practical tasks (obv not neurosurgery in the first week or anything).

Many very senior clinicians have described medical training to me as an apprentice and I think it is. A solid theoretical knowledge is important but I think it is possible and more efficient to consolidate that early with practical exposure.

Things like physical examinations are not that hard to remember the steps of. They stick in the memory a lot better when you actually come across a positive sign of something. I'm sure nobody is expecting new apprentices to diagnose or rule out obscure conditions from a simple examination with no oversight however they will have a lot more value than those rote learnt before exams by bored students with no practical frame of reference.

What I don't see evidence of is kids hothoused into stellar A level results by ambitious parents being the best or only realistic candidates for the profession.

Entry requirements will need to be rigorous but there is too much inequality at play in traditional entry (indeed graduate entry has become a second chance saloon for those that don't quite make the grade first time which was not its original planned purpose- it was more for those retraining and bringing transferable skills).

Hopefully apprenticeships will allow capable would-be doctors from a range of backgrounds to pick up all the knowledge needed with an emphasis on the practical.

I have faith in this as a concept. Of course it will need trial and refinement.

Point is, you need depth and breadth of knowledge to understand how illness happens and is treated, at all levels- e.g. cellular, patient, population, pharmaceutical. Exposure and experience of real cases makes this easier to absorb. I think it is fine if this learning happens in a slightly different order to the traditional.

There is a lot of gate keeping in medicine from those who have come up the hard way. The knowledge base is not that hard to understand for a bright candidate with suitable aptitude and application, it is just BIG.

Same with engineering and yet apprentices make the highest levels. Why be so against this in principle?

www.themedicportal.com/application-guide/graduate-entry-medicine/?v=79cba1185463

According to this, 12 out of the 17 GEM courses accept non-science degrees. It's why the majority of courses require GAMSAT/UCAT now. You need to prove aptitude.

Will the universities not have to agree to offer the apprenticeship route in the first place? I honestly have no idea what is going on behind the scenes in terms of organising all this with the universities. It’s an absolute fact that we need to train more drs, it’s been highlighted for years.
Increasing the number of places for medicine via the traditional route would just cause similar issues as the proposed apprenticeship anyway re: who is training them on the wards. So who knows what the solution is.

Having read the link it seems that you still have to complete medical school, you just work alongside it and get paid.

presumably you won’t get the long holidays in the first couple of years and will start placements straight away.

I can see this scheme would suit someone with a medic adjacent degree like biochemistry or anatomy, or even nursing, who can’t self fund a second degree.

@BadNomad yup they do. My mistake. But most require science A levels, so be unusual to turn not do a science degree. Be interesting to see how many non science grads they have.

@Spacecowboys there seems to be a lot of uncertainty at the moment. Until they give more funding for more ST places there is no point in training more doctors, via any means. Unless the idea is to have F20 😊.
But until they sort out retention the whole thing is a waste of money. And as PAs earn £40,000 starting salary and F1 £29,000, these ACPs positions are not even cheaper in the short term.

I agree re: retention and also many drs choose to pause training , earning much more as locums. I can’t speak for the whole of the uk but here in the north, training posts go unfilled, particularly for certain specialties with a higher payment premium in an attempt to recruit . There’s no quick or easy answer really.

IIRC years ago medical degrees were 2 years preclinical, classroom only, and 3 years clinical on wards/placement.

if you had a related degree you could skip the preclinical years. I had a couple of classmates do this in the late 90’s at St Andrews, as they stuck to the 2 preclinical years for longer (don’t know current arrangements) as the clinical years were done at other unis - Dundee, Edinburgh, Aberdeen etc as they have/had no teaching hospital.

it’s relatively recently medical degrees were rejigged so clinical work started from day 1.

Same in London, we have loads of gaps in IMT. Just can’t recruit anyone into them.

Many of our trainees qualified overseas - they are excellent, but it just shows we really don’t train anything like enough doctors here at the moment.

The plan is to creat a cadre of practitioners with qualifications that are not recognised by any other country, thus solving the health brain drain problem that the U.K. is currently experiencing.

Good to know there are training places going spare as DD was under the impression they were very over subscribed. She'll have to move hundreds of miles away again though.

DH is a doctor and thinks it’s insanity but a realistic representation of where medicine and the NHS are going.

Ultimatley the current process requires a very high level of candidate/qualifications.
Take DH for example. A* across the board at GCSE and ALEVEL, too 10 university, constant reading and expanding his subject area knowledge. The peers he went to uni with are all working in London or abroad earning well into 6 figures, I’m taking £200k+ on average, whilst he’s barely pulling £70K

The Job doesn’t offer a salary in any way competitive or attractive to the level of candidate they demand… so they had two choices; raise their salaries or drop their standards. I’m going to let you guess which one they’ve chosen 😂

The idea I could be being tubed in resus by some apprentice with mediocre academic results, no medical degree and a ‘can do attitude’ scares the crap out of me!

https://www.instituteforapprenticeships.org/apprenticeship-standards/doctor-degree-v1-0

Content above.

