Clinical training in the community: a holistic approach

“I'm not interested in general practice. I'm only interested in really ill people.” This comment by a fellow student seemed a sad reflection on hospital based medical education. As medical students clock up the number of heart attacks they see on the wards, I wonder how many reflect on how the patients got there, the personal impact on them, and what will happen to them when they leave.

I am one of the first four students who started the Cambridge community based clinical course in October 1993. As a former school teacher and mature student, I decided to apply despite the potential risks of a new and radical course. I sympathised with the aims of the course and agreed with the educational philosophy of a problem solving approach and self directed learning. The course, which runs parallel with the first 15 months of the clinical course at Addenbrooke's Hospital, was the idea of Dr Nigel Oswald, senior partner in the practice where we are based and a university lecturer in general practice. The other general practitioners, the community midwife, the practice nurses, the health visitor, and the other staff at the health centre all contribute to the project.

We follow through patients we meet in surgeries or on visits. We record …