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Rapid Responses: Rapid Responses published:
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Education is much more complicated than 'adrenaline-fueled 'experience
- Kieran P Nunn (27 January 2009)
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Inappropriate behaviour
- Anne Savage (27 January 2009)
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Working together for safe, ethical, educational electives.
- Abi Smith, Tim Crocker-Buque, and Vanessa Jessop (4 February 2009)
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Kieran P Nunn, (Academic) Foundation Doctor/Honorary Clinical Fellow Western Infirmary/University of Glasgow, G11 6NT
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I read the story from the elective students with great interest[1]. In 2007 I was an elective student in South Africa, I had a fantastic time and it was without a doubt one of the most beneficial components of my medical course. I had a very practical elective, where I learnt procedures such as insertion of chest drains in a trauma setting. I think this was entirely acceptable, why should we put a glass roof on what one can achieve as a student. Professor Cohen highlights that as students we are not qualified doctors[2], true, but we are apprentices. As an example, inserting a chest drain is a useful skill to know and apart from it not historically being on a western medical school curriculum, there is no good reason to avoid learning this skill appropriately. For example students in the US can gain laparoscopic skills[3]. The ethical issue is how, not at which stage or where, a skill is learned. It is both the student and the teacher’s responsibility to ensure that the educational setting is appropriate so that supervision is adequate and consent is gained. It is also the student’s responsibility to understand the procedure; the anatomy and physiology and what to do if a complication occurs rather than ‘just do it’. In this case the student in question clearly separated ‘education’ and ‘experience’, evidenced by the fact he got a completion form signed in the first few days. Yet equally the supervisor was immoral to have signed it, and should receive equal sanction; both parties breached professionalism. The elective is a fantastic opportunity, examples like this should warn of the potential dangers but not lead to deleterious dissuasion from a potentially beneficial experience; experience from which, could aid career- planning[4]. Ways to ensure supervision are to spend your elective attached to a university, or in a country where you have to register with the equivalent of the GMC (both requirements in South Africa). I will be eternally grateful to my numerous supervisors and departments (which banned photography and insisted on supervision), and suggest that the most important professional competence of all is the competence to accept one’s own limitations. 1 BMJ 2008; 337:a2874 2 BMJ 2008; 337:a2884 3 Gjertson CK, Mohammadi Y, Lipke MC, Sundaram CP. An innovative medical student clerkship in advanced urologic laparoscopy: a preliminary experience. J Endourol 2008; 22(6): 1345-1350. 4 Elton C, Newport M. The reflective elective: using the elective to develop medical students’ skills in career planning. Br J Hosp Med (Lond) 2008; 69(7): 409-411. Competing interests: None declared |
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Anne Savage, retired NW3 5ra
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I worked in three African rural hospitals in the past, all of which took students. They mostly contributed greatly and were very welcome. They learnt a lot but always under supervision. I cannot recall any occasion when a student was asked to do something beyond his/her competence. One student who was a problem was a trouble maker, telling A that B had criticised his management of patients. He also greatly embarrased me and others by loudly proclaiming, in public, his intention to write humerous articles for his local paper when he got home about his experiences. Our most disasterous import was a geriatrician who spent his holidays in developing counrtries, never, for obvious reasons, the same one twice. He worked in 'my' hospital for a time and his approach to an abdominal stab was 'I'll just give him a whiff of gas and push the guts back'. A nurse ran to the phone in horror and the trained surgeon in the village was hastily called and took over. But rumours reached us later of disasters, one a woman who died after he had done a Caesarean section and closed the wound in one layer. Unlike other European countries we do not seem to mind who represents the country abroad. This is some time ago but I doubt if the situation is so very different now. Competing interests: None declared |
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Abi Smith, Medical Student Bristol University, Tim Crocker-Buque, and Vanessa Jessop
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We welcome the attention being drawn to the issue of what should be done in cases of inappropriate behaviour by medical students ('What should you do when you see a fellow student behaving inappropriately?', Volume Number 338, 24th January), and hope that this will stimulate further discussion on this vital area. The BMA recognises that there are issues to be discussed and addressed surrounding elective placements. These include professional practice and patient safety issues, but also extend further to include the impact of students on the health system in which they are placed and the educational outcomes of electives. Having taken into account members concerns in recent months the BMA is taking a proactive lead on this issue, including updating our elective guides. We will also be encouraging the GMC to include clear guidance for students on electives within their revision of Tomorrow's Doctors. The BMA also welcomes input into our discussions from other stakeholders. By working together the professional and educational community can ensure that electives continue to be valuable educational opportunities whilst ensuring that students, patients and health systems are protected. Yours Sincerely Tim Crocker-Buque Chair, BMA Medical Students Committee Abi Smith Deputy Chair, BMA International Committee Vanessa Jessop BMA Medical Students Committee and International Committee Competing interests: None declared |
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