Posted by: Nicholas Swetenham | March 10, 2009

Early patient contact for Cambridge medical students

Like our medicine, our curricula should be evidence based. I believe that the balance of evidence favours early patient contact. Just search PubMed for ‘early patient contact’ and ‘medical students’ and you will find a wealth of evidence.

First, to give you an idea of exactly how much patient contact we get in our pre-clinical Preparing for Patients course, let’s ‘do the math’ as our transatlantic cousins say:

Year 1: Module A – GP 1 afternoon in surgery 1 home visit. 4h, 4 patients.
Year 2: Module B – Hospital 1 visit each in 2 Cambridgeshire hospitals. 4h, 2 patients. Done over 1 week outside of term (i.e. holiday/revision time)
Summer between Years 2-3: Module C – self-organised attachment to social care, voluntary organisation (e.g. bereavement charity, Alzheimer’s society), or alternative medicine clinic. Length variable: 4h, 4 patients.
Year 3 (intercalated year): Module D – 3 home visits to a women during pregnancy and 1 after birth. 4h, 1 patient.

Note that each has briefing/debriefing session on top; the hours mentioned refer only to actual patient contact. Each Module is assessed based on a piece of coursework.

So that’s a total of 11 patients over 16h of contact. That’s very close to 0.01 patients per day. There is also the fact that several of friends did about 35h over five working days for Module C in an alternative medicine clinic. This actually means their ratio of exposure to alternative versus conventional medicine is roughly 3:1 (35/12), which I find quite alarming.

I do think that our strong scientific teaching is an excellent feature or our respective courses and would not want it to be watered down in any way. I do think, however, it is strange that we don’t have just a little bit more. For example in Module B above we a take a week out of our holidays to do it, so why couldn’t we fit in 5 full working days of intensive teaching there, instead of 4h briefing/debriefing and 4h patient contact (a fivefold difference)? Why isn’t there a week of intensive Clinical Skills teaching after 3rd year exams? Oxford has something similar I believe, and Cambridge students who transfer to London school (e.g. Barts) which have more patient contact have to be given a few weeks of a special course to teach them which way round to hold the stethoscope. As one of his year’s top student, my supervisor (tutor) for molecular pharmacology remarked of his 4th year: “When I arrived for my first day at the clinical school, I realised that I knew nothing.”

I also think the argument that one requires a strong grounding in basic science before being able to learn communication skills, history taking, examination and use of procedures/instruments doesn’t hold up. Do all those incredibly skilled nurses have to know the intricacies of molecular pharmacology to understand drug regimens and their administration? They’ve managed so far.

So in summary, I vote yes to lots of basic science in my curriculum, but yes also to a reasonable amount of clinical exposure! Let me know what your views are.

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Responses

  1. As medicine shifts to become more evidence based, schools should also shift from more basic science to clinical aspects. It only makes sense that medical education reflects what eventual practice demands.

    • Hi medaholic,

      I certainly think it’s important that future doctors understand evidence in order to use in their practice of medicine. This, I think, requires 3 things:
      -Critical appraisal skills
      -An understanding of statistics
      -Enough knowledge of basic science to understand what papers are about.

      I think that it would be imprudent to shift from one extreme to another; the key is getting the balance right.

      Best wishes,

      Nico


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