I cannot escape the ethicist and lawyer, Daniel Sokol, it seems. If he is not in the THE, he in the BMJ. Last week he wrote a thoughtful piece for the BMJ. Some quotes to give a flavour:
[Following a presentation in Australis to the Royal Australian College of Surgeons]
Between sessions, I asked delegates from several countries if ethics formed part of their national medical school curriculum. It did, but all my interviewees added that the subject had a poor reputation among students. It seems, sadly, that this is a widespread view.
The possible explanations for this apparent distaste ranged from poor teaching to wrong content, premature delivery in the preclinical years, incompatibility with the scientific temperament, and institutional indifference to the subject.
For me, the key statement here is ‘premature delivery in the preclinical years’. He then goes on to argue that if only the subject were integrated into ‘real’ clinical practice, things would improve. I think he is right, but I am interested in this issue more generally. Clinical medicine is fragmented, and its practitioners, the same. Much of this is a necessity reflecting the complexity of modern medicine. But, from a student’s perspective, this comes at a cost. Given that undergraduate medicine should be simpler (and more superficial in some respects) than post-graduate medicine, the staff who deliver much, if not most teaching, need not be clinical generalists, but undergraduate generalists. It is not so much an integrated curriculum we need, but integrated teachers. If you teach undergraduates you cannot join all the dots unless you know what others teach, and how your students have been taught before you see them. This means many of those providing the teaching need to move away from the lens of a particular discipline, but in addition see the course overall. That we don’t do this, says a lot about how deeply we think about teaching and learning. Sokal is right that the expropriation of content outwith the clinical environment is a problem. The solution is to change the way we train those who teach. Staff cannot do everything.