The changing trends of medical education

SACORE5-9-2011

Livingstone Zambia

Parveen KumarProfessor of Medicine and

Education

Factors influencing how we should train doctors

• Demographic changes– Population health– Percent GPD spent on health– Legislature– Role of doctor

• Societal attitudes- patient expectations

• So where does this leave research?

MEDICINEMEDICINE

Basic Basic SciencesSciences

PathologyPathology

CommunicationCommunication

Clinical SkillsClinical Skills

PatternPatternRecognitionRecognition

Research

Tomorrow’s Doctors, Tomorrow’s Doctors, 19931993

• Reduction in factual factual overloadoverload

• Increase in learninglearning through curiosity (PBL)(PBL)

• Emphasis on clinical clinical skills /communication skillsskills /communication skills

• Understanding of Research Research technologytechnology

Development of the skills Development of the skills and attitudes that befit a and attitudes that befit a doctordoctor

Core Competencies

GMC Good Medical PracticeAdditional skills• Teachers• Researchers• Managers • Leaders

Population healthPopulation health

Complex factors:• Age • Genetic profile• Lifestyle – alcohol, smoking,

obesity, exercise• Environment – pollution• Socio-economic conditions -

poverty• Effectiveness of health service

Changing face of disease and Changing face of disease and disease managementdisease management

Peptic UlcersPeptic Ulcers

THEN……..THEN……..• Bed restBed rest• AntacidsAntacids• Prev- milk dripsPrev- milk drips• ………………OperateOperate

NOW…..NOW…..

Helicobacter pylori !Helicobacter pylori !

Myocardial InfarctionMyocardial Infarction

THEN…THEN…

• Bed rest – 3 Bed rest – 3 weeksweeks

• Mobilisation-3 Mobilisation-3 weeksweeks

• Off work 3-6 Off work 3-6 monthsmonths

NOW…NOW…• ThrombolysisThrombolysis• Angioplasty/stentingAngioplasty/stenting• MedicationMedication• Life style changesLife style changes

Educational strategies in Educational strategies in medical educationmedical education

• SStudent-centred learning• Problem-based learning• IIntegrated teaching• CCommunity-based education• EElectives ( core curriculum+)• SSystematic introduction to skills and

competencesHarden et al 1984

Teaching MethodsTeaching Methods

• Small groups• Interactive• Integrated with

the curriculum• Educational

resource – real patients

– standardised patients

– models– video

Experiential learningExperiential learning and clinical skills and clinical skills

• Apprenticeship is not dead!

• Mentoring• Clinical

Supervision• On the job

training• Clinics

Summary message fromSummary message fromlearning theorieslearning theories

• The learner is an The learner is an active active contributorcontributor

• The The learning environmentlearning environment is is importantimportant

• Learning is related to the solution Learning is related to the solution of of real life problemsreal life problems

• Learners are capable of Learners are capable of self-self-regulationregulation

• The ability to The ability to reflect on practicereflect on practice is is critical and needs encouragementcritical and needs encouragement

MB,BS CURRICULUM PLAN

Year 1 Year 2 Year 3 Year 4 Year 5

A spiral curriculum revisits themes

CARDIORESPIRATORY

METABOLISM

LOCOMOTOR

BRAIN & BEHAV.

HUMAN DEV.

FUN

MED

FY1

PREP

THE WHOLE PERSON

E

How do you learn?

• PBL tutorials• Self-directed study• Learning Landscape and Clinical Skills

lab• Lectures • E learning

The Objective, StructuredThe Objective, StructuredClinical Examination (OSCEClinical Examination (OSCE))

• A circuit of stationsA circuit of stations• Students perform Students perform

standardised tasksstandardised tasks• Structured rating formsStructured rating forms• FlexibleFlexible• Valid, reliable, practical Valid, reliable, practical

(Harden and Gleeson 1979)(Harden and Gleeson 1979)

Basic AppliedTranslational Practice

Hypothesis driven

NHSSolving problems

MRC NIHRnew board

Includes animals patient & people based

Consultation2005

Academic careers (Walport)

• Academic Careers Subcommittee of the UKCRC and Modernising Medical Careers

Why do research?

• Enquiring mind - rigorous analysis of problems. Unchartered waters

• Can be basic science or clinical (both)• Academic pathways established• Improves quality of care to patients• International collaboration/friends• Highs and lows• FUN

Research (making discoveries) is a creative activity, not a standard process that can be prescribed, scored and audited like the accounts of a company.

In a research and teaching environment we need to cultivate:

•Flair• Inspiration•Creativity•Achievement

CETL learning

Available tutorials