Clinical skills in final year medical students

Abstract

Like many older readers (I qualified in 1976), I have been somewhat bemused by Goodfellow and Claydon's report (October 2001 JRSM1), and the subsequent correspondence. First of all, we should acknowledge that the students of today are at least as able as their fore- (and in many cases, real) fathers. The ‘failings’ in the eight core clinical skills (venepuncture, venous canulation, rectal examination, nasogastric intubation, suturing, urinary catheterization, ECT recording and arterial blood sampling) are significant because these, along with lumbar puncture, inserting chest drains and using an ophthalmoscope, are what our ‘duties’ were as medical clerks and surgical dressers admitting patients. Our generation valued competency as an aim in itself, a view shared by our bosses in sharp contrast to today's views on teaching. Is what is needed prolonged clinical attachments to anaesthetic rooms as Mr Sado suggests2 or a ‘skills laboratory’? Surely better to allow a return to clinical apprenticeships where students do things, not just observe. Stress is part of medical life, and if trainees find keeping a logbook a bit much, then they should remember that the end-product of their training is to treat fellow humans safely and competently. As final year students at St George's in the 1970s, we had a month each as ‘shadow’ house officers in both medicine and surgery. It meant what it said, and we did everything except writing up drugs. On qualifying we were able to start our house-jobs knowing we could cope—and so did our consultants. In the district general hospitals the students we see are just as keen as we were, and many are all too aware of the practical deficiencies of their training: that's why they come to us; that's why they head for the ‘third world’ for their electives, so they can learn to be ‘useful’.