Saturday, November 11, 2006

A Medic Comes Of Age

Studying medicine in Cambridge is very different from studying it in other universities. No, I don't mean that Cambridge has a higher incidence of complete psychos amongst their med students, or that we have the highest rate of med student suicides in the world, or that Cambridge medics have a greater predisposition towards brain damage (cue schizophrenic Editor comments! --Editor), though all of those are valid points. Rather, it's our medical education system that I'm taking issue with today.

Medical education in the UK is tending towards Problem Based Learning, as adapted so successfully in some universities like Liverpool and Manchester, where students are set problems and have to work solutions out on their own. Other universities teach integrated courses, where pure scientific knowledge is taught alongside clinically relevant facts. But not in
Cambridge. Here, whilst our counterparts at other unis are learning nifty stuff like history-taking and how to take blood without amputating a patient's arm in the process, we spend the first three years of our extremely traditional medical education sitting on our arses in lecture theatres being force-fed A-Level science gone bonkers. This revelation may put a dent in your trust in Oxbridge medics, but we only properly get clinical knowledge in our fourth year; before that, whilst other medics see patients every week and indeed have their lectures delivered in a hospital, we enter a hospital on an average of twice a year. (Barring any of us being hit by a bus, of course.) This former Oxford pre-clinical student, who recently entered clinical school, writes on a blog I discovered this week:

I'm eagerly waiting for Monday. A glance at my timetable tells me that within the first two days I'll be getting down to the sort of hands-on clinical work that I've merely fantasised about for the past three years. I've enjoyed being a scientist, but next week I have to start learning how to be a clinician.

I know exactly how he feels. As a result of this underexposure, Cambridge medics are starved of clinical experience. We long for cuts, bruises, broken bones, dislocated limbs, and gory injuries to treat. We yearn for the sound of sirens, code blue alarms, A&E doors slamming open, and the opening theme of Casualty.

In short, we're hungry for blood.

A typical Cambridge medic

And so it was that yours truly volunteered to be on the first aid team at the Nottingham Games last weekend. The only non-Nottingham medic there, I was assigned to the futsal pitch along with about four other Notts medics.

Ah, futsal! With its rough sandy pitches and sweaty angry players, I was going to get all the cuts, bruises and gashes I could ask for. Armed with my trusty first aid belt and my BRC qualification card, I marched onto the futsal pitches with my head held high and my chest puffed out, just the way they taught us in that Communication With Non-Oxbridge Humans class (kidding! --Ed). I was ready, oh yes. Bring on the injuries. The Angry Medic was here, baby, and he was brimming with confidence and ability.

It was about then that the first football soared out of the sky and hit me in the face.

Fast forward to about two hours later. I'd treated just over a few thousand cuts and bruises, become breathless rushing up and down the pitches, and been laughed at by no fewer than three Nottingham medics for not knowing basic principles of clinical treatment. I was so busy talking to an injured player, trying to calm him down, that I had dabbed a bit of bloodied gauze into my container of antiseptic, thereby contaminating it, and only realised I'd committed a cardinal sin when I got yelled at by the first-aider in charge. "What about sterility, you idiot?" she spat, yanking the container away from me. "What DO they teach you up there in your smug ivory tower?" I stood there flabbergasted. But...but I'm a
Cambridge medic! I don't MAKE mistakes, you plebe! I was about to open my mouth and make a feeble protest when the fat referee ran up again and screamed "MEDIC!" despite being only a few steps away. (Someone's been overdosing on war movies. --Ed) First-Aider Trunchbull glared at me whilst nursing Bloody Patient #1. I decided to make a dignified exit and slinked off to see Bloody Patient #2.

It was about then that I realised that none of these
Nottingham medics had higher BRC qualifications than I did. All the preparation they'd gotten was a briefing by an A&E doctor that lasted a few hours. The big difference was that they spent their days in a proper hospital. They went for lectures there, got to tag along on rounds, and sat in with GPs seeing patients. They picked up useful clinical tips both from clinically relevant lectures and from being in a clinical environment. These people knew things I wouldn't be learning for years to come.

I realise it was absolutely naïve of me to expect any sort of reward for my work, but in all my wide-eyed med student innocence, I really was expecting at least a ‘thank you’. Surprise surprise, the job was absolutely thankless, and the only reward we got was the satisfaction of sending yet another beaten-up player back onto the pitch. But by lunchtime we were running really low on supplies, and replenishment was slow to come. The management was too busy to bother with first aiders. Then the patients we saw in the morning started coming back with complaints. Some were legitimate, but others came either for attention or, I suspect, for the pure glee of irritating hapless first aiders. Some players didn't like the way we taped their Hansaplasts on. Some didn't like the size of the bandages we gave them. When we ran out of medium-sized plasters, some refused to take bigger plasters even though we assured them that having a bigger plaster would affect neither their sporting prowess nor the number of female spectators yelling their names from the sidelines.

