As a student – any kind of student – one’s favourite academic activity is to criticise. Your syllabus, modules and lecturers are all weighed, measured and found wanting.
I am going to take a wild guess and say that of all courses offered the world over, medicine is the one that varies the most from institution to institution. What’s more, medical syllabi are constantly changing. To the best of my knowledge, my own university has undergone two major syllabus-revisions in the past fifteen to twenty years.
So we spend a great deal of time discussing the shortcomings of our course and how it should be changed once more.
Lord, they should just put us in charge already.
A while ago The Boy suggested we have a first year course in medical terminology, because his Alma Mater offered it and it supposedly worked. The Boy is coincidentally not in the business of healthcare, but about half of his family is.
I admit, I scoffed at him and his idea. I think it is a stupid idea. We all know that the crème de la crème comes to study our course and they should be enthusiastic and eager to learn. When I was a first year and I didn’t understand a term, I used my meagre understanding of Latin combined with my common sense to figure it out. And if that didn’t help there was always medical dictionaries and Google. Our course is full enough (and long enough) as it is, we really do not need another useless subject crammed into our six years here.
But then Friend in my clinical group suggested it too. And he is a medical student, so I could not exactly scoff at him. Turns out a whole bunch of students on our campus would have welcomed such a module in their first year. So much for enthusiasm and the cat’s whiskers and all that.
It set me thinking though. While we do have an awful lot of work crammed into a long six years, much is left to be desired for the optimal management of said time.
For example, in our first year here we do a module called “Personal and Professional Development”. It is much like South African Life Orientation or USA Citizenship Class. It teaches things like introduction to ethics (despite the fact that we do a full course of medical ethics in our fifth year), and some things on well-being and alcohol and what not. To be honest I don’t remember most of it and I actually did attend those classes.
Professionalism should be something that is fostered in the clinical environment by consultants – you should not try to foster it theoretically. Oh yes, we also did some psychological developmental stages which nobody remembers because it was taught late on a Friday. So perhaps medical terminology would be a better thing to teach in those timeslots.
Still on first year courses, we also did a module on Biostatistics. We all hated it and performed poorly in it. This year I learned that our faculty also experiences problems with said module. It is offered by another faculty, which always presents a ton of problems. Furthermore it quite possible that year in and year out, students perform poorly because it fails to be relevant to their field and there are obviously reasons they chose to study medicine as opposed to Mathematical Statistics.
The hope is now that a prospective centre for Evidence Based Medicine, set to be implemented in our faculty, will take over the teaching of statistics, but in a manner that is relevant to the health sciences. It is still a long time to go, but it will certainly be a more beneficial venture.
The teaching of a third African language is a noble plan of our faculty. It is essential for a doctor in any community to be able to communicate with his patients, and in a country with ELEVEN official languages, this offers a unique challenge.
In my first year we were given a six week crash course in isiXhosa. We were given a thick book of terms and the tests were of the nature that you could pass without really having studied. For example, Match the Columns. If you know that “ntloko” means “head” and one of the options is “My head hurts”, it is quite easy to match the column. You don’t really need to know the translation for the rest of the sentence.
Of course the next year they tried making the test more challenging, but that also was not fair because it was still a six-week crash-course.
The latest movement in our faculty – which is truly praiseworthy – is an initiative to make this Xhosa Program one of vertical implementation. In other words, teaching the language continuously throughout the course; making it an outcome for each module so to speak. I am more likely to learn to speak the language at a grassroots level if my clinical logbook includes “basic consultation in Xhosa”.
At my level – doing clinical work – you start realising that you have some serious shortcomings and that it is largely your own fault.
Our theoretical modules are “integrated”. In other words, we do anatomy, physiology, histology, pathology, microbiology, virology, pharmacology (etcetcetc) of one system all in one module.
It is a great idea. The catch however is that some sections may only add up to about five marks in the test and exam. Paediatrics, Microbiology and Pharms are classic examples of this. And of course if you are a busy medical student, you are not going to study eighty pages of memory-intensive stuff for a measly five marks.
So you spot and you pass your exams knowing nothing about, say, the pharmacology and then you get to hospital and your consultant looks at you and says, “Doctor! Your patient is going to die; what do you prescribe?” And you stand with a mouth full of teeth. Nice.
While we were on our Paeds rotation, we decided that we needed a separate Paediatrics Theoretical Module. We had already taken all of our paeds notes from our files and combined them in a separate file. A theoretical module wouldn’t require additional available time, it would simply require rearranging time.
The same goes for pharmacology. We have a pharmacology module at the end of our first year, but that is forgotten long before you enter the clinical arena. Fortunately it seems that another module will soon be implemented for our fifth year.
It is very difficult to educate young people to the level of being medical doctors. The syllabus should evolve constantly. But like I said, just put us in charge already.