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What is the medical doctor degree apprenticeship (MDDA)?
In July 2022, NHS Health Education England (HEE) announced that there will be a new MDDA programme launching in September 2023 (aspirational date) with an initial group of employers and stakeholders. The MDDA was created to provide an alternative pathway to medicine.
The apprenticeship will replicate the current medical degree with apprentices expected to work “the same pattern as university medical students.” The key difference is that the apprenticeship will be designed to allow for more flexible learning, with providers (i.e., NHS teaching hospitals) deciding whether the apprenticeship programmes they deliver will be full-time or part-time. Typically, the course is expected to take around 5 years to complete - like the standard undergraduate medical degree - but if enrolled part-time, this would be longer and for some graduate entry apprentices with certain prerequisites, the course is likely to be shorter.
Once completed, apprentices will be expected to pass the UKMLA and end-point assessments like finals and OSCEs like other medical school graduates from the same academic year. Upon graduation, they will be eligible for provisional registration with the GMC and apply for the foundation programme via FPAS.
What is going to be taught?
What has been published so far is that the knowledge, skills, and behaviours taught to apprentices will meet the General Medical Council’s (GMC) Outcomes for Graduates and they will have the exact same credentials as current medical students. It is currently unclear as to what the structure will be for placements, and how apprentices will be paid, if at all, for their work.
How are they funded?
Apprenticeships in the UK in general are typically funded by a combination of the government and the employer. The government provides funding for the training and education component of the apprenticeship, while the employer covers the on-the-job training and wages of the apprentice.
Funding will include an upper limit of £27,000 by the government apprenticeship funding levy for training apprentices and the healthcare provider employing the apprentice will meet any additional costs. It has been confirmed that apprentices will not have to pay back tuition fees funded through the apprenticeship levy if they do NOT complete the programme, however, for those who do complete the programme and become doctors, the employers will decide whether the apprentice may have to pay back any additional funding they received from HEE/the employer.
On January 13th 2023, funding was confirmed to train the first 200 apprentices in the next 2 years (up to £50,000 per apprentice). That's a relatively small intake but contrary to traditional medical school training, a lot cheaper per student. I suspect this £50,000 'offer' is to attract more universities to partner up to educate these apprentices since it is highly unlikely everything will be able to be taught 'on the job' (NHS is already severely understaffed). This funding will help healthcare employers meet the costs of taking on apprentices, including staffing costs while apprentices are undertaking education and training.
How will applications work?
It is understood that MDDA posts will be advertised by employers internally or via NHS jobs, based on local workforce needs. Employers and associated medical schools will agree on criteria for shortlisting candidates for interviews - which means it could differ across the country.
It is likely that the current entry requirements are going to be similar to the ones to gain entry into traditional medical schools. However, it has been suggested by the apprenticeship standard document that the entry requirements will be more flexible, accommodating academic qualifications, contextual factors, aptitude, and prior healthcare experience.
So what's my opinion?
The main issue I take with the apprenticeship (as do many others) is its aim to 'widen access to medicine' when university medical degrees are CURRENTLY far from financially affordable. In addition to this, we have a 'leak' of junior doctors, leaving their posts during and after foundation training - our focus should be on RETENTION not RECRUITMENT.
Data chart: what do trainees do after completing foundation training? BMJ 2018;361:k1753
Another concern is how the addition of apprenticeships will impact learning on placements (overcrowding and the poor quality of these placements already), workload for universities, training bottlenecks, funding for both the new course and the existing course, and concerns that this qualification will not be recognised outside the UK.
If a two-tier system is indirectly created, or the training experience of apprentices is not matched to that of current medical undergraduates, there is no current backup plan to address this.
However, there is a benefit to doing an apprenticeship over a university course - particularly from a financial point of view. With better funding opportunities and being able to work and study (although salary and pay have not been officially confirmed), this is probably the most suitable option for those already working in healthcare and want a career pivot to medicine (already have achieved the entry requirements).
Sources:
What are medical doctor degree apprenticeships? A brand new route into medicine. BMJ 2022; 379. https://doi.org/10.1136/bmj.o2951
