UK medical postgraduate qualifications can be obtained outside UK(1,2) without any work experience in UK. This is common knowledge among the medical profession around the world. This also a rather unique system since most postgraduate medical degrees and diplomas offered by institutions in many other countries require a period of training within their own countries. We were curious to know if the members of the public were aware of the ways by which UK postgraduate medical qualifications could be obtained and if it made any difference to their choice of a doctor to treat them.
A PubMed search did not reveal any such study about the public perception of doctor’s qualifications and its impact on consumer/patient’s decision making.
Our objective was to find out:
1) If the public knew that UK postgraduate medical qualifications could be obtained outside UK
2) If the public knew that UK postgraduate medical qualifications could be obtained without any work experience in the UK
3) If the public knew that UK postgraduate medical qualifications could be obtained outside UK and without any UK work experience would it make any difference in their choice of a doctor if they needed medical care.
150 members of public in Kuwait from a similar social class and educational background were given questionnaires in either English or in Arabic. Questions were designed in sequence as per the objectives defined.
53% were not aware of the terminology of UK qualifications such as FRCS/MRCP etc
75% were aware that doctors with UK qualifications were practising in their city
72% would prefer to see a doctor with UK qualifications if they had a choice
50% thought that a doctor with a UK qualification would have a higher level of knowledge
45% thought that a doctor with UK qualification would have higher skills
85% said that if they were consulting a doctor holding UK qualifications they expected to benefit from the doctors UK experience
54% expected a doctor holding a UK medical qualification to have worked in the UK
67% did not know that a UK postgraduate medical qualification can be obtained without ever working in the UK
79% said that if they were seeing a doctor with UK qualification and they had the choice they would prefer to see one who has UK experience as well
84% said that if they had a major problem that needs a specialist consultation they would prefer to see a UK qualified doctor who also has UK work experience.
About half the respondents were not aware of the terminology of UK postgraduate medical qualifications, but three fourths knew that doctors with such qualifications were practicing in their city. The majority also said that they preferred to see a doctor who held UK postgraduate qualifications. Therefore we feel that it is in the interest of the medical fraternity in the UK to promote an increased awareness of the terminology of the UK medical postgraduate qualifications so as to enable patients to make a better informed choice in selecting a specialist medical practitioner.
However, half of our respondents did not expect a doctor holding UK postgraduate medical qualifications to have a higher level of knowledge or skills. But, interestingly we note that a majority would like to consult a doctor with UK qualifications. This suggests that there must be other intangible factors at work, perhaps ‘trust’, ‘glamour’, an ability to induce patient confidence and so forth which are inherent or implied.
An overwhelming majority said that when they consulted a doctor holding UK qualifications they expected to benefit from that doctor’s UK work experience. Two thirds of the patients did not know that a UK postgraduate medical qualification could be obtained without UK work experience. This suggests that patient’s expectations could be let down due to a lack of information and awareness of the way in which such qualifications are awarded. Perhaps, more seriously it is possible to speculate that some patients have the mistaken impression that doctors who hold UK qualifications have worked in the UK when that is not actually the factual situation.
An overwhelming majority of our respondents said that if they had a problem that needed specialist consultation they would prefer to see a doctor who had UK postgraduate medical qualification and UK work experience. We infer that lack of information prevents patients from making the choice that they would like to make. Our respondents were all from a more or less similar social background of an educated and middle class nature. It may be possible to assume that in the general population or in a population segment with lesser education, the awareness of such matters is likely to be much less while the expectations may be similar and hence prevents them even more from making a proper informed choice; sometimes, possibly a wrong choice.
In summary, our survey shows that in Kuwait some patients thought that when they consulted a doctor with UK postgraduate qualifications the doctor also had UK experience. Many patients did not know that UK postgraduate medical qualifications could be obtained without ever setting foot in the UK. Patients preferred to consult a doctor who has a UK qualification and UK experience. We conclude, that some of the patient’s expectations are not being met due to the way in which the award of UK postgraduate medical qualifications are made. We also feel that some patients could be misleading themselves into thinking that when they consult a doctor holding UK qualifications the doctor also had UK work experience when in actual fact that may not necessarily be the case.
One of our recommendations would be that UK postgraduate medical qualifications be awarded only to persons with UK work experience. Alternatively separate nomenclature could be used to indicate that the UK qualification was obtained without UK experience and/or training; the Royal College of Surgeons of Edinburgh has already started some movement towards such a practise by the award of SMRCS,(3) etc. Perhaps doctors holding UK qualifications could be obliged to divulge their training information as a part of enhanced ethical disclosure, say in their reception or waiting areas of their office. The institutions awarding such qualifications could have information campaigns that inform the patient hence empowering them with the ability to make an informed choice.
The Americans do not seem to confer their clinical postgraduate qualifications to doctors who have not actually worked in the USA.
The survey was conducted in the year 2000, we are not aware if there have been any changes in the public perceptions and understanding on this matter since.
Note: The above material is extracted from the following poster presentation:
A postgraduate medical qualification from the UK. What does it mean to the public in Kuwait? M. Hemadri and M. Purva. Hull York Medical School First Research Conference, Hull. 11th February 2004.
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