Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Early contact with patients is beneficial in Cuba
- José M. Bermúdez-López, Alfredo D. Espinosa-Brito, and Alfredo A. Espinosa-Roca (10 October 2004)
-
Not experience for experience's sake
- Anna L Pozo, Edmund M Godfrey, PRHO General Medicine (11 October 2004)
-
The Doctor and his Degree
- Dr. Bhalendu Vaishnav, Dr.SmrutiB.Vaishnav,Addl. Professor, Department of Obst. and Gynaecology,P.S.Medical College. (14 October 2004)
-
Optimal efficiency in medical education
- Trevor O Jones (15 August 2008)
|
|
|||
|
José M. Bermúdez-López, Assistant Professor of Internal Medicine Hospital Dr. Gustavo Aldereguía Lima, Ave. 5 de Septiembre y Calle 51 A, Cienfuegos 55 100, Cuba, Alfredo D. Espinosa-Brito, and Alfredo A. Espinosa-Roca
Send response to journal:
|
Dear Editor: As teachers for more than 30 years (first two authors), we agree with your editorial article “Early contact with patients is beneficial” for medical students. (1) We also found, as Dornan and Bundy did, that early experience can generate greater motivation and confidence, greater social and self awareness, and better theoretical understanding among students. (2) All Cuban Medical Faculties’ curriculum are problem based, community oriented, fully horizontally integrated, and –as an especial characteristic-, they provide very early and long clinical experience. Since decade of 80´s of the last century, medical students in Cuba start their first year “learning by doing”, at primary care services (policlinics and family physicians´ offices). So, they can observe by themselves, from the beginning, the “true world” and social context of their future practice. This education in health services was called among us as “Society and Health”. As Dornan and Bundy found, our “students favour this experience, provided it did not weaken the learning of bioscience”. (2) Since early the 90´s, the students in their second year, go to primary care again. In these settings they learn “Introduction to Clinics” during 18 weeks. Trained medical doctors who work at primary care are the teachers. Students learn communication skills and how to do complete physical examinations, with many patients in a real scenario. (3) Until the present course, basic matters or bioscience were taught at the classrooms and laboratories of the Faculty of Medicine, in a “classical way”, we can say. But, based on the good experiences with the previous commented educational changes, since the last month, this new course 2004-2005, some selected groups of medical students started their career at the municipalities, inserted in the policlinics and family physicians´ offices. Here, they will learn also bioscience, in an experimental model of medical university decentralization all over the country. The methodological functions of the Faculties of Medicine persist, but the scenario for teaching changed now. At this very moment, first news about this shift are good. Students and teachers are satisfied. We have to wait and see the future results of this new experience. In our country, when students arrive to the hospitals, they have fulfilled a precedent curriculum, which was very close to clinical practice. From third year on, medical students go to different hospital wards. and they participate in almost all activities of the clinical services (rounds, different types of diagnostic discussions, duties, consultations, minor surgical activities, etc.). (4) We named all clinical practice activities during the medical career as “educación en el trabajo” (“education in the workplace”), and a lot of time is dedicated to them in each course.(5) So, we can say that in Cuba, we also subscribe the main conclusion of Dornan and Bundy: “A rationale for early experience would be to strengthen and deepen cognitively, broaden affectively, contextualise, and integrate medical education”. (2) Sincerely, José M. Bermúdez-López, MD, Assistant Profesor of Internal Medicine Alfredo D. Espinosa-Brito, MD, PhD, Profesor of Internal Medicine Alfredo A. Espinosa-Roca, MD. Instructor of Internal Medicine Internal Medicine Department Hospital "Dr. Gustavo Aldereguía Lima" Ave. 5 de Septiembre y Calle 51A Cienfuegos 55 100, Cuba. REFERENCES 1. Editorial. Early contact with patients is beneficial BMJ 2004;329 (9 October). 2. Dornan T, Bundy C. What can experience add to early medical education? Consensus survey. BMJ 2004;329:834. 3. Ilizástigui Dupuy F. El método clínico: muerte y resurrección Rev Cubana Educ Med Super 2000;14(2):109-127. 4. Moreno Rodríguez MA. El arte y la ciencia del diagnóstico médico. Principios seculares y problemas actuales. Ciudad de La Habana: Ed. Científico-Técnica, 2001. 5. Ilizátigui Dupuy F. Salud, Medicina y Educación Médica. Ciudad de La Habana: Ed. Ciencias Médicas, 1985. Competing interests: None declared |
|||
|
|
|||
|
Anna L Pozo, PRHO General Surgery Jersey General Hospital, St Helier, Jersey, JE1 3QS, Edmund M Godfrey, PRHO General Medicine
Send response to journal:
|
