Wednesday, 16 April 2008

Univeristy Says No

Yesterday we began a series of 'safe prescribing' lectures, there is the potential for a station in our OSCE on prescribing but I think these lectures are more aimed towards making us safer doctors. It is a shame that these lectures are starting 3 weeks before finals, it would have been much more useful to have them regularly throughout the year or even the whole 5 years. It was fairly basic stuff and it would have been better had there been slightly more pharmacology involved.

That said, the lectures were quite useful but it was the other things I learnt which I found most interesting. We asked why these sessions had been left so late, after all we've better things to be concentrating on at the moment. The answer was most enlightening.

It seems that they have had some trouble putting on these sessions, and others like them. In fact, we learnt that in previous years, one of the surgeons had offered teaching sessions throughout the year on things he thought were lacking in our course, suturing for example. Unfortunately for the students, the university had contacted the surgeon in question and ordered him to stop giving the sessions as it would be unfair on students at other hospitals. (For those of you who don't know, the 3 clinical years of our course are spent at 1 of 4 teaching hospitals in the region). Let me get this straight, the university had told staff at this hospital, not to teach us topics where there might be gaps in our knowledge? I was flabbergast, I really hope I've misunderstood something here because as far as I can see the university are actively withdrawing learning opportunities! Perhaps they're right, maybe it isn't fair on students at other hospitals, but that is the university's problem, it shouldn't prevent people from offering to teach! The university should be doing everything it can to ensure everybody gets these opportunities, not preventing them! It must be virtually impossible to prevent this kind of teaching at all 4 hospitals, so I'm sure somewhere some students are going to be getting something that other students are missing out on.

Why don't they just lock us all in a room for 5 years with some textbooks? God forbid we might actually be taught something!

What sort of institution is this and what sort of doctors is it trying to produce?


PhD scientist said...

"The university should be doing everything it can to ensure everybody gets these opportunities, not preventing them!"

Agreed, but that depends on folk - particularly the surgeons - in the other three hospitals stepping up, n'est ce pas? I would imagine if the guy had got his mates in the other base hospitals to offer the same training there it would have been a win-win all round, and would have been rapidly approved.

I agree with you that it is a travesty to tell someone NOT to offer useful teaching, but.... imagine if suturing came up in an OSCE done in all four hospitals, and then word got round (as it inevitably would) that one hospital's students had had "extra tuition on suturing as well as other stuff". Honestly, LM, are you really saying there wouldn't be an absolute shitstorm of complaint from the students at the other three hospitals? Anyone who failed there would be appealing the decision, and the whole system would go into meltdown.

I doubt they are really telling him off for teaching - it is more telling him off for his unilateral action.

the little medic said...

PHD scientist - You're right about the complaints, they happen every year, although usually not a lot comes of it. For example last year the practice 4th year OSCE at one hospital happened to contain all the same stations that came up in the real exam. People complained and it was ignored.

A similar thing happened when a group of students at one hospital was shown about 15 questions from one of our exams. This time, there was a huge fuss and the med school did eventually decide to discount those questions.

I guess it depends on who takes overall responsibility for our education. Is it the university? In which case they should be ensuring a consistant curriculum among the different hospitals. Or is it the Surgical staff as a collective who should be delivering consistant teaching across all hospitals.

Perhaps rotating around base hospitals would offer a slightly fairer solution?

dr_dyb said...

You mean you don't rotate? Thats crazy........

How else can you be switched at 5 weekly intervals between hospitals up to 2hrs drive away, whilst having to use the central library at the med school, and attend random sessions throughout your block. How else can you earn so many tesco petrol points to pay for a summer holiday to the sun?

On the positive side, you develop an encyclopaedic knowledge of the transport links to hospitals, their individual parking charges, and how to operate the photocopier in up too 17 different hospitals across 6 health boards.

PhD scientist said...

Yes, I remember you writing about the the "got shown fifteen Qs" fuss.

It is actually always going to be a very difficult job ensuring parity across four sites. The problem is not agreeing what ought to be done - that is typically relatively straightforward, though see below. Where the problems start is having enough of the appropriate people to deliver the agreed teaching AND support in all four places. The people have to exist AND they have to be prepared to do it. The latter is a sticky problem in the hospitals in the clinical years, since the NHS hospital staff who do lots of the teaching are often not paid by the Univ and are thus doing it for interest, for a session a wk off from wards/clinics, or for "career leg up points". This works OK, up to a point, but they are not under the same sort of contractual obligation to teach as Univ academics in the preclinical yrs. Basically the NHS lots are doing the Univ a favour, they don't HAVE to do it and they can pretty much bail at any point, which makes planning a nightmare.

