More students, less capacity? An assessment of the competing demands on academic medical staff

Medical student numbers in England have increased by more than 60% over the last decade. The capacity of universities and the National Health Service (NHS) to deliver education and training to these expanded cohorts is not clear. We carried out an interview study in three English medical schools, involving 60 academic, administrative, clinical and managerial staff, sampled across disciplines. Given the expansion in medical student numbers, capacity in medical schools must increase. This requirement has become even more immediate in light of the shift towards more resource-intensive curricula. However, the aims of the Research Assessment Exercise and NHS policies are at odds with attempts to build teaching capacity. Although monies have been made available to recruit new staff and to backfill clinical time spent teaching, the success of these strategies is questioned by interviewees. Other initiatives, such as the new consultant contract and educational quality assurance processes, have the potential to promote the importance of teaching but are presently perceived as being inadequate so to do. As was consistently expressed by interviewees, within the competing triad of research, service delivery and teaching, the latter is perceived as taking a poor third place. That research, service delivery and education are in competition will come as no surprise to UK academic staff. However, our results show a striking uniformity of opinion. We would question whether existing NHS and higher education policies enable medical schools and health care organisations to deliver education of the highest quality to the enlarged student population.