Thursday, September 20, 2007

The confusing nature of modern medical courses

Sheepish (from The Paper Mask)posted a comment on the second-last post, and this entry started out as a reply to that, but ended up far too long. I turned it into a post instead (which will make my numbers for this month look far less slack ;) ).

There are many opinions out there that hold that the current nature of medical school teaching and learning in Australia is suboptimal. While I would argue that a keen, quality student from either the old system or the new is still going to make a good doctor (I'm sure nobody would argue with this), I definitely think that the current style of course is in dire need of some changes, at least at the level in which I have been involved.

The current medical courses which integrate PBL and lectures ARE extremely frustrating in that it is very difficult to work out what to learn. PBL seems almost too basic at times, but on the other hand, the lectures are delivered by scientists at a level that is so advanced that people whose undergraduate degrees were in these areas have trouble keeping up.

Perhaps the lecturer wants us to have a solid knowledge base in his or her area, but sadly we just get completely overwhelmed (well, I do!) and end up going back to good old Kumar and Clarke or other clinical textbooks to actually understand anything. The lectures don't tend to reflect what we need to know, or the depth at which we should learn it. As a result, we don't often get a lot out of the hours that we spend in them.

Most students end up relying on the advice of past students to get through exams. I would genuinely prefer to have a more guided course content, taught at the level that we need to know it. PLEASE bring back a more didactic teaching style in some fashion. We spend a week on a condition in PBL and almost never have a lecture on it. I LOVE when we have actual clinicians teaching us, but I think that this will happen more next year.

One of the other problems in PBL is that if you have a more dominant member of the group who has an excessive amount of confidence, he or she can convince the group that whatever they say is right, even when this is only the case in their own head. I would much rather look something up in a book or in a journal than argue a point or wonder whether or not I can believe a single thing that another person at my own level has to say. I would also rather spend time sticking pins in my eyes than arguing with somebody who uses LOGIC to prove that what is wrong is actually right. My brain is too small to take up space learning incorrect information!

I would like the style of course to change, and the universities are apparently receiving a lot of feedback about this, from both students and doctors. It is another matter whether they will listen or are happy to send students through with the course as it is.

It is sad that doctors who give their time to teach in a hospital setting (because we all know how much spare time you have ;) ) get students who aren't interested, particularly when you are making an effort. It isn't fair to you, and it makes things worse for those of us who are keen.

Long before I even considered being a medical student (well, not that long!), I had groups of medical students come through my work area in the hospital to observe things. Mostly they just stood back and gossiped instead of paying much attention to an area in which junior doctors quite often make fools of themselves. In the end, I told them this (in slightly stronger words), but I don't think it sunk in.

There was one student in all of this time who actually paid attention, asked questions and was interested, and in the end she learned a LOT more than the others, as I organised for her to spend a good while learning from one of the medical consultants (who was one hell of a teacher and who students would normally not have known about or wouldn't have had access to). Being interested pays off.

Having spent a little bit of time in clinical areas with others in my year, I was a little dismayed to see the same kind of behaviour. They are genuinely intelligent, nice, and enthusiastic people, and I don't think that they realised what they were doing, but it was still disappointing.
It is hard being in first year and not knowing much, but that doesn't mean that it is too early to get in there, have a go, and start learning. Hell, if somebody is willing to teach me, I'll be in there like a shot!


The Shrink said...

It is sad that doctors who give their time to teach in a hospital setting . . . get students who aren't interested

Doesn't really happen!

I guess that student who really aren't interested simply won't turn up for the teaching. Timetables are so complex we've no notion who should be in which ward round or clinic or community team or continuing care team or liaison psychiatry or day respite or home care liaison team or day hospital or whereever . . .

. . . those who do turn up have consistently seemed interested, so much so that student I'm not even timetabled to subsequently teach have made time to join me in clinics and wards to learn more. Enthisiasm amongst medical students usually is high.

Hell, if somebody is willing to teach me, I'll be in there like a shot!

On the whole, ain't that the truth!

Liz said...

On the whole, i agree with what you said: a keen student can still learn a ton in the current system. Thankfully, most of us are keen.

Also, lectures by clinicians are much better than the crazy lectures by the scientists. I used to be one, so i mean no offense, but do we really need to know about your research and your (biased) theories?!

As for the students giggling in the wards: for the 1st part of first year, my group took it very seriously. However, as we were getting more and more burnt out from studying, and we realized we were going to LIVE in a hospital for the next 10-20 years of our life, we started to take it less seriously. Yeah we come for our required sessions, and try to be prepared for tutorials, OSCEs etc. However by the end of 2nd yr, we run off to the library to do reading at any chance, linger in the lunch room over Dr Phil, and gossip on the wards. Starting in 3rd year, we'll be there EVERY DAY, so i guess we want to enjoy our freedom and lack of accountability while we can!! :)

Brad Smith said...

I'm not a med student so I can't speak from experience.

But in relation to lectures from scientists, it's frustrating when the goal of the student is to learn the material only relavent to the exam while the goal of the lecturer is to teach the facts as well as including relevant "hands-on" implications. In the end, I think the lecturer is the one who needs to make the compromise and teach the student in a didactic fashion. Unfortunately, not all lecturers are great teachers.