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The Renaissance School of General Medicine

E B Peile, general practioner ^a, G P Easton, broadcaster ^b, S Olney, general practitioner ^c. 

^a Aston Clinton Surgery, Alesury HP22 5LB, ^b Science Department, BBC Radio Science Unit,, ^c The Surgery, 1 Glebe Road, London SW13 0DR

We asked three people with an interest in education to speculate on what a medical school of the future might look like. Here Ed Peile and colleagues describe their Renaissance School; then Jeremy Anderson (p 1456) and Cindy Lam (p 1458) outline their visions.

The Renaissance School will produce broadly educated doctors who think in terms of patients rather than organs and are strong, multiprofessional team players.

The irresistible swing towards medical specialisation has brought advantages for patients, but arguably it has gone too far.¹ As Horder puts it, "people are whole units who go wrong as a whole, and do not take kindly to being divided into organ systems."² Now more than ever, patients need generalist doctors who can put their individual problems in context and provide continuity.

"The Ambassadors" (1533) by Hans Holbein the Younger. Note the anamorphic skull in the foreground, which corrects itself when viewed from below and to the right of the painting. The perspective of the viewer or learner is all-important

	The return of the generalist

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In the Renaissance School of General Medicine students will learn only what they need to learn to be supremely effective generalists. From day one the focus of the course will be on "whole patient medicine," which is to be based on holistic consultations with patients in their real contexts.³ There will be no preclinical-clinical divide, and gone will be the days of freestanding courses in biochemistry, physiology, and anatomy. The modular nature of the course will provide a common pathway to careers across the whole spectrum of the health professionfrom medicine and nursing to management and health promotion. Having learnt together as students in a range of disciplines, our graduates will be well equipped to learn both with and from each other and to continue lifelong interprofessional learning.⁴

	The real estate

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Given that our aim is to drag medical learning and, hopefully, medical practice out of the pigeonholes in which it currently operates, we intend to design a new Renaissance Hospital with adjoining medical school. The hospital will be situated in a large town that already has university campus facilities and specialist hospitals. In the Renaissance Hospital, clinics and wards will be based on patient groups rather than medical specialties (table on website). Teachers will have generalist leaningsgeneral practitioners, general surgeons, general paediatricians, and so on. There are of course specialist elements in a generalist training, and these will be catered for at the neighbouring specialist hospitals.

The medical school will have long tentacles reaching out into the surrounding communitythrough general practices that are specially selected for training and that have learning resource centres. These peripheral centres will be designed along similar lines and will have docking stations for each student's notebook computer so they can be networked to the Renaissance hub. The cosmetics may differ; but, like an American in a Hilton, the student will feel instantly at home anywhere. And, on the principle that people learn best in a pleasant environment, the learning centres will have comfortable flats and be equipped with bicycles.

	Selection of students

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The selection criteria will be as broad as possible to include graduates and other students from arts and science backgrounds and all social and cultural groups. This is not the medical school for students who know they want to be super-specialists or pursue a career in medical research. Students must have generalist leanings and want to work across professional boundaries. They will need to have sufficient intellectual capacity to study medicine, but they don't all need to be academic high fliers. Learning styles will be important, because a student's approach to learning is a crucial factor in determining the quality of learning outcomes.⁵

	Spiral curriculum

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The course is designed as a common learning pathway for people who will end up working as doctors and those entering the allied health professions (figure on website). We hope that this will be the foundation of multidisciplinary and interprofessional learning.^6-8 The key idea is "spiral action" learning cycles: the depth of understanding increases as the breadth of learning expands, thanks to tutored reflective processes. ^{9 10} Early on, students will learn how to integrate their knowledge.¹¹ At their disposal will be a rolling programme of workshops and mini-courses (on communication, clinical examination, taking a clinical history, clinical decision making, hunting for evidence, etc), tailormade tutorials, libraries, internet resources, special skills stations, and (a few) lectures. Throughout the course each student will have a mentor who is charged with overseeing the student's psychological welfare and development.

As the central role of the Renaissance School is to help students deal with real patients and their real problems, we will foster learning that is predominantly self directed and problem based (and that will be properly resourced).¹² An "action-learning" approach to the students' learning will involve their being guided and assessed through the use of a handheld computerised personal portfolio, which outlines what they are required to have grasped by a certain point in the course and which will be supported by worldwide videoconferencing.¹³

Learning will be primarily through interaction with patients, so as to develop a narrative based medicine in a variety of forms¹⁴:

• Encounters in primary care teaching centres

• Encounters in the Renaissance Hospital's wards and clinics

• Web based encounters with patients (for example, Dipex, the database of individual patient experiences¹⁵)

• Professional patient partners (groups of patients specially trained to help doctors learn)

• Actor patients

	Rolling assessment

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Assessment will occur continually throughout the course and will be based on portfolios and objective structured clinical examinations. Assessment by patients of students' clinical and communication skills will be important. Although examinations will have a written element, this will be mostly in the form of modified essay questions. There will be no exams in anatomy, physiology, or biochemistry, and no one will need to learn by rote the entire Krebs cycle or the names of all those little holes in the skull. All students will have to demonstrate the critical appraisal skills of evidence based practice.

	The product

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After four years our Renaissance doctors will be proficient generalists. They will think in terms of patients rather than organs and will feel comfortable working in a team with other health professionals. Most will become experts in "first opinion" and continuing care medicine, but some will undergo further training as specialists elsewhere. At postgraduate level the Renaissance School will offer advanced specialist training in generalism to keep generalists firmly based in "whole patient medicine."

(Credit: COPENHAGEN, STATE MUSEUM OF ART) "Allegory of Science" by Jacob Jordaens (1593-1670). Minerva and Cronus protect Science against Envy and Ignorance

	Footnotes

   Competing interests: None declared.

An extra table and figure appear on bmj.com

	References

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4.	Leathard A. Inter-professional developments in Britain: an overview. In: Leathard A, ed. Going inter-professional. London: Routledge, 1994.
5.	Spencer JA, Jordan RK. Learner centred approaches in medical education. BMJ 1999; 318: 1280-1283[Free Full Text].
6.	Harden R. Multiprofessional education. Part 1: effective multiprofession education: a three-dimensional perspective. Med Teach 1998; 20: 402-408[CrossRef]. (AMEE guide No 12.)
7.	Headrick L, Wilcock P, Batalden P. Interprofessional working and continuing medical education. BMJ 1998; 316: 771-774[Free Full Text].
8.	Standing Committee on Postgraduate Medical and Dental Education. Continuing professional development for doctors and dentists. London: SCOPME, 1994.
9.	Erasmus R, Coetzer P, Hay I. Medical problem-solving: a five stage approach in primary medical care. Med Educ 1977; 31: 435-439.
10.	McMahon T. Is reflective practice synonymous with action research? Educ Action Res 1999; 7: 163-168.
11.	Knowles S, Holton E, Swanson R. The adult learner: the definitive classic in adult education and human resource development. 5th ed. Houston: Gulf Publishing, 1998.
12.	Finucane P, Johnson S, Prideaux D. Problem-based learning: its rationale and efficiency. Med J Aust 1998; 168: 445-449[Medline].
13.	Bourner T, Cooper A, France L. Action learning: from management development to generic university learning method. Innovations Educ Training Int 2000; 37: 2-9[CrossRef].
14.	Greenhalgh T, Hurwitz B. Narrative based medicine: why study narrative? BMJ 1999; 318: 48-50[Free Full Text].
15.	DIPex. Database of individual patient experiences. www.dipex.org/ (accessed 14 Dec 2001).