An unconventional treatment

October 26, 2001

The dean of University of East Anglia's new medical school thinks 'doctors' and 'nurses' will become obsolete. His radical curriculum will reflect this, he tells Claire Sanders

Sam Leinster, dean of the University of East Anglia's new medical school, is delighted that the university's motto is "do different". The medical school at Norwich, which will take its first 130 students in 2002, will reflect Leinster's views on medical education and be different.

"The time will come when the terms doctor and nurse will be obsolete," he predicts. "Health professionals will be judged not by their labels but by their competences."

This philosophy, which will underlie the teaching at UEA, is not fully accepted by all in medical education. "I am definitely on the outer spectrum of thinking," Leinster says.

He argues that as the boundaries between the professions merge, so must their education. Before the General Medical Council introduced a new curriculum in 1993, medical schools tried to cover all new developments in science. "The curriculum was irrelevant and encouraged superficial learning," Leinster says. What the modern medical graduate needs is the ability to "access, evaluate and use new information".

Doctors need many of the same skills as other health professionals, he argues. "Nurses can already do many of the tasks done by doctors." Students at UEA will learn alongside other health professionals and learn to work in teams.

At UEA, Leinster is well positioned to develop multi-professional learning. More than half (51 per cent) of students at UEA are registered in professional subjects. Three thousand - a quarter of UEA's student body and half of those in professional subjects - are registered in the health schools, which include a school of occupational therapy and physiotherapy; nursing and midwifery; and social work and psychosocial studies. UEA's health policy and practice school merged with the new medical school in August.

"The curriculum is problem-based," Leinster says. "Medical students will have two terms of system work, learning about the cardiovascular system, for example, followed by an integrative approach based around problem-solving with other health students."

UEA is also working towards coordinated placements and ensuring that lectures that follow problem-based learning can be taken together by different professional groups. "We would want nurses and doctors and other health professionals to have a chance to discuss euthanasia together, for example, after having dealt with such an issue through a problem-solving case," Leinster says. "It is not just an issue for doctors."

But does this approach work? Will boundaries really break down and can a nurse do a doctor's job? Leinster says: "A recent research project on a clinic in New York staffed entirely by nurses showed that it had the same success rates and referrals as one run by doctors. Many nurses already learn the skills of history-taking and clinical examination, and many are trained to carry out advanced practical skills such as endoscopy or vein harvesting for cardiac surgery."

Multi-professional learning and team working should also allow more movement between the professions. "To become a consultant rheumatologist, doctors study physiotherapy. What about the other way round? Why not allow physiotherapists to become consultant rheumatologists? The skills of both are not that far apart," Leinster says.

In keeping with its broad approach, UEA will be the country's only medical school to require students, rather than give them an option, to study a subject other than medicine in the fourth and fifth years. The choices range from creative writing to world development and risk and decision theory.

UEA will also be the only medical school to insist that academics spend half their time teaching and half researching. "Too often teaching is neglected in favour of research, so we intend to protect this time," Leinster says.

He believes UEA's is also the only medical school to ask for A-level biology and not chemistry. "Biology as it is taught now deals more with uncertainties, with probabilities, and that is what the modern medical student has to grapple with."

The school aims to attract mature students by building on the successful access to medicine course at the College of West Anglia, King's Lynne.

In another first, the medical school will be run by a joint National Health Service/university board. Leinster says:"We have representatives from all our partners on the board, as well as the university." The university has five partners, including the Norfolk and Norwich University Hospital NHS Trust, Norwich Primary Care Trust and the Norfolk Health Authority.

The school will build on Norfolk's strong primary-care base. "We want our students to learn alongside GPs because they are patient rather than disease-centred, and that is a good starting point," Leinster says.

Although teaching is clearly emphasised, research - including research into medical education - will be high on the school's agenda. The nearby Norwich Research Park already houses the Institute of Food Research, the Sainsbury Laboratory and the John Innes Centre, and all will have strong links to the medical school.

* The Peninsula Medical School, Plymouth, which opens to its first 1 students in October 2002, plans an innovative approach to teaching.

John Tooke is dean of the school, which is a partnership between the universities of Exeter and Plymouth and the National Health Service in Devon and Cornwall.

He says: "We are appointing a core faculty of eight dedicated teaching staff who will be responsible for the development and delivery of the curriculum, covering the range of scientific disciplines needed to support the programme. They will be research active, but principally in the education field." The new posts will be in the Institute of Clinical Education, headed by John Bligh (pictured).

"We aim to evaluate our teaching programme at the school, seek evidence for what works best in teaching, build up expertise in this area and look at the evidence for inter-professional education for health professionals.

"We have already advertised the posts and have had a strong response. Academics are attracted by the value we are placing on teaching."

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