Expanding horizons: Increasing undergraduate exposure to tomorrow’s specialties

Dear Sir

We read with interest the article by Keating et al. (2013) which detailed their initiative to introduce a specialty earlier in students’ medical education. We agree that it is important for students to be able to explore fields of interest sooner rather than later. Medical school curricula across British universities invariably include clinical placements in all of the core medical specialties. While there is some exposure to the smaller specialties, there is often less dedicated teaching time for these fields. As healthcare demands evolve, this is an issue that needs to be addressed in the undergraduate curriculum.

Some specialties tend to receive coverage in the form of undergraduate lectures but no actual clinical placements: for example, public health. Other new and emerging specialties may not be addressed in medical school at all. In the UK, the General Medical Council states in “Tomorrow’s Doctors” that student selected components (SSCs) “must be an integral part of the curriculum…allowing choice in studying an area of particular interest” (General Medical Council 2009). While these allow students to pursue experiences within specialties that are covered less intensely within the curriculum, not all specialties may be offered within SSCs and it is often left to students to self-organise such placements.

After medical school, the issue persists. The UK Foundation Programme allows newly qualified doctors to rotate through six specialties over two years. There are relatively few jobs offered nationally in the smaller specialties such as dermatology and ENT. Indeed some specialties do not feature in the Foundation Programme at all. While a “taster week” exists to redress this imbalance, one week is arguably not sufficient to gain a thorough understanding of a specialty.

This poses a problem. If there is insufficient exposure to these smaller specialties early in trainees’ careers, there is a risk that they will not have time to develop an interest in a field in which they might otherwise flourish. Many of these specialties are not only expanding but are also competitive: for example, allergy medicine and interventional radiology. With demand in these fields set to increase, we should encourage greater provision of clinical attachments in these specialties during the undergraduate and early postgraduate years. This will provide students and junior doctors with even greater insight into the variety of options open to them and will help them to make more informed choices about the direction of their future specialty training.

Declaration of interest: The authors report no declarations of interest.