British Medical Education Research Articles

Disorders of gut-brain interaction: Highly prevalent and burdensome yet under-taught within medical education.

Background and ObjectiveTo determine the population prevalence and associated health impairment of disorders of gut‐brain interaction (DGBI) across Great Britain, and the emphasis placed upon them within medical education.MethodsAn Internet‐based cross‐sectional health survey was completed by 1906 general population adults across Great Britain without self‐reported organic GI disease. The survey enquired for demographics, symptom‐based criteria for Rome IV DGBI, healthcare use, non‐GI somatic symptoms, and quality of life. As a separate analysis, we evaluated which DGBI are considered core knowledge at undergraduate medical school level and post‐graduate specialization level for Gastroenterologists and General Practitioners.ResultsThe overall prevalence of DGBI across Great Britain was 37%, being similar for England (37%), Scotland (33%), and Wales (36%); p = 0.66. There was no difference between English regions (range 33%–43%, p = 0.26). The prevalence of DGBI was highest in those aged 18–40 years (40%), then 40–64 years (37%), and least amongst those ≥65 years (29%); p < 0.001. The most common DGBI were bowel disorders (30%), followed by gastroduodenal (10.5%), anorectal (8.1%) and oesophageal disorders (6.2%). Individuals with DGBI were significantly more likely than those without DGBI to have increased GI‐related healthcare visits, medication use, surgical interventions, non‐GI somatic symptoms, and reduced quality of life. One‐in‐three people with DGBI had multiple GI organ regions involved and this correlated with increased health impairment (p < 0.001).The only DGBI mentioned across all medical training curricula is irritable bowel syndrome, while the General Practitioner and Gastroenterology Curricula also recognise the outdated term non‐ulcer dyspepsia (as opposed to functional dyspepsia). The 2010 Gastroenterology Curriculum also includes functional constipation and disordered defecation, with the incoming 2022 iteration adding in functional upper GI syndromes, functional abdominal pain, and opioid‐induced GI disturbances.ConclusionDisorders of gut‐brain interaction are common across Great Britain and incur substantial health impairment. However, they are generally under‐taught within the British medical education system. Increasing awareness and education of disorders of gut‐brain interaction might improve patient outcomes.

The rise of psychological physicians: The certification of insanity and the teaching of medical psychology

This paper investigates the nexus between the legal provisions for the certification of insanity and the introduction of psychological medicine into British medical education. Considering legal and published sources, it shows that the 1853 Lunatic Asylums Act proved fundamental for the promotion of medical psychology as part of medical training. By giving doctors the authority to report “facts of insanity”, this law created the need for “psychological physicians” capable of certifying lunacy. I explore this connection in three sections. First, I introduce the emergence of medical certificates in the context of asylum committal. Second, I focus on the certification procedure introduced in 1853 which required “facts of insanity personally observed”. Third, I consider how British asylum doctors advocated for the diffusion of psychological medicine as an essential university subject for certifying practitioners. This paper emphasizes the relevance of confinement legislation in the development of psychiatry as a medical specialty.

How did Ideas about Gender Influence Women`s Entry into the British Medical Profession Prior to WWII?

The path for British women into medicine has changed beyond recognition. This short essay examines how gender role ideology has influenced women's entry into this profession, tracing the arduous journey travelled by the early pioneers and the obstacles faced. This article is particularly relevant with today's context, where women now outnumber their male counterparts in the British medical education system. The common belief that women were not explicitly discriminated against by the medical establishment is also challenged. Furthermore, the means by which male incumbents monopolised skills are discussed and the effects of war on occupational entry are outlined.

History of British medical education.

History of British medical education.

Asa Briggs, A history of the Royal College of Physicians of London, vol. 4, 1948–1983, Oxford University Press, 2005, pp. xii, 486, illus., £60.00 (hardback 0-19-925334-X).