As far as I know it's only going to be open to existing NHS clinical staff, they won't be coming with with the same lack of experience of most current medical students.

It's not going to be worthwhile unis offering it though given the last two years are effectively unpaid.

As previous posters have said, expanding the number of placements is going to be a massive problem for trusts.

Watered down nhs, watered down schools, watered down services and standards across board. The only think that’s not being watered down is the cost of everything around- it’s sky rocketing. What’s not to like?

It isn't "gatekeeping" to have high entry standards to a degree that literally puts people's lives in your hands.

I agree with widening participation - grad medicine, foundation/year zeros and access courses are all good initiatives.

What I don't agree with is dumbing down medical degrees or admitting candidates without proven academic achievement, without also giving them opportunity to make up the knowledge/skills deficit (e.g. by access course or foundation year).

I did an access course and the tuition fee for the course was waived once I completed my medical degree. I think this is a fair way to widen participation.

What I don't agree with is relaxing standards in the name of WP. WP is used cynically as a government tool to push less qualified candidates into pseudo-doctor roles in order to benefit offering NHS healthcare on the cheap, staffed by people who can't work anywhere else. It's quite cleverly done, because if you oppose it, you sound elitist.

This won't work. Who is supposed to supervise these 18 year olds starting their apprentices? Doctors are over-worked and stressed to start with. How is an 18 year old supposed to juggle working in a hospital with learning all the theory that their contemporaries are doing at university. It's just a recipe for disaster.

I was one of the first cohorts to do a school-centred PGCE, back in 2000. I worked in a school from day 1, assisting in classes and then gradually taking on more responsibility and then having full responsibility for the class during the placements (within my home school and at another school).
It was a good way to train a teacher BUT it was very dependent on who your mentor was, whose classes you were observing and so on. And it was also very hard work - working in the school all day and then having to complete reading and essays at home at night as well as planning for any lessons that you had been asked to take that week.
I know for a fact my mentor was knackered after having to supervise me for two terms. I was moved to someone else for the last term. There was so much extra work for the mentor - filling in forms, checking off competencies, mentoring me, making sure I had work to do in the school that was useful both to the school and to me.
The school were more than happy to use me as free supply too. Whenever anyone was off they'd move my mentor to the other teacher's class and I'd have to take the class I was working in. Which was good experience of course, but still stressful and in my first few weeks there I was really not very competent yet. They weren't supposed to be using me as free supply but that's the way it was.

This on the job training for teaching sort of works but I don't see how it can for medicine. Add in the in-depth scientific knowledge that is absolutely essential for medicine to working on the wards (whatever the heck they are supposed to be doing) and extrapolate what I have said about on-the-job teacher training and you've just got a disaster waiting to happen. People's lives are at stake.

I am a senior physiotherapist with over twenty years experience. I have a Master’s degree in advanced clinical practice and a qualification in non medical prescribing. I hold a very senior position within my team and the clinical aspect of my role requires me to support the management of patients with complex multimorbidities.

I am married to a GP and have friends who are GPs and hospital consultants.

The only path for me to safely become a doctor would be to resign and to restart my training as an undergraduate medical student.

The foundations of being a doctor are built on those preclinical years. Lectures, hours and hours and hours of study and punishing exams. The only aspect of my undergraduate studies which was in any way comparable to that of my husband’s was in the musculoskeletal system. We learnt about the cardio-respiratory system and neurology in depth, but not to the extent my husband did and no internal medicine (in addition to all the other multitude of subjects he learnt about).

Our postgraduate training and experience is also in no way comparable, and nor should it have been, I was on a path to becoming a senior physio and he a GP, however as tough as my masters was it was nothing nothing like as intense or difficult (or expensive!) as what my husband and my doctor friends had to get through to where they are today.

These government proposals horrify me, if they do indeed turn out to be a path to nurses and AHPs becoming doctors. There should be (and are) pathways to senior HCPs remaining clinical and progressing in their careers but not at the expense of cheapening the medical profession and ultimately putting the safety of patients at risk.

It is not gate keeping it is years of experience of the way out of the ball park unusual cases, it's being qualified 25 years and then they bring out a totally novel drug and you have to drag out that immunology you learnt in year 2 to understand it. Then a new surgical technique comes along and you really need that detailed anatomy of the femur including all the angles that you learnt on year 1.
Being a good scientist makes you an good clinician.

@huntingcunting thank you for your post and insight. It is refreshing to hear when everyone seems to think they can have a go at being a doctor nowadays and cry elitism if you object.