… at the …
Number 99
Monthly news
Dr Simon Ackroyd, Consultant Paediatrician
writes:I have been asked to reflect on my experience of the
changes I have witnessed in education. Since starting
out 46 years ago the curriculum has undoubtedly
changed dramatically. Other aspects of the style of
education have changed, sometimes less obviously.
First experience
In ‘pre-clinical’ there was no contact or discussion
about patients and the closest that any of us got to a
patient was the Post-Morten room, which we could
freely attend and hear entertaining, if somewhat
garrulous, discussions of what patients had wrong
with them. Keith Simpson, a renowned Forensic
Pathologist, was immensely popular for both his
lectures, which were highly entertaining, as well as his
post-mortem performances, which were really an act
of theatre. However we did see a lot and there was
no doubt that exposure to post-mortem evidence,
along with pathology teaching, was immensely
valuable and perhaps is rather neglected now.
Ward Rounds
I overlapped the era of very autocratic Consultants
talking down to everyone and the newer, more
communicative Consultants. However there were the
older Consultants who did not change! This was
sometimes quite entertaining and I remember one
particular occurrence when the Queen’s Physician
decided to do a sigmoidoscopy in front of the students
and, in the process, entangled his rather expensive tie
with the sigmoidoscope. A demand for “Scissors
Sister” led to the loss of said tie and general
entertainment and hilarity, although of course you
could not show that!
Bedside Teaching
This was considered the priority. Hence a lot of time
was spent standing in groups around unfortunate
patients whilst their diagnosis and clinical signs were
discussed and dissected quite openly. Little thought
was given to the misinformation they may have been
picking up in the process.
1st February 2012
Communication Skills
The only communications teaching I had was from
a Microbiologist about whether to tell patients what
was wrong with them. He described the case of a
young man with leukaemia. On being told the
diagnosis he drove out in his sports car up the
motorway and killed himself. On the strength of
that the best advice is to never tell patients what is
wrong with them! No further discussion and no
further training. Certainly no role play – thank
goodness.
Since then things on the ward front have, I feel,
been fairly static. The curriculum has changed
hugely, with obvious emphasis on communication
skills and breaking bad news. All of that has been
a good move forwards, although at times it is
rather over-emphasised to the detriment of
learning anything about medicine.
The emphasis on round-the-bed teaching
continues, though in a more considerate fashion
with patients not being upset.
Essential
information is discussed around the bed but
subsequent discussions are carried out elsewhere.
Computers – of course the most dramatic change
in the last 40 years has been computers. This has
affected teaching, moving from blackboards to
overhead acetate sheets to computers and DVDs.
The ability to put together a lot of information and
make it available to a lot of people at the same
time has, I think, transformed teaching. It makes it
much easier to communicate.
Students in Cheltenham used to attend from
Bristol and other Universities, particularly London,
for two or three weeks at a time. In Paediatrics we
would have them here for a few weeks and then
they would go back to the more formal training
within their training base. This was very enjoyable
from the point of view of teaching and most
students enjoyed it a lot. However the more
recent change to the Academy setting has, I think,
been a great advantage on all sides.
Having regular groups of students for whom we
are responsible to train gives departments a sense
of ownership of the training programme and also an
opportunity to really ensure a really good attachment
for students.
In Paediatrics we have been doing this now for about
seven or eight years. Four blocks of seven weeks
gives good access without taking over the whole
year’s timetable and so there is plenty of room for
catch up of other commitments.
Work load is shared across the department so that all
Consultants will potentially be involved at times with
teaching, with formal tutorials and workshops, around
the bed and in outpatient clinics.
The involvement of Registrars and SHOs is difficult in
the formal setting because of the shift system of
working but with acute work it is a good opportunity for
them to take part in teaching and experience that.
The increasing emphasis on self-directed learning has
its advantages but it also has its disadvantages. It is
much easier as a student to get to grips with a subject
initially from a good discussion or tutorial and then to
read about it than it is to sometimes read a clinical
work, which they are not familiar with at all and which
does not always make sense.
Linking clinical
teaching to patients, and individual patients, helps and
I think the emphasis on that is considerably stronger
now than it has been in the past.
The Future
I envisage that the Academy will continue as it is but
develop, possibly getting larger. The idea of sharing
out students around different hospitals is an excellent
one and I think that for DGHs it provides a very good
involvement with teaching and a stimulus to the
Department. Hopefully that will continue.
DATES FOR YOUR
DIARY
5th
We still require examiners for
Year FINAL LONG CASE EXAMS
6th March 2012 – Redwood Education Centre, GRH
REFLECTIVE ACCOUNT MARKERS
WANTED
Markers are needed through March to assess 5th Year
Medical Students Reflective accounts
COMP 2 OSCE’S
(GOAM & GP Examiners needed)
12th June 2012 – Sandford Education Centre
If you are interested in taking part in any of the above
please email: [email protected]
Gloucestershire Academy website:
http://www.gloucestershireacademy.nhs.uk/bristol_
st/index.htm
University of Bristol
[email protected] (MB ChB Programme Director)
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[email protected] (Deputy Programme director)
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http://www.bris.ac.uk/medical-education/tlhp/
Teaching and Learning for Health Professionals Certificate course
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Ophthalmology ‘MDEMO’ & Deputy Dean
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Year 5 Senior Surgery (G & C respectively)