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Letters
Medicine in the
21st century
Medical students are no longer taking a passive role in
their education. Medicine in the 21st Century, a publication
by United Kingdom (UK) Medical students, attempts to open the
way for greater student involvement in educational reform and
reflects a growing international trend.
In 1993, the General Medical Council (the governing and licensing
body for UK doctors) published clear guidelines on the required
outcomes that medical students should meet upon graduation (1).
These principles acknowledged the need to tailor undergraduate
education towards developing a learning process and the skills
of interaction with patients and colleagues, thereby building
foundations for lifelong learning and effective patient-physician
partnerships. Such broadening of the doctrine led to increasing
diversity in undergraduate medical curricula with an emphasis
on student-selected components. This provided the opportunity
for students to govern some of their education, while simultaneously
guaranteeing that the core competencies required of the profession
would also be met. Such a radical revision of the foundations
of the profession provoked further innovative thinking outside
of the mainstream infrastructures including serious considerations
of the potential merits of a virtual medical school (2).
In addition to these changes, increasing numbers of UK medical
schools are updating their courses. Some are moving towards
problem based and skills orientated teaching, where the emphasis
is on the integration of core knowledge with real life patient
scenarios, and encouraging the development of thought processes
particular to the task of being a doctor. Entrance to the profession
and the arena in which learning is achieved is also shifting
with the advent of single entry foundation courses for health
professionals, and the devolvement of some teaching responsibilities
from hospitals to primary care.
But what about the 'consumers' of medical education? Are future
doctors simply passive, detached observers of these processes
of reform, or are they using the opportunities of change to
input their own views? North America in particular has seen
dynamic activity on this front. The American Medical Students
Association (AMSA) has it's own “bill of rights”
in which it states: “Medical students have the right to
shape the content of their education, they practice what they
preach”. In this case, the various official bodies and
working groups involved in ongoing curriculum development are
augmented by a strong student presence at both local and national
levels so as to influence and hopefully improve the learning
experience for their colleagues. AMSA has instituted many successful
reforms, for example, the recent acquisition of a grant from
the National Institutes of Health (NIH) to start teaching complementary
and alternative medicine in medical schools.
Here in the UK, we have not been idle either; we have seized
the opportunities that the aforementioned reforms have granted
us. In the UK, medical students have made sure that their voice
is heard on a whole range of issues. The British Medical Association
(BMA), which is both the UK doctor's trade union and a professional
body, has its own Medical Students Committee (MSC), which has
over 13,000 members, and represents the UK's biggest single
voice for future doctors. Past successes have included the addition
of students to the official quality inspecting teams which visit
and inspect medical schools, improving equity of treatment of
students with health difficulties, and the contribution by students
to key negotiations of the content and structure of undergraduate
curricula.
The BMA's MSC recognised the need to reflect and input on the
implementation of official recommendations set out by the GMC.
This led to the genesis of "our own" policy document
titled Medicine in the 21st Century. In this publication, the
MSC sets out students' rights and responsibilities as professionals
in training, delving further than existing guidance on standards
in medical education. This is achieved by being specific in
areas where the official guidance is too broad, and by looking
at education holistically as part of a wider experience of living
and training as future professionals. The spectrum of subjects
covered includes: funding, careers advice, pastoral care, occupational
health advice, and research. Medicine in the 21st Century was
sent out for consultation last year and received positive feedback
from the key players in UK medical education, including the
Council of Heads of Medical Schools (the authoritative voice
of UK Medical school leaders) and the General Medical Council.
However, some were concerned that the document placed a disproportionate
emphasis on students' rights, and said less about their responsibilities.
The theme of the document remains to provide a simple but realistic
agenda for change; one of partnership between current professionals
and future professionals so as to provide for the basic academic
and non-academic needs of medical students.
It is envisaged that Medicine in the 21st Century will be
more than a dry policy statement, but an effective lever for
change at both a national and local level. Indeed, it is already
opening discussions with the regulators of medical education.