It was a looooooooong day. But by the end of it, dishevelled as we were, I was happy. I'd seen blood and gore, and learnt stuff that I wouldn't otherwise have for a few years. I hesitate to say it, but (cliché alert! cliché alert!--Ed) I became a better medic for it. So is the medical course in
Cambridge worth it? I honestly don't know. Like my old headmaster said when he came up to visit us last week, many medics know what they're giving up when they accept an offer here. But they're willing to make that sacrifice for the sake of the big fat Cambridge coat-of-arms on their degrees. I'm not convinced it's the best way to learn medicine, but in the end I don't think it really matters. I've seen great doctors from Cambridge and great doctors from Hull, and it's convinced me that, just like any other profession, it's what's on the inside that matters. All the same, I’d like a little more blood on my shield before I go out into the great big battlefield that is today’s world.


Anonymous said...

Really interesting stuff you have here. I am impressed.

Dan said...

bloody politicians. one of the major causes of my headaches that day.

i seriously disagree with your treatment of patients at the futsal place at notts. you shouldn't have given them plasters. just sleep-inducing painkillers. then maybe the cambridge team could have had a chance at winning a match :P

Anonymous said...

Being a qualified St John first aider, I can sympathise with you, patients don't, shockingly, grab you by the hand thanking you vigorously for a job well done. They expect that you will do so and then they can slink off to do whatever they feel like, be that kicking each other in the face (full contact taekwondo), driving unstable vehicles at high speeds (moto racing), or merely getting drunk at 4pm and starting riots (12th July Parades). Still, I have sent off my application to Cambridge Medical school and am now shitting myself for interview. The less said about the BMAT the better.

Anonymous said...

Nice entry, but seriously, if you really wanted so much hands-on, why cambridge? Apart from the obvious fact about recognition which is what most of us want anyway. =P

p/s : wee loong commented!!! WHOA!!!

Spirit of 1976 said...

I have Problem-Based Learning on my nursing degree here at Cardiff Uni too. Though we normally work through the problems in small groups rather than on our own. Personally, I find it really helpful as a learning exercise.

Phoenix said...

Look on the bright side - by the time you learn how to examine a patient, you'll already know what you're examining, and why. And you'll be able to think about the things you find rather than just going through the motions.

And at the end of the day (well, at the end of the medical degree) you'll all be on even keel. Theoretically.

Dan said...

i agree with hospitalphoenix.

on another note,just hang in there and learn as much as you can. it all boils down to what you've got in you.

Gregory House, PA-C said...

Since America is kind of behind in a lot of aspect of life PBL isn't offered at all medschools, but a good number. But you have to apply to that program once you get into the school. Personally this is what I want to do since I've already proven time and time again that I don't flourish in the typical lecture style class. :-D

Shen-Han said...

Cambridge medics kena pwned!

The Angry Medic said...

Murk: I sympathise with you too. Let's go out to the pub one day and drown our sorrows together. Then whip out AK-47s and go Columbine on the next thankless first-aid-needing athlete who comes along. Good luck for the BMAT!

HospitalPhoenix: Wow. I think you're the first person to actually point out the clinical benefits of such a textbook system! The dons here are happy to maintain their silence unfortunately.

They should get you to write for the prospectus :)

Dr Wannabe: As I've mentioned before, I get all my info on American medicine from Grey's Anatomy, so I'm not sure, but isn't American medical education also progressing in this direction?

Kal said...

First aiders get a rough time, I started out as one, but there are certain basics that it teaches you well (talking to patients, not dipping bloodied gauze into antiseptic...).

And no, they never say thankyou.

They never say thankyou once you're not doing it voluntarily either.

Anonymous said...

If you wanted PBL, you could always have gone to a univeristy that uses that method. Some people actually COME here for the very fact that this place has avoided the PBL plague, at least during the first 3 years. Cambridge is one of the dwindling few refuges of the slpit course, which PfP is, unfortunately, already spoiling. You'll spend the rest of your life learning through experience (i.e. what they try to re-create with PBL and fail dramatically), so why not enjoy the few short years you have left to absorb the wisdom of your betters in lectures and bask in proper student life. I pray that Cambridge retains the traditional course which, to my great regret, will probably not happen in a Britain under labour.

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