Letters to the Editor
procedures, and practice presentations to attending physicians. Recent research indicates that over half of US medical schools now staff SRFCs, which collectively serve tens of thousands of patients yearly (Simpson & Long 2007). In single center surveys, students have endorsed SRFCs as valuable educational experiences that positively influence their attitude toward working with underserved populations (Smith et al. 2012). Yet no surveys to date have investigated SRFCs integration with formal curricula or the complementary curricula that students themselves develop. Medical students have gained the foundations necessary to care for patients during their preclinical years through classroom instruction, shadowing clinicians, and standardized patient experiences. These formal curricula typically follow the model of skill acquisition outlined by the Dreyfus and Dreyfus model, as students gain responsibilities in accordance with their developmental stages (Dreyfus & Dreyfus 1980). This model has been especially important in medicine, where learners invariably begin as novices whose practice may cause inadvertent iatrogenic harm. In our recent experience, a complementary curriculum developed by upperclassmen at our institution offered first-year medical students a guide to problem focused history taking, medical heuristics, and therapeutic options. Though well intentioned, these guides could encourage novices to perform intern level skills prior to receiving formal instruction. While early skills-training has been successful, supervision and proper definition of roles will be crucial to the provision of ethical patient care. Future studies should investigate the integration of formal curricula with SRFCs, the complementary curricula that students themselves develop, and the impact of these interventions at SRFCs. Michael Putman, Shalini Reddy, Department of Medicine, University of Chicago, Chicago, IL, USA. E-mail: [email protected] David Siebert, Department of Family Medicine, University of Washington, Seattle, WA, USA Jason Espinoza, Seattle Children’s, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Chicago, Chicago, IL, USA Kohar Jones, Department of Medicine, University of Chicago, Chicago, IL, USA Declaration of interest: The authors report no conflicts of interest.
References Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisition. No. ORC-80-2. California Univ Berkeley Operations Research Center, 1980. Simpson SA, Long JA. 2007. Medical student-run health clinics: Important contributors to patient care and medical education. J Gen Intern Med 22:352–356. Smith SD, Johnson ML, Rodriguez N, Moutier C, Beck E. 2012. Medical student perceptions of the educational value of a student-run free clinic. Fam Med 44(9):646–649.
1088
Expanding horizons: Increasing undergraduate exposure to tomorrow’s specialties
Dear Sir We read with interest the article by Keating et al. (2013) which detailed their initiative to introduce a specialty earlier in students’ medical education. We agree that it is important for students to be able to explore fields of interest sooner rather than later. Medical school curricula across British universities invariably include clinical placements in all of the core medical specialties. While there is some exposure to the smaller specialties, there is often less dedicated teaching time for these fields. As healthcare demands evolve, this is an issue that needs to be addressed in the undergraduate curriculum. Some specialties tend to receive coverage in the form of undergraduate lectures but no actual clinical placements: for example, public health. Other new and emerging specialties may not be addressed in medical school at all. In the UK, the General Medical Council states in ‘‘Tomorrow’s Doctors’’ that student selected components (SSCs) ‘‘must be an integral part of the curriculum. . .allowing choice in studying an area of particular interest’’ (General Medical Council 2009). While these allow students to pursue experiences within specialties that are covered less intensely within the curriculum, not all specialties may be offered within SSCs and it is often left to students to self-organise such placements. After medical school, the issue persists. The UK Foundation Programme allows newly qualified doctors to rotate through six specialties over two years. There are relatively few jobs offered nationally in the smaller specialties such as dermatology and ENT. Indeed some specialties do not feature in the Foundation Programme at all. While a ‘‘taster week’’ exists to redress this imbalance, one week is arguably not sufficient to gain a thorough understanding of a specialty. This poses a problem. If there is insufficient exposure to these smaller specialties early in trainees’ careers, there is a risk that they will not have time to develop an interest in a field in which they might otherwise flourish. Many of these specialties are not only expanding but are also competitive: for example, allergy medicine and interventional radiology. With demand in these fields set to increase, we should encourage greater provision of clinical attachments in these specialties during the undergraduate and early postgraduate years. This will provide students and junior doctors with even greater insight into the variety of options open to them and will help them to make more informed choices about the direction of their future specialty training. Kartik Kumar, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK. E-mail: [email protected]
Letters to the Editor
Fangyi Xie, Buckinghamshire Healthcare NHS Trust, Mandeville Road, Aylesbury, Buckinghamshire, HP21 8AL, UK. Declaration of interest: The authors report no declarations of interest.
References General Medical Council. 2009. Tomorrow’s Doctors. London: General Medical Council. Keating EM, O’Donnell EP, Starr SR. 2013. How we created a peer-designed specialty-specific selective for medical student career exploration. Med Teach 35:91–94.
