Make practical training more effective

Many of the developments and research in medical education have focused on the undergraduate curriculum, especially the theoretical parts. Clinical attachments and postgraduate training have not received nearly as much attention. This is unfortunate because not only are these practical aspects largely unstructured but they also waste too much time on non-educational activities and rely on learning by doing.¹²

Changes in society have made this approach inadequate. Firstly, patients' growing awareness about quality of care makes them understandably reluctant to act as learning tools for medical students or registrars. Secondly, the European Working Time Directive, which limits the number of hours a registrar is allowed to work to 58 a week, has implications for training. The directive is a good thing for individual patient care, as working long hours increases the risk of medical errors,³⁴ but there is a downside. The evidence from cognitive psychological research on expertise shows that to become an expert you need many hours of practice.5

The challenges are thus to find ways to allow registrars to practise without using patients as learning objects and to optimise the educational effectiveness of …