When education is life or death

I became interested in the way that medical training is done in the UK because I wanted to find an example of what is the best way to educate.

Medical students are among the best and the brightest to come out of our education system and these young people go on into positions where they are in charge of the life and death of their patients.  

“So how do we educate those at the cutting edge of medicine” 

The following information came from a resident anaesthetist in South Yorkshire and may not apply to all medical training across the country, but I hope that its themes will remain instructive.

What he described was pyramid of gradually removing support.

The pass/fail process

The goal of the education process is that the learner becomes experienced. 

In the early stages they are observing, then they are carefully guided through procedures, then this supervision becomes deliberately light-touch before finally they are effectively independent and only occasionally need help from a consultant.

At each stage of progression the trainee doctors have to pass exams. At each of these stages the exams commonly come in threes:

1. A written exam with short answers to set questions

2. 250 True or False or multiple-choice style questions

3. A Viva - an oral examination - where a student answers questions from a panel of examiners about their specific field of medicine.

The first significant difference between this system and the GCSEs and A Levels that we ask our young people to sit in school is that there are no quotas or given percentages of young people that achieve each grade.

The second difference is that you could choose to sit these exams at a few different times across the year and there is no set age that you need to be to take the test. These tests can also be resat many times if needed and this is not uncommon or negatively stigmatised. 

The goal, like in a driving test, is to ensure consistency and quality of the candidates that pass for the safety of society as a whole.

Teaching and support

To prepare for these assessments the candidates meet once a week in groups of 10 for a day. In general these days are split into two. In the first part of the day the doctors take it in turns to give a 15 minute prepared presentation on a different part of the syllabus to the others with an expert in the room there to clarify if any specific points were missed or if any points need any more particular emphasis. 

The second part of the day is more like a traditional classroom with an expert delivering subject knowledge to the group.

However it is noted that unlike in most traditional classrooms this group is a small, highly motivated group who are free to challenge and interrupt to ask questions or for points of clarification throughout. The power dynamic is one of support, not of control.

Meanwhile on the other days of the week, the doctors are continuing to learn whilst working in the hospital.

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Throughout this process learners are gaining experience through multiple methods:

• Observation

• Supervised practice with feedback

• Practice

• Reading and research

• Creating and delivering presentations

• Direct instruction

• Group dialogue and mutual support

I was also encouraged to hear examples of the ways that these learning methods have evolved over time through regular student feedback and adaptation.

The main identified weakness with the medical education system as it is currently set up is a lack of training places available and for residents to progress through the system.

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Lessons for the rest of us working in education

1. Create an exam system that is designed to reward learners for reaching a required standard. Don’t grade people against their peers.

2. Destigmatise failure and allow the learner to choose when to take the exam and allow multiple resits.

3. Learner’s end goal is directly related to their job and questions are specific to their chosen area of expertise. It is not learning for learning’s sake.

4. Experience is gained and learning happens through multiple different methods. Not just classroom instruction.