The neglect in the diagnostic process of Chinese doctors – Communication and interpersonal skills
Dear Sir Poor communication between patient and doctor and lack of interpersonal skills is known to increase the risk of doctorpatient ineffectiveness and poor health outcomes (Ha & Longnecker 2010). In recent years, Chinese doctors have been paying more attention to improving medical conditions and continuing to overcome various difficult and complicated diseases, but so far, the strained doctor-patient relationship still exists in some places. Some patients are not satisfied with their access to treatment and experience poor doctor-patient communication. Communication and interpersonal skills are easily neglected by doctors in the diagnostic process. In a letter (Wen et al. 2013) Wen and colleagues demonstrated, through their use of a Chinese-validated version of the Jefferson Empathy Scale, that three factors were lacking
in their graduating Chinese doctors: placing patient care within the right context; being compassionate; and an ‘‘ability to stand in the shoes of the patient’’, and these elements were most prominent in paediatricians. Despite this important piece of internal research, little change has occurred to national curricula to rectify this situation and little has changed in assessing the ability of graduating doctors to work in the real world of healthcare. If China is to produce doctors that can cope with the expanding population of elderly patients, can care for the increasing number of patients with co-morbid chronic health conditions and can address the need for a complimentary non-medical approach to care, it must change its approach to the teaching, learning and assessment of communication and interpersonal skills. Recent times have sadly seen the murder of several doctors within the Chinese mainland by relatives of very ill or dead patients, who clearly had not understood many of the issues related to patient care, no doubt related to poor communication and interpersonal relationships. This is perhaps another and more serious reason to improve these skills in all Chinese graduates and for all assessing bodies within China, including medical schools is to re-address their procedures. Guangwei Deng, Jing Qian, Xiaoqing Zhang, Hengqiu Xu, Anhui Medical university, Meishan rode, Shushan District, Hefei, Anhui 230032, P.R. China. E-mail: denggw2013@ 126.com
References Ha JF, Longnecker N. 2010. Doctor-patient communication: A review. Oschner J 10(1):38–43. Wen D, Ma X, Li H, Xia B. 2013. Empathy in Chinese physicians: preliminary psychometrics of the Jefferson scale of physician empathy (JSPE). Med Teach 35(7):609–610.
Notice This letter has been withdrawn and republished with revisions since its original early online publication date (4th August).
1089
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
procedures, and practice presentations to attending physicians. Recent research indicates that over half of US medical schools now staff SRFCs, which collectively serve tens of thousands of patients yearly (Simpson & Long 2007). In single center surveys, students have endorsed SRFCs as valuable educational experiences that positively influence their attitude toward working with underserved populations (Smith et al. 2012). Yet no surveys to date have investigated SRFCs integration with formal curricula or the complementary curricula that students themselves develop. Medical students have gained the foundations necessary to care for patients during their preclinical years through classroom instruction, shadowing clinicians, and standardized patient experiences. These formal curricula typically follow the model of skill acquisition outlined by the Dreyfus and Dreyfus model, as students gain responsibilities in accordance with their developmental stages (Dreyfus & Dreyfus 1980). This model has been especially important in medicine, where learners invariably begin as novices whose practice may cause inadvertent iatrogenic harm. In our recent experience, a complementary curriculum developed by upperclassmen at our institution offered first-year medical students a guide to problem focused history taking, medical heuristics, and therapeutic options. Though well intentioned, these guides could encourage novices to perform intern level skills prior to receiving formal instruction. While early skills-training has been successful, supervision and proper definition of roles will be crucial to the provision of ethical patient care. Future studies should investigate the integration of formal curricula with SRFCs, the complementary curricula that students themselves develop, and the impact of these interventions at SRFCs. Michael Putman, Shalini Reddy, Department of Medicine, University of Chicago, Chicago, IL, USA. E-mail: [email protected] David Siebert, Department of Family Medicine, University of Washington, Seattle, WA, USA Jason Espinoza, Seattle Children’s, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Chicago, Chicago, IL, USA Kohar Jones, Department of Medicine, University of Chicago, Chicago, IL, USA Declaration of interest: The authors report no conflicts of interest.
References Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisition. No. ORC-80-2. California Univ Berkeley Operations Research Center, 1980. Simpson SA, Long JA. 2007. Medical student-run health clinics: Important contributors to patient care and medical education. J Gen Intern Med 22:352–356. Smith SD, Johnson ML, Rodriguez N, Moutier C, Beck E. 2012. Medical student perceptions of the educational value of a student-run free clinic. Fam Med 44(9):646–649.
