The changing trends of medical education SACORE 5-9-2011 Livingstone Zambia Parveen Kumar Professor...
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The changing trends of medical education
SACORE5-9-2011
Livingstone Zambia
Parveen KumarProfessor of Medicine and
Education
Factors influencing how we should train doctors
• Demographic changes– Population health– Percent GPD spent on health– Legislature– Role of doctor
• Societal attitudes- patient expectations
• So where does this leave research?
MEDICINEMEDICINE
Basic Basic SciencesSciences
PathologyPathology
CommunicationCommunication
Clinical SkillsClinical Skills
PatternPatternRecognitionRecognition
Research
Tomorrow’s Doctors, Tomorrow’s Doctors, 19931993
• Reduction in factual factual overloadoverload
• Increase in learninglearning through curiosity (PBL)(PBL)
• Emphasis on clinical clinical skills /communication skillsskills /communication skills
• Understanding of Research Research technologytechnology
Development of the skills Development of the skills and attitudes that befit a and attitudes that befit a doctordoctor
Core Competencies
GMC Good Medical PracticeAdditional skills• Teachers• Researchers• Managers • Leaders
Population healthPopulation health
Complex factors:• Age • Genetic profile• Lifestyle – alcohol, smoking,
obesity, exercise• Environment – pollution• Socio-economic conditions -
poverty• Effectiveness of health service
Changing face of disease and Changing face of disease and disease managementdisease management
Peptic UlcersPeptic Ulcers
THEN……..THEN……..• Bed restBed rest• AntacidsAntacids• Prev- milk dripsPrev- milk drips• ………………OperateOperate
NOW…..NOW…..
Helicobacter pylori !Helicobacter pylori !
Myocardial InfarctionMyocardial Infarction
THEN…THEN…
• Bed rest – 3 Bed rest – 3 weeksweeks
• Mobilisation-3 Mobilisation-3 weeksweeks
• Off work 3-6 Off work 3-6 monthsmonths
NOW…NOW…• ThrombolysisThrombolysis• Angioplasty/stentingAngioplasty/stenting• MedicationMedication• Life style changesLife style changes
Educational strategies in Educational strategies in medical educationmedical education
• SStudent-centred learning• Problem-based learning• IIntegrated teaching• CCommunity-based education• EElectives ( core curriculum+)• SSystematic introduction to skills and
competencesHarden et al 1984
Teaching MethodsTeaching Methods
• Small groups• Interactive• Integrated with
the curriculum• Educational
resource – real patients
– standardised patients
– models– video
Experiential learningExperiential learning and clinical skills and clinical skills
• Apprenticeship is not dead!
• Mentoring• Clinical
Supervision• On the job
training• Clinics
Summary message fromSummary message fromlearning theorieslearning theories
• The learner is an The learner is an active active contributorcontributor
• The The learning environmentlearning environment is is importantimportant
• Learning is related to the solution Learning is related to the solution of of real life problemsreal life problems
• Learners are capable of Learners are capable of self-self-regulationregulation
• The ability to The ability to reflect on practicereflect on practice is is critical and needs encouragementcritical and needs encouragement
MB,BS CURRICULUM PLAN
Year 1 Year 2 Year 3 Year 4 Year 5
A spiral curriculum revisits themes
CARDIORESPIRATORY
METABOLISM
LOCOMOTOR
BRAIN & BEHAV.
HUMAN DEV.
FUN
MED
FY1
PREP
THE WHOLE PERSON
E
How do you learn?
• PBL tutorials• Self-directed study• Learning Landscape and Clinical Skills
lab• Lectures • E learning
The Objective, StructuredThe Objective, StructuredClinical Examination (OSCEClinical Examination (OSCE))
• A circuit of stationsA circuit of stations• Students perform Students perform
standardised tasksstandardised tasks• Structured rating formsStructured rating forms• FlexibleFlexible• Valid, reliable, practical Valid, reliable, practical
(Harden and Gleeson 1979)(Harden and Gleeson 1979)
Basic AppliedTranslational Practice
Hypothesis driven
NHSSolving problems
MRC NIHRnew board
Includes animals patient & people based
Consultation2005
Academic careers (Walport)
• Academic Careers Subcommittee of the UKCRC and Modernising Medical Careers
Why do research?
• Enquiring mind - rigorous analysis of problems. Unchartered waters
• Can be basic science or clinical (both)• Academic pathways established• Improves quality of care to patients• International collaboration/friends• Highs and lows• FUN
Research (making discoveries) is a creative activity, not a standard process that can be prescribed, scored and audited like the accounts of a company.
In a research and teaching environment we need to cultivate:
•Flair• Inspiration•Creativity•Achievement
CETL learning
Available tutorials