After reading one of our teachers' blog, I couldn't disagree on what he said.
Having gone through the medical year three curriculum, what I feel is that we were having the third pre-clinical year, rather than the first clinical year. I expected we should have received more training on clinical than basic science. Nevertheless, they are fundamental to clinical medicine, but they cannot be over-emphasized. While I was in my pre-clinical years, I thought clinical years will be challenging, in the way that there would be always exciting things happened around me. Yes, exciting things really happened, while we were reciting things.
At the beginning of year three, Prof. JS said, "A student nurse knows more than you." This is of course! In contrast to nursing curriculum, we have far much less to learn in practical skills. For the theoretical side, I must say their lecture notes are or less similar to ours, in terms of quantity and quality. I was deeply impressed by one of the student nurses in a non-university based nursing school, when she could fluently tell me the five etiologies of hyperthyroidism, and clinical presentations of Cushing's syndrome, knowing the complications of TURP, and management of hyperkalaemia. Our future nurses are having similar level of knowledge as us, what next to compare, is our practical skills.
Yet, we focus on physical examination skills targeting various organ-systems, but it is not enough. Say, student nurses have sessions on "How to assist a sterile procedure", "How to scrub up in an operation theatre" or "How to insert a Foley catheter / Ryles' tube" in a simulated laboratory before really coming into practice. For us, merely none of them. Surgeons were shocked when they learnt about that scrubbing up was not taught in our newly furnished skill laboratory. All these were learn totally and only from bedside. I can imagine how the crocodiles replied "Well, we expect students to go more to wards and operation theatre, in order to expose themselves to more procedures, and learn though these process."
Damn, I know. Going back to the last entry, 又要羊兒好，又要羊兒不吃草. The problem is, we have no time to expose ourselves to clinical environment. The root of problem is those regular summative assessments (SA), with two of these holding monthly, taking us away from wards and theatres. In the past, the MB was done in days, with these four major subjects were examined at the last of a year, and to the best of my knowledge, there is nothing like summative assessment.
From our seniors and teachers, students were fond to attach at night, following house officers admitting cases, sitting in the out-patient clinics. I also noticed that there were "blue progress sheets" on wards for medical students to put down their notes into patients' case history. These were not our draft paper, as I once came across a senior nursing officer briefing her subordinates, "These blue sheets are for medical students to put down their notes into the case history (to bullshit on blue sheets?) . However, it is rarely done nowadays."
Teachers, I can realise that you would like to dilute the pressure of studying MB, by cutting it short and diffusing it into regular assessments instead. However, two problems arise:
Having gone through the medical year three curriculum, what I feel is that we were having the third pre-clinical year, rather than the first clinical year. I expected we should have received more training on clinical than basic science. Nevertheless, they are fundamental to clinical medicine, but they cannot be over-emphasized. While I was in my pre-clinical years, I thought clinical years will be challenging, in the way that there would be always exciting things happened around me. Yes, exciting things really happened, while we were reciting things.
At the beginning of year three, Prof. JS said, "A student nurse knows more than you." This is of course! In contrast to nursing curriculum, we have far much less to learn in practical skills. For the theoretical side, I must say their lecture notes are or less similar to ours, in terms of quantity and quality. I was deeply impressed by one of the student nurses in a non-university based nursing school, when she could fluently tell me the five etiologies of hyperthyroidism, and clinical presentations of Cushing's syndrome, knowing the complications of TURP, and management of hyperkalaemia. Our future nurses are having similar level of knowledge as us, what next to compare, is our practical skills.
Yet, we focus on physical examination skills targeting various organ-systems, but it is not enough. Say, student nurses have sessions on "How to assist a sterile procedure", "How to scrub up in an operation theatre" or "How to insert a Foley catheter / Ryles' tube" in a simulated laboratory before really coming into practice. For us, merely none of them. Surgeons were shocked when they learnt about that scrubbing up was not taught in our newly furnished skill laboratory. All these were learn totally and only from bedside. I can imagine how the crocodiles replied "Well, we expect students to go more to wards and operation theatre, in order to expose themselves to more procedures, and learn though these process."
Damn, I know. Going back to the last entry, 又要羊兒好，又要羊兒不吃草. The problem is, we have no time to expose ourselves to clinical environment. The root of problem is those regular summative assessments (SA), with two of these holding monthly, taking us away from wards and theatres. In the past, the MB was done in days, with these four major subjects were examined at the last of a year, and to the best of my knowledge, there is nothing like summative assessment.