As recent graduates from a medical course that contained virtually no “experience” in the early years, we wish to add our views to those of Dornan and Bundy’s subjects. We were interested that “students were disappointed to enter medical school and not to meet patients and doctors.” We expected our early years to involve lectures and textbooks, and enjoyed developing a broad base of scientific knowledge. Tutorials encouraged us to discuss and defend our opinions. It was this type of learning that gave us the maturity and confidence to then talk to patients, and to face intimidating consultants on ward rounds. Rather than feeling “dumped into a hospital environment,” we found this transition smooth because a final-year student was designated to teach and support us during our clinical foundation course. The breadth and depth of the biological sciences has increased dramatically over the past fifty years. With ever more material to cram into the early years of medical school, there would need to be a strong argument for stretching the timetable further. Whatever educational theory suggests, there is no evidence that early patient contact improves the communication skills of PRHOs. Nor is there any need to learn clinical skills with inadequate opportunities to practise them. As for improving motivation, we found that every effort was made to make our science teaching clinically relevant, maintaining our interest in the absence of patients. While our opinions cannot substitute for the 33 students interviewed, we would point out that students embarking on medical courses are diverse. We feel that they should still be able to choose a course with a level of early experience appropriate for them, particularly in the absence of evidence that learning outcomes are affected. Given that most medical schools now offer some early experience, the emphasis should be on making this relevant to students’ learning needs, rather than subjecting them to “experience for experience’s sake.” Competing interests: None declared |
|||
|
|
|||
|
Dr. Bhalendu Vaishnav, Addl. Professor, Department of Medicine, P.S.Medical College, Karamsad,Gujarat,India.PIN :388325, Dr.SmrutiB.Vaishnav,Addl. Professor, Department of Obst. and Gynaecology,P.S.Medical College.
Send response to journal:
|
Sir, The article has very rightly pointed out a very important but largely overlooked aspect of medical education. When we discuss about ills of medical field and try to think about their solutions, we overlook the fact that unless we view our profession as a human science there can be no real remedy.The problems of our science are not due to limitations of the mind but are due to inadequate role that we allow our heart to play over the mind .... Here lies the need and the direction of a paradigm shift in the present medical education. The solution does not lie in better 'evidence based medicine',nor does it lie in better spread of information but lies in making bettre doctors. Someone has wisely said (fail to recollect the source , chinese proverb ? ),'If you want to invest for two decades plant trees;but if you want to invest for lifetime,educate children. This piece of wisdom is more apt in in our profession than any other profession since our 'products' are programmed to serve the society. Contact with patients enables a medical student to become a doctor which is much more valuable than obtaining a degree sans the 'human touch'. It facilitates the growth of the 'Physician within'. Competing interests: None declared |
|||
|
|
|||
|
Trevor O Jones, Retired veterinary surgeon Loughborough, Leicestershire LE12 6LQ
Send response to journal:
|
Optimal efficiency in medical education. Lectures consisting largely of facts readily available in textbooks are arguably not optimal use of medical school staff and student time. There is a basic core of fact taught in all medical schools. This could be made available to all medical students as concise information using modern Information Technology. Portions of this information would have to be assimilated by students by a specified date, when the lecturer would hold a session on the subject, answering questions raised by students and posing mind stretching questions and concepts. Self-managed student study time and a self-assessment test followed by a single group session with the lecturer could possibly replace (e.g.) four lectures. Basic core fact would have to be regularly updated. Concise additions should be dated and in differing script or colour for each year. The system could form a basis for systematic and logical Continuing Professional Development following graduation. United Kingdom (EU, world?) students would be provided with a level playing field. They could learn at a time of day suiting their biological clock. There would be fewer misunderstandings. Also fewer of the distractions of the lecture theatre (the attractive young lady/gentleman two seats in front). Can a short letter such as this spark a revolution, or are all agreed that the teaching/ learning system currently practised is optimally efficient? Yours sincerely, T O Jones, MBE, FRCVS.
Competing interests: None declared |
|||