The future of medical schools?

I came across this video, which presents a scenario for the future of Leicester Medical School via AJCann.  Medical students at Leicester worked on a 3 week SSC project in August 2009 that provided training on how to collaborate to prepare future scenarios, assess their plausibility, construct arguments about the future and present their ideas creatively. This video was produced by Kate Charles, one of the students, and presents a scenario which sees Leicester Medical School turned into a car park in 2020!

Whilst I don’t think we’ll see medical schools converted into hospital car parks the video does raise very real issues. Kate highlights that medical students are likely to face a bottleneck of jobs in the future and that they need to stay ahead of the game and not miss out on a job beacuse they lack the necessary experience.  A similar point was made in a comment that DundeeChest made in response to a post made by one of our second year students on the DundeeChest blog ‘Will we all become GPs?

There will be fewer jobs in the future, there’s no doubt. But I think you’re missing a vital point – there will be fewer ‘everythings’. Fewer consultants, fewer GPs both. We train too many doctors, the government is reducing the numbers of doctors in training, and thus the numbers of senior doctors will fall also. The predicament your generation finds itself in is how to make sure that you are in the top xx % of your peers, to ensure that you are the one that gets the job – be it in General Practice, or Secondary care.

With the current economic climate and uncertainty about the levels of public spending post the General Election how else might medical education be affected?  Last November at the NHS – HE forum, it was concerning to hear the CEO of a district general hospital (DGH) in the north of England say that they were not sure whether DGHs could sustain their role of teaching and training medical students in the future because of affordability issues. DGHs make a very valuable contribution to undergraduate medical education. Is anyone discussing the implications of this possible scenario on medical education and the training of future doctors?

7 comments

  1. It’s a annoying paradox of the current system that we train too many doctors, the government tells us that we have too many doctors on the books, but I can’t fill a vacancy on our ST1 medicine rota, despite advertising 4 times. We’ve pushed good people out of the system, and there’s no-one left.

    What does the future hold for Dundee Medical School? I hope a great deal of innovative, exciting changes, to produce the top xx % of doctors in Scotland. But I would say that.

    I think we have to accept that there will be fewer senior clinicians knocking about, and that they will alway have direct clinical care as their first priority, teaching second. So delivering premium learning experiences is going to be about maximising contact time with senior clinicians, devolving other teaching responsibilities to the most appropriate teachers, a sensible approach to e-learning, and, most of all, a shift in responsibility back to the students for their own educations. We can provide the learning opportunities, but we can’t do the learning for them.

    I seem to have strayed from point.

    See you later.

  2. DC makes a good point at the end ‘a shift in responsibility back to the students for their own educations’. If you have come straight from school, were spoon-feeding is rife, is it not a little optimistic to expect students to take responsibility for their own education? Why not move to an American style system, whereby, a degree is done first? That way perspective students will have done a degree, learnt to fend for themselves, taken responsibility for their work, done extra work experience just to get the foot in the door of an interview room and then only the committed will want to proceed to Medicine. It may not seem fair to compare as the health services are not like for like but considering that it cost £250,000 of the tax payers money to educate a medical student for 5 years and similarly $250,000 tuition fees in America, its not so way off the mark.
    Which brings me to my second point. If there are to many doctors why don’t we reduce places across the board? Taking the above figure of £250,000 and assume that all 28 medical schools accept 160 people onto the course for last year. If this year that amount was halved across all schools that would save £112,000,000 per anum, which would go a little way to helping national debt?
    I also agree with the comments made above about innovation and e-learning but that is no use with school leavers, look at DundeeChest, they will take more and learn more but that is still spoon feeding but tailored to there modern ‘facebook’ needs. They don’t take responsibility and they don’t give back, apart from a small few. They just want to get their grades and become doctors, who can blame them?
    Dundee may have been voted top Medical school but it needs to keep pushing and innovating if it wants to start to get anywhere near the likes of the American Schools, which is fair given the above figures. However I think a perennial problems is the lack of inspiring people. I ask a school leaver friend of mine on the course ” who had inspired him in the 18 months he had been at Medical School?” his reply ” No one”. How can he and the others expect to want to change or innovate when they are uninspired by lecturers who, in general, are teaching because they have to not because they want to?
    This still leaves me with one question? Do we not need these people, who go through Medical school getting the grades, being spoon fed, uninspired and giving little back? These people will do good jobs, get by and get out what they put in. Leaving others to reach higher positions. If that is what people want then leave it but if you want everyone to excel and push the boundaries of healthcare then we need to make a few bold changes not lots of little ones and we need to make them now.