Students currently involved in feedback and assessment of existing
courses will be best placed to use the document to suggest improvements
to their Deans, curriculum design teams, staff-student committees,
and similar bodies. Furthermore, the publication of the document
on the BMA medical students website, will allow more medical
students to access it, and highlight any deficiencies in their
own training programmes, encouraging them to raise these matters
locally.
The broad scope of Medicine in the 21st Century sets it apart
from other documents on standards in medical education. Not
only does it cover the "bread and butter" subjects
of curriculum content, finance, welfare, and admission policies,
but also several current "hot topics" including pre-graduation
careers advice, elective research, and postgraduate study. Students
have a unique perspective on education. It is sometimes difficult
for those designing curricula and writing legislation, to appreciate
the end product, its interpretation, and its shortfalls at grass-roots
level. This perspective needs a comprehensive and coherent voice;
this is the heart of Medicine in the 21st Century. The emphasis
on students' responsibilities, as well as their rights, flows
throughout. It states: “The stresses and strains of the
medical degree can be considerable; learning how and where to
seek help is an important skill that will benefit students not
only as an undergraduate, but also throughout their medical
career.” This emphasises the importance of professionalism
and self care.
The issues surrounding equal opportunities for students in
medicine has been a source of contention in the past, particularly
regarding physical disability (3), Medicine in the 21st century
explicitly calls for, “Medical schools [to] ensure that
appropriate measures are in place to enable students with disabilities,
including those suffering from dyslexia, to complete the course…medical
schools should show flexibility and innovation when determining
the process by which curriculum outcomes are met.”
The issue of equal opportunities doesn't end there. The document
is the first of its kind to finally acknowledge the religious
and cultural diversity of those studying medicine, and the implications
this may have. Medicine in the 21st Century states; “Medical
students should not be penalised for participation in religious
or cultural events…[but] should give prior notice of their
religious commitments when they impinge on the medical course”.
The constant evolution of medical education reflects a need
for the relevance, effectiveness, and values of medical education
to keep up with scientific advance, as well as the expectations
of society; this way, tomorrow's doctors will be equipped to
function safely and effectively in tomorrow's world. Medical
students as professionals in training, stakeholders in the education
they receive, and as grass-roots consumers of medical education,
must seize this opportunity to argue for full participation
in the development and implementation of new initiatives. In
Medicine in the 21st Century, UK medical students have set out
their own ideas of how to move forward in improving the overall
package of education. It is imperative that students continue
to be encouraged by senior medical educators in engaging with
these issues, and contributing their unique perspective.
Sincerely,
Nicholas France, Bruno Rushforth and Rameen Shakur
The University of Warwick Medical School, Manchester University,
and the Universty of Edinburgh respectively.
Competing interests: BR and RS were on the BMA MSC medicine
in the 21st Century Working group. NF was deputy chair of the
MSC 2002-2003. BR and NF have served as observers on the GMC's
Education Committee
REFERENCES
1. General Medical Council. Tomorrow's doctors. London: GMC,
2002.
2. Barratt H. Virtual medical school will soon be a step closer
to reality. student BMJ 2002;10:309. (September).
3. McDonald R, Discrimination in Medicine. BMJ 22 June 2002;
324:S199
Nicholas France holds an
honours degree in Pharmacology from Kings College University
of London and is currently a final year medical student at The
University of Warwick Medical School. He is the previous deputy
chairman of the BMA (British Medical Association) Medical Students
Committee, current deputy chair of the Medical Students Conference
and student observer to the General Medical Council (GMC) Education
Committee. Bruno Rushforth holds a B.A (Hons)
in Philosophy from Cambridge University and an M.A. in Health
Care Ethics and Law from Manchester University where he is currently
in the final year of his medical studies. He is employed by
the GMC as an Education Visitor and has also been a student
representative on the BMA Medical Students Committee where he
chaired the working group that drafted Medicine in the 21st
Century in 2001-2002. Rameen Shakur is a Medical
student at the University of Edinburgh; he holds a BA and an
MPhil from Cambridge University and is a Churchill Fellow at
Harvard University.
