Catherine Matheson

How well prepared are medical students for their first year as doctors? The views of consultants and specialist registrars in two teaching hospitals

Objective: To evaluate (1) the extent to which first year doctors (foundation year 1 doctors, F1s) in two teaching hospitals in the Trent Deanery were rated by specialist registrars (SpRs) and consultants as being well prepared for practice; (2) the importance ascribed by SpRs and consultants to the various items of core knowledge, skills and attitudes outlined in the publication of the General Medical Council, Tomorrow’s Doctors. Method: SpRs and consultants were asked to rate: how well prepared F1s were in a range of items of core knowledge, skills and attitudes that a new medical graduate must possess as outlined in Tomorrow’s Doctors; the importance for a new doctor of each item of core knowledge, skills and attitudes; and how well the medical school had prepared F1s in respect of key generic issues related to their practice. Results: In most of the items of core knowledge, skills and attitudes covering 8 of the 11 topic areas of Tomorrow’s Doctors, F1s were seen as not prepared for starting work, especially in regard to clinical and practical skills and the more challenging communication skills. They were best prepared in asking for help and in basic communication skills. Conclusions: Overall, F1s in the study were not well prepared either to perform the tasks that await them or in terms of most of the specific background knowledge and skills necessary for the successful execution of those tasks. The level of preparedness raises important issues about medical training and transition from medical graduate to first year doctor. Further research is needed to determine whether this situation exists in other regions of the UK.

The educational value and effectiveness of lectures

B efore 1850 medical students learned primarily through an often unstructured apprenticeship system, whereas after 1850 teaching was increasingly by way of structured formalised lectures. However, the Flexner Report (1910) on Medical Education in the USA and Canada criticised the emphasis on ‘memorisation of facts’ and ‘cramming of knowledge’ and recommended that, for more in-depth understanding of how to apply the knowledge in practice, students should participate in active learning through laboratory work and clinical experience, rather than lectures. Only after 1950 did learning through applied situations become more common, with lectures being replaced or combined with small group teaching, problem-based learning, case-based discussions, roleplay and simulation. Although the proportion of lectures in relation to other teaching methods can vary considerably between medical schools, Exley and Dennick point out that the lecture remains ‘the cornerstone of many undergraduate courses’.

Lifelong Learning and Lifelong Education: a critique

It is suddenly fashionable in political circles in the United Kingdom (and elsewhere) to talk about lifelong learning and lifelong education. This seems to be the direct result of the present economic climate which has called into question many previous assumptions: job security has become an effective myth for most of those who can actually get work; long?term unemployment seems to have become structural and permanent. Consequently, the notions of lifelong learning and lifelong education have taken on dimensions far removed from the almost Utopian ideals of their supporters in the years following the publication of the report Learning to Be. Given the current economic gloom, the popularity of the terms with politicians and the fact of being in the European Year of Lifelong Learning, it is perhaps appropriate to take stock of the whole notion of lifelong learning and lifelong education and to see just what meaning (if any) lies behind these words and where they might take us in the future. This essay lays its foundations in the historical background to the ideas of lifelong learning and lifelong education before moving onto a critique of the post?Faure advocates of the principles. It discusses various problems inherent in the concepts (such as lifelong inadequacy) before concluding that, although many of the difficulties in the concepts are due to the confused nature of adult education itself (e.g. is it education or leisure?), there is a greater need than ever for sustained efforts in favour of lifelong education to help to restore the hope which seems to have become a rare commodity among an all too large section of society.

The views of doctors in their first year of medical practice on the lasting impact of a preparation for house officer course they undertook as final year medical students

BackgroundThe UK General Medical Council recommends that medical students have the opportunity of shadowing the outgoing new doctor whose post they will soon undertake. At the University of Nottingham the two-week shadowing period was preceded by two weeks of lectures/seminars wherein students followed sessions on topics such as common medical/surgical emergencies, contracts, time management, surviving the first two years of clinical practice, careers advice and so on.The present study aimed to gain a better knowledge and understanding of the lasting impact of a four-week preparation course for new Foundation Year 1 doctors [F1 s - interns]. The objectives chosen to achieve this aim were:1/ to determine the extent to which the lecture/seminar course and shadowing period achieved their stated aim of smoothing the transition from life as a medical student to work as a new doctor;2/ to evaluate perceptions of the importance of various forms of knowledge in easing the transition between medical student and new doctorMethodIn the spring of 2007, 90 graduates from Nottingham were randomly selected and then emailed a link to a short, online survey of quantitative and qualitative questions. Of these 76 responded. Analysis of quantitative data was carried out using SPSS 16.0 and employed McNemars test. Analysis of the qualitative data was carried out using the constant comparative method.ResultsOnly 31% of respondents strongly agreed or agreed that the lecture/seminar part of the course prepared them well for their first FY1 post; 14% agreed that during their first job they drew on the knowledge gained during the lecture/seminar course; 94% strongly agreed or agreed that the shadowing part of the course was more useful than the lecture/seminar part.Experiential knowledge gained in the shadowing was the most highly valued, followed by procedural knowledge with propositional knowledge coming far behind.ConclusionsOur study shows that new doctors retrospectively value most the knowledge they are able to transfer to the workplace and value least material which seems to repeat what they had learned for their final exams.

Languages of Scotland: culture and the classroom

The indigenous languages of Scotland are in a precarious position faced with the massive presence of English. This essay examines the state and nature of the Scots and Gaelic languages. It places them in their historical context and traces how each has had its heyday in Scotland, in the case of Gaelic to be supplanted by Scots and in the case of Scots to be supplanted by English. Both have become marginalised in Scottish life and in the Scottish school. Both have been subject to various concerted campaigns aimed at their destruction. Gaelic, however, has at least had the consolation of being regarded as a language while Scots has not. The changing relationship between the school and these languages is examined in the context of the current revival of Scottish culture on a multiplicity of fronts.

Community development: Freire and Grameen in the Barrowfield Project, Glasgow, Scotland

This article is an attempt to examine one of the better-known failures in UK community development – the Barrowfield Project in Glasgow (1986–1996) – and to compare and contrast it with other attempts at community development, especially some associated with the work of Mohammad Yunus and the Grameen Bank, and the legacy of Paulo Freire. We conclude that both Freire and Yunus make assumptions about the pre-existence of community which limit the potential impact of their ideas in an area such as Barrowfield, where anomie and apathy were rife. We further find that just as actions intended to be liberating may reinforce the dominant hegemony, the converse may on occasion also be true. In recent years the Barrowfield Project has risen from the ashes of its previous demise, and so the present work needs to be seen in that context.