1088
Expanding horizons: Increasing undergraduate exposure to tomorrow’s specialties
Dear Sir We read with interest the article by Keating et al. (2013) which detailed their initiative to introduce a specialty earlier in students’ medical education. We agree that it is important for students to be able to explore fields of interest sooner rather than later. Medical school curricula across British universities invariably include clinical placements in all of the core medical specialties. While there is some exposure to the smaller specialties, there is often less dedicated teaching time for these fields. As healthcare demands evolve, this is an issue that needs to be addressed in the undergraduate curriculum. Some specialties tend to receive coverage in the form of undergraduate lectures but no actual clinical placements: for example, public health. Other new and emerging specialties may not be addressed in medical school at all. In the UK, the General Medical Council states in ‘‘Tomorrow’s Doctors’’ that student selected components (SSCs) ‘‘must be an integral part of the curriculum. . .allowing choice in studying an area of particular interest’’ (General Medical Council 2009). While these allow students to pursue experiences within specialties that are covered less intensely within the curriculum, not all specialties may be offered within SSCs and it is often left to students to self-organise such placements. After medical school, the issue persists. The UK Foundation Programme allows newly qualified doctors to rotate through six specialties over two years. There are relatively few jobs offered nationally in the smaller specialties such as dermatology and ENT. Indeed some specialties do not feature in the Foundation Programme at all. While a ‘‘taster week’’ exists to redress this imbalance, one week is arguably not sufficient to gain a thorough understanding of a specialty. This poses a problem. If there is insufficient exposure to these smaller specialties early in trainees’ careers, there is a risk that they will not have time to develop an interest in a field in which they might otherwise flourish. Many of these specialties are not only expanding but are also competitive: for example, allergy medicine and interventional radiology. With demand in these fields set to increase, we should encourage greater provision of clinical attachments in these specialties during the undergraduate and early postgraduate years. This will provide students and junior doctors with even greater insight into the variety of options open to them and will help them to make more informed choices about the direction of their future specialty training. Kartik Kumar, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK. E-mail: [email protected]
Letters to the Editor
Fangyi Xie, Buckinghamshire Healthcare NHS Trust, Mandeville Road, Aylesbury, Buckinghamshire, HP21 8AL, UK. Declaration of interest: The authors report no declarations of interest.
References General Medical Council. 2009. Tomorrow’s Doctors. London: General Medical Council. Keating EM, O’Donnell EP, Starr SR. 2013. How we created a peer-designed specialty-specific selective for medical student career exploration. Med Teach 35:91–94.
The neglect in the diagnostic process of Chinese doctors – Communication and interpersonal skills
Dear Sir Poor communication between patient and doctor and lack of interpersonal skills is known to increase the risk of doctorpatient ineffectiveness and poor health outcomes (Ha & Longnecker 2010). In recent years, Chinese doctors have been paying more attention to improving medical conditions and continuing to overcome various difficult and complicated diseases, but so far, the strained doctor-patient relationship still exists in some places. Some patients are not satisfied with their access to treatment and experience poor doctor-patient communication. Communication and interpersonal skills are easily neglected by doctors in the diagnostic process. In a letter (Wen et al. 2013) Wen and colleagues demonstrated, through their use of a Chinese-validated version of the Jefferson Empathy Scale, that three factors were lacking
in their graduating Chinese doctors: placing patient care within the right context; being compassionate; and an ‘‘ability to stand in the shoes of the patient’’, and these elements were most prominent in paediatricians. Despite this important piece of internal research, little change has occurred to national curricula to rectify this situation and little has changed in assessing the ability of graduating doctors to work in the real world of healthcare. If China is to produce doctors that can cope with the expanding population of elderly patients, can care for the increasing number of patients with co-morbid chronic health conditions and can address the need for a complimentary non-medical approach to care, it must change its approach to the teaching, learning and assessment of communication and interpersonal skills. Recent times have sadly seen the murder of several doctors within the Chinese mainland by relatives of very ill or dead patients, who clearly had not understood many of the issues related to patient care, no doubt related to poor communication and interpersonal relationships. This is perhaps another and more serious reason to improve these skills in all Chinese graduates and for all assessing bodies within China, including medical schools is to re-address their procedures. Guangwei Deng, Jing Qian, Xiaoqing Zhang, Hengqiu Xu, Anhui Medical university, Meishan rode, Shushan District, Hefei, Anhui 230032, P.R. China. E-mail: denggw2013@ 126.com
References Ha JF, Longnecker N. 2010. Doctor-patient communication: A review. Oschner J 10(1):38–43. Wen D, Ma X, Li H, Xia B. 2013. Empathy in Chinese physicians: preliminary psychometrics of the Jefferson scale of physician empathy (JSPE). Med Teach 35(7):609–610.
Notice This letter has been withdrawn and republished with revisions since its original early online publication date (4th August).
1089
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
