Mike Harrison works as a GP for Cumbria Health and is an NIHR doctoral research fellow at Newcastle University researching the use of innovation to expand placement capacity within general practice.
As an NIHR doctoral research fellow researching innovative ways of expanding undergraduate, community-based medical education, I recently spent two weeks on a research visit to the University of Dundee to learn more about the Scottish Graduate Entry Medicine (ScotGEM) programme. ScotGEM is a graduate entry course focused on educating students for rural, generalist practice in Scotland.1 The course, which is jointly delivered by the Universities of Dundee and St Andrews, is designed around community-based clinical exposure, and the quantity of GP-led teaching and experience is significant. ScotGEM is unique in that it represents the closest model to delivering a curriculum substantially based in general practice.2
A need for reinvention of undergraduate medical curricula?
The 10-year NHS plan aims to reinvent healthcare in the UK.3 However, reinventing healthcare cannot be achieved without radical shifts within clinical education. Healthcare and clinical education are coupled. Undergraduate medical education influences the knowledge & skills students acquire, the role models they encounter and the career they choose to embark upon. Current cohorts of medical students are the future resident doctors, GPs and consultants within the plan. It is thus, perhaps surprising that, notwithstanding discussion of the expansion of medical student places, the role of undergraduate medical education in achieving the plan’s goals is largely overlooked. Whilst many medical schools have increased the amount of curriculum time spent in community settings, specialism continues to dominate many aspects of UK medical curricula. The most recent figures suggest students spend, on average, 9.2% of curriculum time within GP.4 Thus is far below targets suggested of 25%.5,6 Medical students’ interest in GP is declining. ScotGEM, and other community-orientated tracks, aim to buck this trend.
Reflections from my ScotGEM research visit
There is significant early clinical experience within primary care and role modelling. In many courses, medical students in the early clinical years get limited opportunities to interact with GP role models. This represents a significant missed opportunity to shape career intentions as this is a time when students are beginning to form their attitudes about different specialities. The evidence base would support this argument: personal experience of interacting with GPs has been identified as the most important factor influencing attitudes of undergraduates to the speciality; and exposure to GP role models through high quality, early clinical placements positively influence students’ views on a career in the speciality.7
Early clinical years exposure to teaching by GPs during the ScotGEM course is substantial (around one and a half days per week throughout the first two years). Students are taught clinical and communication skills as part of the Clinical Interactions Course (CLIC) by Generalist Clinical Mentors (GCMs), all of whom are practising GPs. This includes one full day per week throughout the year at the GCM’s own practice to allow students to practice their skills on actual patients. This set-up provides them with regular interaction with a range of GP role models from day one of the course.
In year three, students spend two and a half days per week in a GP practice undertaking clinical learning as part of a Longitudinal Integrated Clerkship (LIC). This year-long placement allows students to consult independently with patients and form meaningful relationships with the practice team. There is evidence that longitudinal placements are more influential than block patients in influencing career choice, particularly towards primary careers.8 There is also evidence that longitudinal placements can have an enabling impact on placement capacity because, over time, students become embedded within the team and contribute to patient care in increasingly meaningful ways.9 ScotGEM students also spend an additional half day per week in the community conducting a service-learning project, allowing them to meet some intended learning outcomes within community settings without necessarily requiring intensive GP supervision.
The ScotGEM course has a strong focus on social accountability and aims to produce graduates capable of driving change within healthcare systems. The ‘Agents of Change’ module is embedded across the degree programme and allows students to engage with healthcare providers and communities beyond traditional healthcare settings,1 often through project work and with a focus on disease prevention and health inequalities. Medical education has traditionally been heavily focussed on disease treatment rather than prevention, producing graduates not always orientated to preventative medicine. The NHS 10-year plan’s focus on disease prevention rather than cure, alongside governmental priority to address rising health inequalities, provides a strong argument to embed service-learning approaches more extensively within undergraduate medical degree programmes.
Looking into the future…
Whilst the ScotGEM programme is unique, other UK medical courses are also trialling community-based tracks in which students achieve intended learning outcomes within community, rather than hospital, settings. Examples include ScotCom (hosted by the University of St Andrews) and the Community Orientated Medical Experience Track (COMET, hosted by the University of Glasgow). Delivering increasing amounts of teaching within the community comes with challenges, including funding, capacity for placements and stakeholder buy-in. Evaluation data, particularly regarding graduate outcomes, are needed to help lever political support and persuade hesitant stakeholders. But there is no doubt in my mind that a community-orientated NHS needs community-orientated medical degree programmes.
References
- Graham F, Dowell J, Flynn A, Gupta S, MacFarlane AD, O’Malley A, et al. Development and innovation in a new distributed medical programme: Scottish Graduate Entry Medicine (ScotGEM). Frontiers in Medicine. 2025;Volume 12 – 2025. doi: 10.3389/fmed.2025.1586851
- The Scottish Government. Medical Education Capacity in General Practice in Scotland Working Group: interim report. 2025. https://www.gov.scot/publications/medical-education-capacity-general-practice-scotland-working-group-interim-report/ [accessed 8/5/26]
- UK Government. Fit for the future. 10 Year Health Plan for England. 2025. https://nhsfitforthefuture.campaign.gov.uk/ [accessed 8/5/26]
- Cottrell E, Alberti H, Rosenthal J, Pope L, Thompson T. Revealing the reality of undergraduate GP teaching in UK medical curricula: a cross-sectional questionnaire study. British Journal of General Practice. 2020;70(698):e644-e50. doi: 10.3399/bjgp20X712325
- The Scottish Government. Undergraduate medical education in Scotland: Enabling more general practice based teaching. 2019. https://www.gov.scot/binaries/content/documents/govscot/publications/corporate-report/2019/10/undergraduate-medical-education-scotland-enabling-more-general-practice-based-teaching/documents/undergraduate-medical-education-scotland-enabling-more-general-practice-based-teaching-final-report/undergraduate-medical-education-scotland-enabling-more-general-practice-based-teaching-final-report/govscot%3Adocument/undergraduate-medical-education-scotland-enabling-more-general-practice-based-teaching-final-report.pdf [accessed 8/5/26]
- Harding A, Rosenthal J, Hawthorne K. Teaching general practice: Guiding principles for undergraduate GP Curricula in UK Medical Schools. 2021. https://sapc.ac.uk/article/teaching-general-practice-guiding-principles-undergraduate-general-practice-curricula-uk [accessed 8/5/26]
- Lamb E, Burford B, Alberti H. The impact of role modelling on the future general practitioner workforce: a systematic review. Educ Prim Care. 2022;33(5):265-79. doi: 10.1080/14739879.2022.2079097
- Amin M, Chande S, Park S, Rosenthal J, Jones M. Do primary care placements influence career choice: What is the evidence? Education for Primary Care. 2018;29(2):64-7. DOI: 10.1080/14739879.2018.1427003
- Couper ID, Worley PS, Couper ID, Worley PS. Meeting the challenges of training more medical students: lessons from Flinders University’s distributed medical education program. Medical Journal of Australia. 2010;193(1):34-6. DOI: 10.5694/j.1326-5377.2010.tb03738.x
Featured Photo by Duncan McNab on Unsplash
