Doctors in self-help

Iain Percy-Robb and David Lloyd describe Glasgow medical school's pioneering curriculum.

Undergraduates starting their medical studies at the University of Glasgow next October will follow a curriculum with a radically revised teaching and learning content. Following General Medical Council recommendations, the existing divide between pre-clinical and clinical study will disappear with students introduced to clinical problems from the start.

The new curriculum for a five-year degree will consist of four main components: a "core" within which biological science and clinical topics are fully integrated; a further clinical core devoted to case work; vocational studies; and special study modules. This will prepare medical students for the long-term intellectual and attitudinal demands of a professional life.

The philosophy behind the curriculum is to make learning student-centred. This places responsibility for study in the hands of the learner and conforms to the recommendations in Tomorrow's Doctors, published by the GMC in 1993.

This is a sea change for teachers who will be mainly responsible for enabling the students to operate as self-learners. The traditional lecture also gets a reduced role with a shift to self-directed study around the presentation of real-life problems and medical experience.

Problem-based learning, or PBL, using clinical problems, will be used across the integrated core, which accounts for 40 per cent of the total curriculum and has at its heart a learning "spiral". This spiral will complete four turns of increasing complexity and breadth. The first round emphasises the importance of the individual and the patient's perspective. The second deals with molecules and tissues. The third deals with systems, such as the digestive system, and the final round addresses broad clinical presentations, such as abdominal pain.

Students will usually have no more than two lectures, two seminars and two laboratory sessions per week. Provision of adequate learning resources for students is essential and includes a multi-copy library facility, computer-assisted learning, and study space.

Vocational studies, accounting for 15 per cent of the course, will from year one allow students to acquire and practise professional skills and attitudes. A valuable feature is that it gives students early contact with patients and other health professionals. Students can also use a skills laboratory to practise interviewing techniques, physical examination and a range of practical procedures.

A quarter of the curriculum is devoted to the clinical core in which students will be presented with cases to solve and expected to show their developing skills in communicating and physical examination.

In Tomorrow's Doctors the GMC observed that "the greatest educational opportunities will be offered by that part of the course which goes beyond the limits of the core". Special study modules will allow students to pursue subjects of their own choice in greater depth.

The aim is that students are driven through their own curiosity, developing the ability to evaluate evidence critically and the skill of handling data and writing reports. Some modules will offer topics, such as experience in an industrial environment, not usually associated with a medical curriculum.

A complex matrix of planning has underpinned the development of the new curriculum with a convenor appointed for each of the four main components, a year co-ordinator for each academic year, and "theme advocates" responsible for such themes such as multicultural implications and gender issues in Tomorrow's Doctors.

The medical faculty at the University of Glasgow has agreed that the curriculum will be centrally developed, managed, evaluated and assessed. A new medical education unit has been set up and an associate dean (education) and a curriculum development officer appointed (the latter funded by the Scottish Office Home and Health Department). Staff development is seen as a priority and an extensive programme is now in place.

Assessment will be two-fold: one continuous to give feedback and encouragement to students; the other determined by end-of-year exams consisting of a written paper with essay questions, short-answer questions and objective testing using extended matching questions.

Tomorrow's Doctors sets out 12 attributes of the independent practitioner. They range from the ability to solve clinical problems in medical practice to the handling of ethical issues, to the mastery of teamwork skills and the passing on of skills to doctors in training.

The curriculum planning group at Glasgow recognises that the basis of many of these attributes is gained during undergraduate study. They are further refined during postgraduate study and through postgraduate experience. While this is the case, the undergraduate curriculum should set the standards and provide knowledge, attitudes and skills that will equip new graduates for their postgraduate work.

Iain Percy-Robb is associate dean, education, and David Lloyd is curriculum development officer in the University of Glasgow medical faculty.