Early learning for docs

May 26, 2000

A London teaching hospital is sending its trainee medics back to primary school. Claire Sanders learns why training doctors is child's play

The walls of Mary Seabrook's office in the heart of Guy's, King's and St Thomas's School of Medicine are covered with children's pictures. The painstaking handwriting of six and seven-year-olds spells out which foods are good for you and which are not and carefully explains the benefits of cleaning your teeth.

For Ms Seabrook, senior lecturer in medical and dental education, they bring together two strands of her career to date - primary school teaching and teaching medical students.

"When I joined King's eight years ago I brought with me years of teaching experience. I was appointed as an administrator but became involved in research and developing courses, and, to be honest, I didn't feel I would draw much on my teaching experience," she says.

But all that has changed. As King's has wrestled with the demands of the General Medical Council, Quality Assurance Agency and Institute for Learning and Teaching, it has revolutionised its curriculum. A bout of mergers has made it the biggest dental and medical school in the United Kingdom, and it has increasingly called on the education skills of people such as Ms Seabrook.

In 1998, the school set up a department of medical and dental education. Part of its job is to "assist teachers who take on the challenges of the new educational methods of the new curriculum". It is also described as "a resource to support research and evaluation work in the educational field". Ms Seabrook is based in the department with three other former teachers.

So what do medical students and primary school pupils have in common?

"Well, for a start, you have to establish the right teacher-student relationship," Ms Seabrook says.

But she also describes children as "less forgiving. You cannot afford to be a passive teacher with children. When a medical student loses concentration their eyes may politely glaze over, but a child will start to walk around the room. It is stressed to primary school teachers that they must involve the children, that message has to get through to those teaching older age groups as well."

One way of ensuring student involvement is to get the students to do part of the teaching. Ms Seabrook runs a module in which students teach health matters in primary schools. "It improves their communication skills and makes them think through how to present complex information clearly," she says.

She gives a number of examples where the students have found themselves negotiating the sort of medical and social minefields they will encounter everyday with patients.

"You have to be careful what you say about smoking, for example," she says. "Many children will have parents who smoke. You have to find a balance between educating a child about the dangers of smoking and terrifying them about a parent's habit."

Then there are always those tricky questions. "One student was shocked to be asked, 'What is impotence?'" Ms Seabrook recalls.

Ms Seabrook runs a two-day course for doctors and dentists on teaching skills. "Many will have been teaching for years without training or an opportunity to reflect on how they teach," she says. "I ask people to reflect on their own learning experiences, to question their techniques and devise ways of ensuring that students are understanding information."

She agrees that some lecturers find this easier than others. "But no one should think that because they are not a 'natural' at teaching, they cannot learn and improve."

After the 1993 publication of the GMC's recommendations for a new curriculum in its report Tomorrow's Doctors, medical schools throughout the country radically altered their curricula.

Tomorrow's Doctors emphasised the need to concentrate on the understanding of essential principles rather than simply acquiring increasing quantities of information to be regurgitated in examinations.

The report also stressed the importance of behavioural and social science and highlighted the importance of attitudes, skills and competences as well as knowledge. Problem-solving exercises play an important part in the new curricula, with students introduced to patients far earlier in their course.

When King's merged with Guy's and St Thomas's in 1998, all three had to bring together the new curriculum that each had developed.

Ms Seabrook has carried out a number of research projects for the school. One looked at what students learnt in different clinical placements, called firms. "We found huge variations," she says. "This was due in part to which patients happened to be in on particular days, but was also due to the old apprenticeship-style of teaching with its lack of planning and coordination." The new curriculum has sought to remedy this.

Ms Seabrook is doing a PhD on the changes in medical education over the past five years. "The work of the QAA and the introduction of the new curriculum has encouraged a focus on teaching that was perhaps lost with the stress on research," she says. "But we still need to know whether our changes are working. Are we producing better doctors?" Following a QAA visit in March, the school was awarded a score of 22 out of 24, in its assessment. This is the highest score achieved by any newly merged medical school in London. It was achieved 19 months after merger.

So the school appears to be on the right track. But whether it really is producing better doctors will only become apparent in a few years, when the new curriculum has become embedded and the new doctors qualified.

Ms Seabrook is already looking at ways of evaluating the impact of the changes.

"I feel that because I am not a doctor I can bring something new to the education of doctors," she says. "I can draw on experience of education in other fields and see things from a patient's point of view."

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