"Remember that guy that taught XYZ last year... oh wait, he says he doesn't want to do it this year... shit - who else is there, quick, semester starts in 4 wks" etc etc. Believe me, as the planner of bits of a medical curriculum I've been there, done that, got the t-shirt.

So e.g. to get enough surgeons to teach "surgical anatomy and techniques" on all four sites, and make it comparable, you would be looking at lots of wheeling and dealing, schmoozing, favour-trading etc etc. And if someone says "well our surgeons don't think this is needed, and we don't have the manpower, unless you fund a half-time Nurse Educator post"... blah blah blah.

Now where I would agree with you is that the medical school are ultimately responsible and therefore OUGHT to be prepared to take on the organising properly, but we come back to time and resourcing again. Who, exactly, is going to do it? If MEDICAL faculties have a recurring fault, it is that most of the clinical academics (esp. senior ones) are unprepared - or far too busy - to get their hands dirty. They like to take "academic responsibility", and do the higher order conceptual planning, but it will be someone else's job to actually implement it - to organise things. Who is that to be? Even mid-level clinical academics are too scarce or too grand, so it often falls to fairly poorly paid administrators who don't really understand the academic aspects of things. If you get the right academic overseer "in harness" with the right administrator it works OK, but with the wrong people it is a balls-up waiting to happen. And when you have to do this in four separate places the chances of a balls-up simply increase x4, or rather x more than 4 since you are arguably selecting the people to do the jobs from a smaller local talent pool.

All a bit of a merry go round, really. But proper resourcing, and proper "priority" assigned to teaching within the University's activities, is the key. But that is a top-of-the-Faculty, or even top-of-the-University thing. The local person organising the curriculum will usually be trying their best under sub-optimal conditions. Come to think of it that sounds like the NHS...

Hospital Wallpaper said...

On the positive side, you develop an encyclopaedic knowledge of the transport links to hospitals, their individual parking charges, and how to operate the photocopier in up too 17 different hospitals across 6 health boards

And even better work out where you DON'T want to end up as an F1/2.

the little medic said...

dr dyb - 3 of the hospitals do rotate to other various places but my hospital doesn't really. I think that is because it is already 40 miles away from the university. If you get sent there you're not really 'at' your university anymore because apart from exams you never have anything to do with it really. My decision to live where my univeristy is and commute to my hospital means that I earn plenty of petrol points (I prefer nectar myself) and I have an encyclopaedic knowledge of every petrol station on my 40 mile route from price to the names of the staff!

Kelly said...

Seems crazy to prevent one surgeon from organising informal teaching sessions. It's akin to telling keen students to stop being pro-active and seeking extra teaching. I could understand it better if it was formal stuff that the university paid extra for but if they are only paying the hospital in question the SIFT money same as the others then why on earth are they grizzling? I'd have thought they would have been better off trying to encourage other hospitals (doctors and students) to set up similar informal schemes...

PhD scientist said...

kelly, the hospital in question is, I am pretty sure, an "academic base centre" for the students - i.e. w. "student learning centre" and students based there for all of yrs 3-5 - thus what goes on there will always look (and be interpreted by the students) as if it is officially sanctioned, or at least condoned.

"Seems crazy to prevent one surgeon from organising informal teaching sessions. It's akin to telling keen students to stop being pro-active and seeking extra teaching."

Well in principle I agree 100%... but I come back to the fact that this kind of mindset in Univs is a direct response to student complaints about "lack of parity" and even lawsuits - see my first post on the thread. Students can, and do, regularly try to get fail grades rescinded on the grounds that "my tutor this semester was no good and that other group's tutor told them lots more stuff."

This is the current reality, I'm afraid, and with this as the norm Univs will inevitably be practising "defensive management" of the kind LM describes.

Anyway, I don't think students (collectively) can escape a large chunk of responsibility for the current state of affairs. But I agree that the end result (telling someone who wants to give instruction and teaching not to) is tragic.

Anna said...

nice post