Johanna Kuila is a Policy Analyst for the General Medical Council. In this blog she explains the Medical School Annual Return (MSAR) and how the data it yields is helping to improve end of life care for patients.
What is the MSAR?
Every year the General Medical Council (GMC) sends out the Medical School Annual Return (MSAR) for medical schools to complete. This allows schools to demonstrate that they are managing the quality of their undergraduate medical programmes in line with Promoting Excellence, our standards for medical education and training.
We see MSAR as a method for schools to share challenges and good practice with us. The information collected is then used to inform our quality assurance activities as well as policy development. Annually the MSAR focuses on particular thematic questions that are designed to support our planned policy development work.
The MSAR and End of Life Care
End of life care has been an area of focus for MSAR since 2014. In that time we’ve asked schools a range of questions around end of life care and how it is taught to students to help us gather baseline data. As well as how it is taught, these questions provide insight into innovations and good practice, as well as challenges encountered by schools in their teaching of end of life care.
Feedback from 2014-2017 showed a wide variety of approaches to covering end of life care issues in undergraduate curricula, and in the approach to providing practical learning for students at different stages of their undergraduate programme. But they also demonstrated an increased focus over time on providing opportunities for hands-on learning in hospitals and hospices. This has been supported by more emphasis on personal and group reflection, with the aim of ensuring more meaningful exposure to, and interaction with, patients, carers and family members helping students gain a better understanding of their needs and perspective.
The 2017/18 return showed an increased focus on students’ communication skills as well as knowledge of pain and symptom management and advanced directives. It also showed increased focus on other aspects of dying such as social and public contexts, medicalisation as well as psychological. Public health and palliative care provision were also observed as areas of increased focus.
This return also showed continued growth in the use of placements, with a high percentage of these in hospices. Schools reported that challenges included access to placements, student access to patients, clinician availability, managing student well-being, curriculum time, and aiming to ensure that end of life care was not restricted to palliative care.
Despite these challenges, the 2017/18 return highlighted some notable achievements including the appointment of palliative care leads that act as champions, cross-discipline working groups, and a new palliative medicine student society. It also showed that recognition of the challenges provided an opportunity for medical schools to explore options to mitigate some of the challenges, as part of their curriculum planning.
Looking ahead to 2018/19
In 2018 we released our new Outcome for Graduates and there is inclusion of a specific End of Life Care outcome:
‘Newly-qualified doctors must demonstrate that they can make appropriate clinical judgements when considering or providing compassionate interventions or support for patients who are nearing or at the end of life. They must understand the need to involve patients, their relatives, carers or other advocates in management decisions, making referrals and seeking advice from colleagues as appropriate.’
The 2018/19 MSAR questions have been sent to medical schools for completion by the end of January. This year the end of life care section asks two questions. The first relates to the challenges identified in the 2017/18 return and asks ‘Since the last return, have there been any changes or improvements made to overcome these challenges? If so, can you describe how you achieved this?’ The second question relates to the new end of life care outcome in Outcome for Graduates and asks ‘What is your plan for implementing changes to learning and teaching of end of life care to enable doctors to meet this outcome when they become newly qualified?
How does the MSAR contribute to End of Life Care?
We work with educators and others to achieve high standards of care for patients, including those receiving end of life care. The information on end of life care gathered from the MSARs contributes to the evidence that informs policy development. The MSAR is also one of the ways in which we work with medical schools to improve our understanding about the learning of end of life care so we can collaboratively improve the capability and preparedness of doctors in this area.
More information about the MSAR can be found on our website