Monday, 17 March 2008

Clinical Skills

Dear Bloggers

Now is the season when medical students visit various hospitals around Japan for a 3-day period to see what each institution has to offer for the purposes of future training in the respective residency programmes.

In Japan, most medical students do not have any clinical 'hands on' experience until the beginning of the 4th or 5th year of medical school.

From my previous interactions with several students and residents at different institutions, the general consensus is that the teaching of clinical skills at university is not optimal for what they need to examine patients. Of course, some medical schools have many sessions for teaching on real patients and there is the newly introduced OSCE system to ensure that there is a basic minimum standard. Hence, training can be variable depending on the institution in question.

Some UK medical schools have the medical students learning clinical skills from their very first year by placing them with a community general practitioner who can select for them well patients with chronic illness, who attend the clinic to have their history taken in full in addition to examination by the student. The general practitioner then listens to the history and demonstrates the examination to reinforce good practical skills and to advise on additional history which can help to make a bedside diagnosis.

My medical school was one of the first to do this in the UK and that was nearly two decades ago.

Although the basic knowledge of medicine was still to be learnt, by intercalating the learning from each system, over time it was then possible to gain deeper understanding plus having the background knowledge of how to examine for signs.

Hence, when it comes to the official clinical years, which start from the third or fourth year in the UK system, the medical student already knows the basics such as percussion, auscaultation etc...

One method that is very informative is the ward round system and listening to the consultants taking extra history and examining the patient. The UK medical system is somewhat adversarial in its way towards medical students because invariably they get picked on to be asked the various causes of XYZ disease or how to examine for ABC sign. Although this can sometimes be a stressful process, it forces the medical student to read about the patients they see. Moreover, the consultants invariably ask the medical students again at various stages of their attachment to a firm. Knowing the answer shows that medical student has taken the time to find out what the consultant wants to know.

By joining ward rounds and seeing the patients 'hands on' is the best way to learn clinical skills rather than just from a book in the class room. Patients do not write the books and there can be any number of possible combinations of acute and chronic diseases to provide a challenge to the doctor. This cannot be found in detail to any great extent in a book.

To really understand clinical medicine, you have to do clinical medicine.

Although these 3-day snap shot visits by medical students provide a mere glimpse of how hospital life operates, it is in my opinion, insufficient to learn new clinical skills.

At this hospital, there is the opportunity to do short term externships of several weeks to a month whereby the medical student can be exposed to the daily rigors of clinical medicine and how to treat the common acute problems and the difference of how to treat chronic diseases.

They get the opportunity to take histories from patients and to learn clinical examination in depth.

Such students who have done this in the past with me have learned a lot and their experiences have been very positive.

If you are interested in such an externship at this institution, then please contact me at the email address at the bottom of the blog page.

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