From our seniors and teachers, students were fond to attach at night, following house officers admitting cases, sitting in the out-patient clinics. I also noticed that there were "blue progress sheets" on wards for medical students to put down their notes into patients' case history. These were not our draft paper, as I once came across a senior nursing officer briefing her subordinates, "These blue sheets are for medical students to put down their notes into the case history (to bullshit on blue sheets?) . However, it is rarely done nowadays."
Teachers, I can realise that you would like to dilute the pressure of studying MB, by cutting it short and diffusing it into regular assessments instead. However, two problems arise:
- The MB is really too short for differentiating students. I must say, I did not deserve a distinction viva and some of us did not deserve a fail.
- Those regular assessments are our trammels (緊箍咒), inhibiting us from devoting ourselves to clinical medicine wholeheartedly.
There were many opinions saying that many medical students today stay away from wards. Yes, this is true. But please! Please look into the problem behind. The reason was not we are too lazy, we are actually too hardworking. With an examination ahead, one may treat it as "no big deal", but most of us did strive for merely a pass. Ya, a pass only, may be a bad pass. Two more problems concerning the summative assessment per se:-
- The topic was too board with too few MCQs.
- The result was released in grades relative to our classmates, not the marks we scored.
It is impossible to study everything hard, except some bright students, while most of us are not. You may think less is better, but you know percentage right? We can easily fail ourselves in just half a dozen of MCQs. More often, those MCQs dig on minute things that was rarely seen or hardly correlated to the goal of lectures. While the grades can reflect your position in class, this would only induce competition, more probably a vicious one. I agree that competition does enhance improvement, but couldn't those examinations be reflecting how much knowledge I had learnt, not how high I got by stepping onto the heads of my classmates. To cope with this unchangeable reality, we have not methods but to skip wards, in order to gain more time for study.
Writing case reports is one way of assessing students, but it is not the best way. Most of the time we were "referencing" from the sample case report, or the case notes; and I can see some teachers did not really read through my report, having it returned to me with simply a score on it. I learn nothing from writing. In addition to bedside teaching and tutorial, we have nothing else to do. We may choose to attend operating theatre or outpatient clinics, but what hinders us has been discussed. Besides, we are isolated from the day-to-day ward duties or activities, nobody wants us or welcomes us. We are so unimportant. Therefore, we leave, as we, hardworking loyal lambs, have to utilise our time best to study for those summative assessment.
"若要羊兒好，讓羊兒吃草。" If the crocodiles really want to improve the number of students stay in wards, please:-
Writing case reports is one way of assessing students, but it is not the best way. Most of the time we were "referencing" from the sample case report, or the case notes; and I can see some teachers did not really read through my report, having it returned to me with simply a score on it. I learn nothing from writing. In addition to bedside teaching and tutorial, we have nothing else to do. We may choose to attend operating theatre or outpatient clinics, but what hinders us has been discussed. Besides, we are isolated from the day-to-day ward duties or activities, nobody wants us or welcomes us. We are so unimportant. Therefore, we leave, as we, hardworking loyal lambs, have to utilise our time best to study for those summative assessment.
"若要羊兒好，讓羊兒吃草。" If the crocodiles really want to improve the number of students stay in wards, please:-
- Abolish those summative assessment. Since SA is the root of problem, but it is impossible.
- Increase the number of MCQs. So as to cover a boarder topic and get harder to fail.
- Give results in the marks we scored, plus or minus relative position in class.
To increase the attractiveness of staying in wards, BEFORE alleviating the pressure on regular examination, please DO NOT add the following into our clinical teaching:-
- Every student have to take up two to three patients in his ward.
- He is responsible to see his patients at least once daily, and present the progress, or be it less formal, discuss, his cases with the case MO.
- He should write progress notes daily with those blue sheets, which has to be co-signed by MO.
- He may also write about management plan. If possible, his plan may directly taken into action.
- He may choose to perform or assist procedures (blood taking, pleural tap, lumber puncture) of his patients.
- Follow his patient to operating theatre, endoscopy centre, or radiology department. I bet many of us haven't seen how a CT is being done.
- On-call to 9 p.m. once biweekly.
Well. May be I have talked too much. Time to shut up.
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