We recognize that these proposals carry significant challenges to healthcare education and its professional boundaries - the key issue is defining learning outcomes, competences and credit values. Gaps in knowledge and skills competences may be viewed as a barrier to change. Yet there is little agreement on the level of detail for disciplines needed for each health profession. Variation in emphasis in UK medical schools is welcomed, but tempered by the General Medical Council who accredits the award and quality assures the knowledge, skills and professional attributes achieved for confirming fitness to practise as a doctor. It might be argued that the skills of decision-making, diagnosis and breadth of training makes medicine different to other health professions - here again, skills may be learned within profession-specific modules and breadth through exposure.
A common foundation curriculum would aid flexibility in moving between programmes. But prior declaration and enrolment for a specific programme (e.g. physiotherapy, radiography, medicine) would be essential if competition between students for the professions was to be avoided. The aim is not for everyone to become a doctor, but to acknowledge and credit areas of common learning to allow ease in retraining for another profession in the future.
The medical school in Brunei suggests a good working model: a common foundation programme of multi-professional and specialist modules in the initial three-year integrated medical programme. Students then complete the final three years of medicine within partner medical schools with independently-developed curricula in another country, for example the UK, Canada or Australia.15
This is much the same as when UK medical schools with an integrated curriculum accept students from a traditional medical programme with limited integration for their ‘clinical years’, but without evidence of compromised standards.
This concept of credit transfer is not radical, as academic transcripts already allow mobility between degree programmes (including medicine) on a case-by-case basis. University registries regularly deal with students who, owing personal circumstances, transfer mid-degree to another programme or institution. Why not use the same system to transfer from one profession to another? Academic regulations on the use of credits would overcome the issues surrounding knowledge retention and skills for transfer to another programme.