I graduated from a UK medical school back in 2007. Currently I am working abroad to gain a more global perspective (something that I feel is essential but certainly not a commonly held view point). During my time in the NHS I noted a steady increase in management, management that seemed more specifically led by non-clinicians. One memory that resonates clearly was the typical on call shift. Whilst attempting to take referrals and manage the acutely unwell, managerial forces would pin me down (not literally I might add!) and inquire about bed status and why I was not discharging patients. After explaining the clinical need for their admission several times over it eventually got tiring, particularly at times when I was being told about potential ways to manage patients by non-medical degree holders. As juniors we have all been there right... we just choose in the most part to ignore it... teamwork and all that jazz.
When I completed medical school, I left bemused. I was eager to start working but less enthralled by the fact that my tuition fees were spent funding a problem based learning (PBL) programme. I was young and foolish to believe that teaching myself medicine case by case with no expert guidance was how things should be done. On paper the concept seemed great. Enhancing self-directed learning and a Sherlock Holmes type approach to connecting the dots between potential clues and hypothesising how the case became a case in the first instance. I don't mean to sound over critical, it is just my style, but I am glad to see that such issues have been noted and acted upon, case in point team based learning and expert guidance. For those of you currently on a £9000 or so fee per year PBL programme, I can imagine your frustration is certainly going to be more explosive than mine.
As I spend more time dipping my toes in the muddy waters of medical education, reading around the topic from whatever journal access I have, due to lack of funding for conferences and postgraduate programmes, much of what I read in terms of educational evolution focuses on new teaching and learning approaches or assessment strategies. So for instance, PBL is one, E learning another, portfolios one more and in the UK, the newly signed, sealed and delivered situational judgement test and prescribing safety assessment.
Seniors rave about their expected benefits and juniors (as is the case with the management saga) stay silent. I will no doubt receive some form of backlash in terms of the evidence base patrol in this regard but at times I am not convinced. As I glance through systematic reviews on various new headliners, the general conclusion seems to be a plus and minus effect... it may help and it may not, further research is needed and so on.
What worries me is the silence on our part. By staying silent we stand to lose control of our grips on the clinical domain. We see what happens on a day to day basis and the issues that arise and should be targeted yet at times we seem passive to educational reform. One such example that repeats globally is the lack of ability as a newly qualified doctor, armed with theory yet little practical application. It is not their fault I might add. When we look at a PBL school, it is often not doctors guiding such sessions, when we look to E learning, are we simply so short of staffing measures that we can allow our students to passively plod through, are portfolios truly an engaging process with documentation done in real time and are more and more assessments truly the best approach?
I can appreciate the importance of a good education, without it I wouldn't even be putting pen to paper. Yet I feel that as juniors we must speak out. We must emphasise the potential downsides of such intervention, downsides that we see happening in front of us and we must appreciate that as juniors we must take steps to put things right. I have no expertise in education, in fact I don't truly know what an expert is in the general sense, but apparently they exist. I am not saying we disengage from them but instead join forces to reach an agreeable end point. As is the case with science, various biomarkers are very much their bread and butter and patients ours. The clinician scientist approach helps to ensure what happens bench side can eventually be bed side. It is time to adopt the same mantra in medical education.