Wotcha
Today I will speak a little on medical education from the point of view of teaching
a changing world in medical education
Students sometimes tell me how out of touch the medical school is and the learning situations they participate in. I think it would be worth a few lines to try and explain this
When I trained, the world was a different place (we didn’t even have computers) – the pace of change was phoenomenal, so by the time I graduated half the students were word processing their essays. The internet was coming into life and changed from being a tool where one could look up paper abstracts to one where some people knew how do download pictures (which appeared one line at a time)
Anyway – I’m waffling. I’m going to say that medical degrees evolve too. Though not quite at such a blistering pace. I heard it said that
‘changing a medical school curriculum is like trying to relocate a cemetary’
There were bits about our course which were great and others that made it seem like people were pulling off you toenails (slowly). Some lecturers I still recall many of their sentences and slides (yes many still used chalk boards too) – others I recall simply drawing their caricatures as their funny shaped ears proved the most lively part of their lecture
the purpose of a lecture was to transfer what was on the notes of the lecturer to the notes of the students without passing through the minds of either
good teaching
If people teach well, their subject lifts and inspires their students, who become self motivated informed learners (apparently the best sort and most likely to do well according to modern educational theories) – spurred on by this is I sought to try and learn how to teach too and be one of the good ones
I had no idea how tricky it is to have to meet the learning needs of all those in front of you. Each are at a different place on their own learning journey and have done differing amounts of preparation. Each learns material in a different way (visual, auditory and kinaesthetic embraces one viewpoint of learning styles)
Your students are diverse individuals (some with hangovers, some fasting, some about to menstruate) from vibrant and diverse backgrounds (socially, politically and culturally)
Each deserve the best you can produce, all the time
drawing up a curriculum
When a curriculum if formed it is a monstrosity. It is a leviathan. A huge melange of spreadsheets and bits of paper, committees and meetings. The essence is to take what you did for the last few years and make it better
You do this by teacher training (many of whom think they do quite a good job already because they are senior clinicians and that is the way they’ve always done it) – some are right, they are brilliant, some aren’t
It is difficult for a medical educationalist (often a doctor but usually in their thirties) to try and encourage a 50 year old senior head of department to change their teaching style to embrace change and flexibility. This is the task faced with improving the standards of teaching. Big ego’s (though no fault of their own – that was always how it was done, but the pace of change is too rapid now)
Changing the curriculum is tricky. Last few years was better than before and the few years before that. Most of the obsolete stuff has now gone (evidence based medicine has been practised for so long that it has just filtered through into the medical degree)
what do you include?
The challenge is that what was taught is still important. The basic sciences are evolving so their is more to learn. But the old stuff is still relevant too. Anatomy is still there, physiology still needs to be in there. All the old specialties are practised. New ones have arrived (interventional radiology and gerontology being too and I do hope you’ve got hold of palliative care). Genetics and molecular medicine are becoming increasingly important. Communication skills are now taught, telephone consultation, breaking bad news and how to write an illegible prescription with a suitably impressive flourish of a signature. Medico-legal aspects and complementary therapies are vying for attention along with multi-disciplinary team case based approaches
All of these are trying for an extra hour in the teaching timetable and clamouring for attention at committee meetings where the sandal wearing primary care physicians try (in a caring understanding way) to point out that 90 to 95% of all consultations happens in the community and they need two more weeks to spend with the students.
The students point out that the course is too long, costs them too much (for they are now empowered consumers) and could they please have a half day on Wednesdays for sport and the option to study at home because of childcare commitments). The education is moving increasingly online and some are even delivering lecture material over the internet – this is not evidence based, but seems quite gadgety and may save all concerned time and money – but at what cost?
on trying to be a good teacher
My expounding is over (polydirectional and pointless though it may have been) – changing a curriculum is not easy. All those who are involved think they know best. The time is limited and there are pulls from all sides including the end-users. Patient groups too I’m sure will be chipping in before long
As a medical teacher it is important you know your material well enough teach without notes and really communicate with who you have in front of you. Keep up to date with educational theory and embrace change. Be aware of their needs (upcoming social events in the students calendar and individuals on personal crisis and accept that some of them can’t even remember what on earth succinyl CoA is for). Make it fun and they will learn better. You don’t have to teach them everything, but get them leaving wanting more so that they will want to take their own journeys
on being a good learner
As a student, know the difficulties the medical school had coordinating everyone to the right place at the right time. Know the challenges of an evolving curriculum. Become involved in the future and try to be the best for your patients and future generations of doctors. Read up on your subject before you attend any teaching. Keep your notes brief – long stuff is when you are in the library. Focus on the learning and review afterwards, review it all at the end of the week. Preview the next sections. Teach it to others in small groups – only by knowing it well enough to teach it well do you fully assimilate your learning
Above all, keep yourself well. Eat well, exercise, play, socialise, get enough rest. Your body is the most important tool you will ever own, treat it well. You cannot learn well if you aren’t looking after yourself – and that is not fair on the patients you will come to treat, they deserve your best. You must look after yourself then too – same rules. You are more important than them – because you cannot give to people from an empty cup. Full your cup full to brimming and then and then you will overflow and give in abundance
Keep well
Dr B