Friday, 30 August 2013

What would I do if I was I was in charge of Day One at Medical School?

As a new university year is fast approaching, I have been thinking abut the messages that our future doctors will be getting on their first day at medical school in a few weeks time.

Thinking back to my first day, aside from the intoxicating mix of fear and excitement, the messages I remember were about how hard the next few years would be and how much science we would have to learn. I really don't remember there being much of a patient focus at all, although I know it was six years ago, and memory can be selective. The first time I met a patient was a few weeks in, in the setting of a GP surgery - exactly how you imagine a patient to be, receiving care. But since being a patient myself, I have realised that patients are more than just a problem to be cured, or a recipient of care, they are their own experts and have capacity beyond the walls of the clinic, to supporting every aspect of healthcare through their involvement. Shouldn't we be introducing our future doctors to this wider potential of patients as resources and colleagues in healthcare? And when better to do it than Day One? 

What would I do if I was in charge of Day One of medical school? 

The initial welcome in the enormous lecture theatre would be co-delivered between the senior Dean/Professor of the medical school and a patient - to welcome them to the profession and the university. The patient co-deliverer would talk about how much they value clinicians in supporting them to manage their health and keep them well, but also how patients are a resource themselves to help the doctors.
Hopefully there would be more students!
Between the professor and the patient, I would hope they got the message across that the science is important, but not sufficient - that medicine needs to be framed within the lives of people who happen to be ill - their patients. 
The science of medicine is essential and I wouldn't want my doctor to not know the science, so this isn't about devaluing the academic aspects of medical school, but grounding that in the personal narrative. This would only work if the patient and professor were on the same page - to break down the 'us and them' mindset, and create a positive role model for students of collaboration between professional and patients.
I would use this wonderful summary from the brilliant Kate Granger about medical education from her article in British Journal of Hospital Medicine:

"learning the skills to become a good doctor is a very human journey."

The standard reading list would include the standard texts book fondly referred to by their principal authors (Grey's, Guyton & Hall and Rang & Dales to name a few), but the reading list would also include some blogs from patients, such Being a Patient Isn't Easy, GleefulKaz and Brain Lesion and Me - if medicine is about more than the science, shouldn't that be reflected in the reading list? As well as competing to get Rang & Dales out of the library before anyone else, shouldn't our students also be keen to read the next instalment of a patient or carer blog they are following? Any other blog suggestions are welcome in the comments below!

Day One is about setting the tone, expectations and aspirations of the students for the rest of their time at medical school and their ongoing years as professionals. So why shouldn't patients and all of their potential be central to that very first introduction?

I am not trying to say that this is going to change a generation, but ripple by ripple, we can grow attitudes. I'd be really interested to hear what other medical students and doctors remember from their first day, and if something like this is already happening anywhere? 
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  1. This is so true Anya and could be first day in school for a nurse, physio, Occupational therapist, etc. We need to bring the humanity back to healthcare education and stop the 'them and us' attitude developing from day one. We will get there though, even if it only feels like it is chipping away a bit at a time. Keep the faith!

    1. Of course! I don't know how other courses start, as medicine is the only one I have done, so didn't want too assume! But the principles are exactly the same for every single health care professional! Excellent point!

  2. Excellent points Anya. For an understanding of what dementia is like, I would recommend my blog charting my dad's 19 years with vascular dementia, and Kate Swaffer's blog, all about what living with dementia is really like (from someone living with dementia) So much for clinicians (and future clinicians) to learn from lived experience.

  3. I think this is an exceptional idea! The need for this kind of thing was really brought home to me the other day when I attended a medical school's session about their teaching. The speaker commented that 1st year students would hear from expert patients during their training, but that "when they go out into the community is when they'll meet the real patients in the NHS" - not sure that division between 'expert' and 'real' is very helpful! When asked why the students don't meet patients sooner, the speaker said that they wanted the students to 'make the most' of the patient encounters, which meant being fully prepared about what to ask them. To me, this seemed to be saying that they wanted students fully prepared in the role of 'doctor', which in my opinion might limit the kind of learning that can happen, and doesn't exactly encourage students to approach patients with an open mind.

    I think working how to get the balance between educating students with the necessary knowledge and skills but also making time for them to be open to what they can learn from patients is crucial. Your idea of having a patient leader there on Day 1 sounds like a great example.

    1. That is a really interesting point about expert patients perhaps not being normal! I guess that the average patient may not be really engaged in their care, but there is no average patient anyway!
      Thanks for a thought-provoking comment!