Medicine students not learning ‘to use brains’ in hospitals

MEDICINE graduates have problems dealing with simple clinical problems, because the education system is too focused on rote learning rather than getting students to “use their brains”, two leading doctors have warned.

Professor Paul Finucane of the University of Limerick and Dr John Kellett of Nenagh Hospital said they “pity the students of today” who get their clinical training in chaotic hospitals, by dealing with patients who are drunk and abusive. The two made their remarks in this month’s editorial of the European Journal of Internal Medicine.

Their article, entitled “Whatever happened to the doctor’s brain?” calls for an overhaul of medical education in Ireland, so that students are “encouraged to think, and apply their knowledge in solving clinical problems”.

They wrote the article after Dr Kellett interviewed 48 junior doctors and presented them with two common medical scenarios. “When asked to solve mundane clinical problems, all 48 junior doctors struggled to apply their knowledge,” claimed Prof Finucane.

The authors said medicine education has “emphasised rote learning rather than getting students to understand and to think”.

They said: “Moreover, assessment processes reward the retention of knowledge rather than the ability to use that knowledge in solving clinical problems.”

Prof Finucane yesterday added that this is a symptom of the education system as a whole: “There is significant concern that the Leaving Cert system, as it is currently configured, encourages people to memorise factual information instead of encouraging deep thinking, or to think around a concept. People who do extraordinarily well in the Leaving Cert are struggling when they have to deal with problems. There are two different intellectual capacities, learning things off by heart, and applying knowledge in a practical situation,” he said.

He said the changing role of doctors means there’s a need for new strategies in how they are educated.

“There was a time in medical education when a student would just have to absorb knowledge, and that was enough to set people up in the profession. We now know that knowledge is constantly evolving,” he said.

The editorial said hospitals no longer provide a good environment for doctors to train: “Hospitals everywhere have become extremely busy with occupancy rates of 100% and over, and are often in a state of chaos. Many patients are either young, intoxicated and have abusive personality disorders or else demented old people with few physical findings,” it said.

Prof Finucane added: “In the 1970s, for example, people stayed in hospitals for longer, students had time to get to know the patient and to know their clinical problems. Also you would be around the hospital a lot longer, in the evenings and weekends, it was a part of the culture, and that gave you the opportunity to know patients and their medical needs. Now it is a lot more phonetic, patients don’t stay in hospital very long, there are a lot more investigations and it’s generally not a good environment for students to learn.”

Medicine courses in university remain the most difficult to get into, according to yesterday’s CAO offers.

Students wishing to enter the profession need at least 570 points.