Reviews SOUNDINGS

Student selected caesareans

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7432.175-a (Published 15 January 2004) Cite this as: BMJ 2004;328:175
  1. James Owen Drife, professor of obstetrics and gynaecology
  1. Leeds

    2004 is my 40th year in medical education, as student or teacher. Back in 1964 our class was special—the first to experience the New Curriculum. The idea had been to reduce factual learning and make the course more integrated.

    I now know that reducing factual learning is a tradition stretching back to the 19th century. Each generation of educators discovers that designing a fully integrated and really challenging course is fun. It certainly beats teaching.

    Our last new curriculum in Leeds had special study modules (SSMs). Our current one has student selected components (SSCs). When I asked about these damn fool initials, I was told they came from the General Medical Council (GMC). Ah yes. Back in Hallam Street it had seemed a good idea to let students choose subjects for in-depth study.

    When the Leeds ethics theme team asked for topics for a third year SSC, I suggested: “Should women be allowed to choose caesarean section?” Later the emails started arriving, asking: “When can we meet?” That's when the magic started. After decades of force-feeding students the basics I had five lively undergraduates talking to me by choice.

    Never having done obstetrics, they soaked up background information about indications and risks. I tried (but not too hard) to disguise my own opinion that a well-informed woman can choose how to have her baby. Then off they went to surf the literature.

    Most of the stuff on the internet is written by people who believe that pushing a baby through your pelvic floor is a harmless and fulfilling experience. The students, rather pro-choice to begin with, were persuaded that caesarean section is risky, bad for bonding, and too expensive for the NHS. People who like it don't say so on the web.

    The climax of the SSC was dramatised presentations. Emily wore a pregnancy belly with an umbilical ring. Hinaa was the NHS obstetrician and Imran the hospital manager. David played the suave Brazilian husband and Aysha provided the commentary.

    They wrote the script but let me direct. “Now, luvvies, let's do the moves. Autonomy here… Beneficence here… Marvellous, darlings!” I got a text message when they were about to start. They were terrific. I went home a happy medical academic. Now that is new.