12 tips for potential
MJM authors
Dear MJM,
I joined the editorial team at MJM in March 2003. Over the
last year I have greatly enjoyed being an external editor for
MJM and welcome the opportunity to get involved with the production
of such a high quality journal. My duties as an external editor
primarily involve reading and commenting on papers submitted
to MJM. However, as the number of papers that I have been involved
with accumulates, I have noticed that authors tend to make a
number of common errors. In general these are errors in presentation
and style, rather than science. I have summarised these here
as 12 tips for potential authors.
1. Above all, remember that the editors are busy people. Although
we all try to be as objective and constructive as possible,
like examiners and members of a job interview panel, we will
be influenced by first impressions. Pay attention to details
and don't let poor presentation let you down.
2. Don't be afraid to ask for help. Writing a paper for publication
is a skill that can take years to develop. Many faculty members
will be more than impressed that you are even attempting it
and more than willing to offer advice on style, presentation
and content.
3. Read the “Instructions for Authors” on MJM’s
website (http://www.mjm.mcgill.ca). These detail clear directions
concerning the presentation and structure of manuscripts, manuscript
length and the citation of references. If you do not stick to
these instructions it gives the editors the impression that
you do not care much about your work.
4. Be clear what your aim is. Decide what you wish your aim
to be and state this unambiguously as early in the paper as
possible. When you have finished check that you have achieved
your stated aim and that this is clear from your conclusions.
5. Use headings and subheadings - even if the instructions
for authors do not require these in the type of article you
are writing. Headings help to structure your thoughts and, therefore,
your writing. They help any argument you are trying to make
flow in a logical order and should help you avoid repeating
yourself.
6. Keep your writing specific and simple. Go through every
sentence and ask: what do I mean by this sentence? Have I said
exactly what I mean? Is there any way it could be misinterpreted?
Are there any unnecessary words? This process can be time consuming
until you are used to it, but the result should be a much better
piece of writing which requires much fewer revisions if accepted.
7. Remember that MJM is an international journal. Don't assume
that all your readers will be Canadian or even North American.
If you are referring to some procedure or policy that is particular
to Canada you must explain it for someone who has no knowledge
of it.
8. Remember that MJM is a general medical journal. If you
are submitting a paper on a particularly specialised topic,
you must be careful to explain it for a general audience who
have a broad knowledge of medicine but not necessarily specific
knowledge of the topic you are discussing.
9. If you are reporting original data, remember that data
description is not the same as data analysis. Provide an appropriate
statistical analysis of your data and make sure you are clear
what the results of your statistical tests mean.
10. Never confuse association with causation. A relationship
between two variables does not mean that one causes the other,
it merely means that the two are associated with each other.
Association is a necessary, but not sufficient, criterion for
establishing a causal relationship between two variables.
11. Remember that medicine and biomedical sciences are complex
and evolving fields in which there are always controversies
and differences of opinion. Learn how to search the literature
and critically appraise the papers that you find. Make sure
the sources you cite are up to date and that you do not rely
on a limited number of sources.
12. Always proofread your work before submission - and then
proofread again. Many papers submitted have numerous basic spelling
and grammar mistakes which should have been spotted before submission.
If you cannot be bothered to read your work why should the editors
or readers of the journal? If English is not your first language,
ask someone who is fluent in English to help you check your
work before submission.
I hope that these points will be of use to authors considering
submitting manuscripts to MJM.
Yours faithfully,
Jean Adams, BMedSci, MBBS, PhD (2004)
School of Population and Health Sciences
University of Newcastle upon Tyne, UK
Jean Adams is in the final year of a three
year PhD research fellowship. She obtained her medical degree
in 2001 and also has a BMedSci degree in health psychology and
psychiatry. Her current research focuses on socio-economic inequalities
in health.
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