A little awhile back after a teaching session, I asked — as I often do — a googly: ‘What is the worst thing about being a medical student?’ The response: ‘Feeling like a spare part’.
My quick and facetious response was to argue that at least spare parts were useful, whereas students were (usually) not. The humour was appreciated 🙂
But if you think this through, it is possible to argue that students are indeed less useful than they once were. At one time, final year students were a key component of clinical service. They clerked people, they could insert iv lines, write up drugs, and they were around long enough in one environment for people to make meaningful judgments of their abilities and remember them. And to be able to trust them. They could do paid locums, and even when they were not being paid, they could not be absent, nor did you need to formalise start and finish times. One of my colleagues reported that he used to be able to ‘prescribe anything apart from diamorphine’ as a final year student.
This all raises some interesting questions
- Medical education may be getting worse. This is not to attach blame, merely a speculation based on what I see. There are indeed more educationalists, but making things explicit is easily confused with competence that is implicit. It is even conceivable that those who ran medical schools were once more thoughtful, possibly because they were not juggling so many roles, and because the environment was less cluttered by regulators.
- Engagement with clinical service helps learning, but the opportunities for this may be diminishing. Again, this is in part a change in the environment. The inpatient service is not where most medicine occurs: the office is (whether in the OPD or in primary care)
- I wonder if we are sequencing medical education incorrectly. The pressure is for more and more training and less and less education, but the facilities for training are diminishing all the time and are largely outwith the control of the universities. In a health service that is falling to bits, medical students are not a priority (and expect things to get worse). The NHS has never taught doctors: doctors have taught doctors. If culture eats strategy — as the saying goes —the toxic nature of much NHS provision, will negate all those lectures on ethics, fairness and sense of vocation. And don’t mention resilience.
- Never promise ‘engagement’ when you cannot deliver it, otherwise disenchantment grows. We overpromise, and universities increasingly advertise with exaggerated claims. Scholarship, and advertising are opposing world belief systems.
- Comparisons with some other EU countries makes me wonder if we should revisit the boundary between ‘student’ and ‘practice’.
- Our ideas of medical education owe much to a time when most people did not go to university.
Medical education is indeed always advancing: but many of us think it is increasingly out of phase with the world we live in. Magnitudes matter.