The changing facade of medical education

Adversity brings opportunities and the human race is quite adaptable, adoptable and flexible in utilising these adversities to its advantage. This is true for the Covid-19 pandemic, which has been devastating but has also allowed us to think beyond the traditional box.

Teaching and training is one area that has completely transformed from face-to-face to virtual meetings. This was unthinkable a few months ago, but we are accepting this as our new normal and continuously evolving to make further improvements.

At my hospital, the post graduate medical centre is about 200 meters away from the main hospital. It is well-equipped with a ultra-smart, ultra-modern audio-visual system. It has a lecture theatre, alongside small rooms and tutorial rooms. It is quite busy all year round. However, with the first national lockdown in March 2020, all forms of teaching were cancelled.

Yet, we realised that the trainee junior doctors were missing out on essential teaching so we adapted and the post graduate centre was made Covid secure. Face-to-face teaching was re-started with very limited seating and capacity was reduced from 150 to 24. Limited face-to-face teaching began, but soon it was changed to hybrid with the wide introduction of Microsoft (MS) teams in the NHS. We as trainers struggled with the new methods of teaching especially with the introduction of the MS teams app but with time, we settled.

How have we evolved? At the start of my career in the NHS in 1995, we used  an overhead projector with acetate paper; later we used a carousel and 35mm slides; this was followed by computers with specific programmes that could enhance the talks like power point presentations. The presentations were initially stored on floppy discs (my youngest daughter found a couple of floppy discs while cleaning the cupboard recently and could not make out what they were!). Later, we saw the use of CDs and memory sticks (pen drives). With the use of emails, the pen drive also seems obsolete. It is no surprise that the latest PCs or laptops do not have slots for floppy discs or CD drive!

Medical training during a pandemic

Ours is a small training hospital with six medical wards and the accident and emergency (A&E) works from 08.00-22.00 hours, seven days per week. It has all grades of trainee doctors, trainee physician associates, ANPs and medical students from Keele University.

The junior doctors and the consultants alike are quite enthusiastic and motivated to teaching and training. Before the Covid-19 crisis, there were teaching programmes three days a week and this has now evolved to five days a week. Each day has a different theme and a dedicated consultant supports the programme with the registrar and middle grades doctors taking the lead. This helps develop further skills among junior doctors. All the programmes are linked to the curricula with a strong emphasis on the clinical side through interactive sessions. More or less the programme runs on a four-monthly cycle reflecting the junior doctors’ rotation.

1. Monday: SET (Specialised Endocrine Teaching) by the endocrine team
2. Tuesday: Journal club under the Care of the Elderly team
3. Wednesday: CIIT (Clinical Investigation and Interpretation Teaching) €“ this includes talks ranging from urine analysis to ECG interpretation, to chest drain insertion and so on
4. AMU teaching: Interesting clinical cases by the Acute Medicine Team
5. Grand round: This is by the local clinical team including consultants from neighbouring hospitals and invited speakers (this is a sponsored programme).

We are lucky to have enormous help and support from our postgraduate medical centre (PGMC) who do the current admin work for Tuesdays and Fridays but more help is planned after Spring of 2021. Juniors have created a WhatsApp group, which allows them to join straight away with their smart phones. Email links are also sent by the PGMC, which is useful to link with desktop/PC/laptops. As mentioned above, the talks are quite interactive with a good use of €˜raise hand’ or chat box on the MS teams session, however, shortly we are going to introduce Kahoot (an app which works with MS teams) so that attendees can vote anonymously through their mobile.

Junior doctors missing out on social benefits of the job

What we have noticed with teaching being so portable is that junior doctors have even joined while they are at home or when they are off on leave. There is excitement among them to present and be part of the whole process with presentations sometimes taking place from their own home. The popularity of the programme has also increased and doctors from neighbouring hospitals and GPs are joining in too.

What is missing is the good sumptuous food and the ambient atmosphere where networking is done. Also, we are missing out on the physical demonstration of gait or movement disorders. However, this has been circumnavigated by using video. If we reflect, then it seems that the argument that good food brings juniors to teaching is untenable. To me it is the portability of teaching that brings juniors to teaching.

Secondly, it forces one to think how best to utilise the postgraduate centre otherwise it may become a white elephant. Vigilant managers must be looking at how to save money in the future!

Dr Anil Kumar, Consultant Physician & Geriatrician, County Hospital, Stafford, Honorary Clinical Lecturer, Faculty of Medicine, Keele University, England

[email protected]

Acknowledgment- Katie Gordon, Postgraduate medical centre, County Hospital, Stafford