    1. Josh – plenty of food for thought in your comment! Re innovation and e-learning, in a few year’s time we’ll have students studying medicine who’ve grown up with the technology in schools. A few months ago I sat in on a webinar presented by a teacher from Australia who was showing some great examples of blogs written by 10/11 year old school kids. There are also plenty examples of kids developing content so we may see a shift in the next few years to students sharing more and not just taking and being spoon fed.
      Re your school leaver friend, who hasn’t been inspired by anyone at medical school, I’d be interested to know what inspired them to study medicine.

  3. I think it’s a real shame that Josh’s chum finds no one inspirational in the medical school. I was lucky enough to be taught be a plethora of inspirational tutors at medical school, particularly within my own college: one of my tutors discovered that Angiotensin II is a neurotransmitter in the brain; one of my tutors mapped out the function of the amygdala; one of my tutors was Stephen Hawking…

    Without inspirational teachers in the medical school, I fear we may be fighting a difficult battle. But success begets success – a couple of bright sparks in the faculty will attract more bright sparkiness, and so it will spiral – much like the curriculum.

  4. What does anyone think about moving to a graduate degree?
    Re e-learning blogging and the like seems to be the way forward. I was showing a friend, who is a history teacher, the PRN site and seeing if she could take any of it back to her classroom. She thought it was a great idea but that it was being started, if a little slowly, already.
    Re my chum, he is a great guy and while in my limited opinion make a great doctor. He loves medicine, the patients, the challenge and is constantly amazed at how fascinated the subject is. I try to get to know as many people as I can on the course and I can say with a little bit of certainty that this wonderful view is held by the vast majority on the course. Where it is a shame is that he and others haven’t meet teachers, with the exception of Dr Fardon whoever he is, who inspire them to do anymore than they have to or to change things. That is a very simple definition of inspiration but we need more like the above doctor for Dundee to claim top spot. May be if this chum of mine had been at Cambridge where you have more functioning amygdala’s than you can shake a stick at, he would want to innovate and make changes. But then he isn’t at Cambridge but why should that stop him?

  5. There are definite advantages to the graduate entry system. Cambridge began a graduate entry, 4 year, fast track medical degree whilst I was there. I presume it is still running. The other Dr Fardon (DundeeGPTrainee) entered Edinburger medical school as a graduate, and she’s done pretty well for herself.

    Maturity, more sense of purpose, reason for being there, and having got all the excitement of university out of the way – all positive reasons to move to graduate entry. But 3 more years at university is another 3 years of debt to build up, and perhaps more importantly, graduates enter foundation older – working weeks of nights, doing all the scut work, working long hours, it’s all much easier at 23 than at 33, I can tell you. And working nights when you have a family isn’t a lot of fun either.

    Add into that any research you might want to do, and the years of working available start to shrink a bit. The government wants 40 years of work out of us all, at least; after all they invested a lot of money in training us, so if a student enters medical school at 24, leaves at 30, should they continue to work until they’r 70? I started at 24, and I’m paying the extra super-an to get out at 60! Also, being able to get a consultant job at 32 meant I could stop doing all those registrar nights, and “settle down”; DundeeGPTrainee was a FY2 at 32.

    There is much that can be changed, advanced and improved in the medical school. I think there is a will from the NHS to be involved, and work in partnership with the university, and I think there is a shift in leadership within the university, a shift that is willing to embrace change. What Josh points out here, and over on DundeeChest, is that we just don’t know if the enthusiasm lies in the student body: you can take a student to the internet browser, but you can’t make the decision between interactive medical education, and Facetwit.

  6. While I agree with the generalisation that older and wiser generally go together, to go to the American system of graduates only (if I understand it correctly?) would add yet more years, as DC pointed out. And of course the equal opportunities bandwaggon folks would probably say it’s discriminatory against those from less well-off backgrounds.

    I can’t remember at the moment, but there was a consultation on student funding recently, and one suggestion was to “pay” medical students a (minimum) wage, making them feel valued etc. I think if that were introduced, even if the *medical* degree was lengthened, it could foster a greater sense of responsibility – not least with money. If we’re to act responsibly, we need to have a degree of responsibility. However, I certainly wouldn’t have been ready to go straight from school, so it was a good idea after all that I took a while to decide and didn’t get in first time – and got some life experience, working in a job. The danger of dragging everyone through yet more extra years of pure academia is a generation of “academic” doctors without any life skills.

    Just my tuppence worth!

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