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• W2123643373 abstract "Wherever clinicians teach, there is a conflict between the provision of clinical service and the provision of quality teaching. For the clinical rheumatologist in the UK, Government waiting list targets, changes in hospital bed use and consultant job planning have put increased pressure on the ability to teach medical students. For academics, there is the additional pressure to produce quality research, underlined by the Research Assessment Exercise in the UK. Add to these pressures a large expansion in student numbers and there is the potential for a very daunting challenge! This is the situation in Derby and many other medical schools in the UK. In this article, we would like to describe how we have addressed these challenges along ‘best practise’ lines. Our aim is to provide an effective and efficient teaching programme. We hope that this description will be useful for other teaching hospitals that are grappling with similar problems. For some years, the rheumatology department at Derby has taken students from Nottingham University at two different stages of their training. Firstly, third year (first year clinical) students rotate through our department for a week at a time as part of their junior medical attachment (the Clinical Practice course). The main aim of this week is for them to develop their history taking skills and learn basic musculoskeletal examination in the form of the ‘GALS’ screen [1]. In the final year (the Advanced Clinical Experience course), four blocks of students in turn spend 8 weeks in Derby studying musculoskeletal disorders and disability (MDD), the course being run jointly with the orthopaedics and rehabilitation departments. As with many UK medical schools, Nottingham has increased the number of students over time, with 200 students per year group in 1999 and 246 in 2004. Furthermore, a large step increase is due in February 2006 as 90 clinical students from the Graduate Entry Medical School in Derby enter the clinical course. For Derby Rheumatology Department this will mean a large increase in students coming through the department. This expansion has already affected the 12 weeks of the year in which we teach the third year students, where numbers have doubled from 6 to 12 at any one time. It will impact on the 36 weeks of the MDD course in 2006 when numbers will increase more than 3-fold, from 12 to 40 students attached to the department in each of the 8-week blocks. Clinical teaching relies on students seeing a good mix of patients with an enthusiastic clinician with enough time for teaching. Because of therapeutic innovations, such as anti-TNF drugs, and pressure on beds, there are fewer rheumatology in-patients to teach on. In addition, out-patient clinics are under pressure to concentrate on service delivery, and therefore have limitations for student teaching. Whilst in the Derby rheumatology department, we can reduce patient throughput in teaching clinics due to ring-fenced SIFT (Service Increment for Teaching) funding, waiting list pressures have meant that colleagues elsewhere are unable to spend time discussing cases or teaching skills to students. This conflict with service commitments is common within medical education [2]. Despite being able to reduce numbers attending rheumatology clinics, there is no control of the type of patients available for teaching, and accordingly it is difficult to ensure that all topics are covered. This is made worse if the student:patient ratio is increased. Above all, it is important to ensure that teaching should, if anything, be of benefit and not detrimental to the patient. This becomes harder to ensure if there is less time and fewer patients. The introduction of the new consultant contract in the UK and the European Working Time Directive has meant that clinicians are now less likely to ‘squeeze’ teaching into their weekly schedule. Whilst this may make teaching ‘on the cheap’ difficult, it does delineate the need for all teaching to be in protected and financially recognized time-slots. In Derby, SIFT funding was available to support the extra teaching, but only if it could be shown to be being used directly on teaching and not, for example, to swell consultant numbers. Many established medical schools cannot disentangle SIFT from other service delivery monies paid into the hospital trusts. The disheartening effect is that departments who support teaching see no more resources than disinterested departments. In Derby, the trust has a creditable desire to ring-fence SIFT for teaching. This allows teaching time to be clearly delineated from clinical service time (protecting both aspects) and encourages new teaching developments through a recognition of teaching activities. The patients, the case-mix, the clinical teacher and the available time are all key resources for the provision of quality education. However, each is under threat and traditional teaching needs to adapt accordingly. Despite the constraints, Derby consultants have always been enthusiastic about undergraduate teaching and were keen that this should remain highly effective. This challenge has given us the opportunity to look at improving quality. However, it was clear that any expanded course needed to be highly efficient. Inefficiencies were evident in the old course, for example in the overlap of teaching between departments and lack of clarity as to which learning objectives were taught and when." @default.
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• W2123643373 date "2006-05-16" @default.
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• W2123643373 title "Meeting the needs of increasing numbers of medical students—a best practise approach" @default.
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• W2123643373 doi "https://doi.org/10.1093/rheumatology/kel070" @default.
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