The writing of institutional histories is a notorious poisoned chalice. The unfortunate author is caught in a no-win situation between the Scylla and Charybdis of the expectations of the eminent Members and Fellows and those of academic historians about what constitutes an effective historical treatment. Briggs, as one would expect with his experience and talents, makes a good stab at a readable history (and it is actually possible to read this book all the way through—quite an achievement in itself given the subject matter). However, Briggs is no medical historian and has not attempted to read himself into the literature very far, apart from the standard historiography on the NHS (although there is no Rudolf Klein, no Nicholas Timmins, no Michael Foot and no Bernard Harris). This means that, while the Comitia might be happy with this volume, which is much less full of dry and dusty administrative details than its predecessors by George Clark and Alexander Cooke, it is very unlikely to satisfy any academics. Briggs's attempts to associate this work with academic conventions notwithstanding (see bottom of p. 1373), it addresses none of the key themes in the history of twentieth-century medicine that occupy the academic history of medicine community. Moreover, since Briggs has gone for readability, it is also of limited use as a reference work (the one great strength of those earlier impenetrable volumes). The other main problem with institutional history is what to write about. The RCPL is a medical examining body, but it is also the voice of the metropolitan medical elite and thus carries great weight within medicine and has some policy influence. Briggs does not examine the social/professional/epistemological basis/bases of College power or how it was maintained. He notes the clinical bias but does not comment on the College's position(s) on the relationship between clinic and laboratory. He notes (in the case of George Godber) the interpenetration of government by Members and Fellows, but fails to explore adequately the ramifications of this point. Briggs organizes his material in two ways: specific broad contextual themes (for example, the NHS 1946–68 and 1968–84, ‘Smoking and health’, although in this last there are no references to the work of Virginia Berridge), and catch-all general chapters like ‘Five Presidents’ or ‘Munk's Roll’. These latter are entertaining and methodologically justifiable as prosopography, but are rather anecdotal and break up the flow of the narrative. In the former, Briggs seems to err too much on the side of general context of medical politics, rather than focusing on the role of the College. One can sometimes forget one is reading a history of the College at all, so infrequently is it mentioned. Briggs is cleverly insightful in choosing to dedicate a chapter to “communicating”, although, again there is little acknowledgement of the existing secondary literature (Anne Karpf, Virginia Berridge, Kelly Loughlin, etc.). In general there is a frustrating lack of references for large swathes of text, and a concerning tendency to cite the President's annual addresses rather than detailed minutes of the council and its committees. Surely the latter provide a better way into the day-to-day concerns of such an institution. However, once again these criticisms reflect Briggs's compromises on the book he has chosen to write: it is for the Members and Fellows and not academic historians. Briggs's best chapter is perhaps that on the College's core activity: examining, training, educating. However, here, because of his lack of familiarity with the medical history literature, Briggs, rather ironically, given his over-attention to contextualization elsewhere, does not adequately explain how and why the Colleges developed greater roles in postgraduate medical education and examination. Most obviously lacking is any discussion of the centrality of the Goodenough Report to the evolution of British medical education, and the way it was synchronized with the new NHS to produce a regional educational structure for academic medicine based around the local intellectual powerhouses of universities and university hospitals. There is also no adequate exploration of the way the Colleges responded to specialization. This is dealt with in the literature on postgraduate medical education in the UK, and in some of the more recent histories of UK Royal Colleges. However, there is little evidence in the footnotes that Briggs has read anything about non-London Colleges, and they are certainly exceedingly rarely mentioned and never in any detail. This lack of a comparative perspective is disappointing, but will probably not unduly trouble his core audience. Briggs's book, then, falls between two stools. Such are the perils and potential pitfalls of institutional history; but then Briggs should know that as he has written a well-received history of the BBC, another pillar of the institutional establishment. Could it be that being a famous, readable, popular historian is not the best qualification for writing the history of medical institutions?

Medical Education past, present and future

Medical Education past, present and future

A model for British medical education.

A model for British medical education.

The ERASMUS programme: is British medical education going to lose out on educational opportunities in Europe?

The ERASMUS programme: is British medical education going to lose out on educational opportunities in Europe?

The Scientific Revolution in Victorian Medicine

Originally published 1979 The Scientific Revolution in Victorian Medicine looks at the discovery of inhalation anaesthesia in 1846, and how it began a new era in surgery. The book looks at James Young Simpson’s demonstration of the value of chloroform as an anaesthetic, and how many surgeons quickly adopted it. The book also looks at the dangers of chloroform if mishandled and only after considerable controversy and numerous fatalities was its use thoroughly understood and established. Ten years later an even more lengthy struggle began over antiseptic surgery. The ‘germ’ theory, on which Lister’s technique was founded had few adherents among British surgeons, and his methods were deemed absurdly complicated. He was opposed and sometimes ridiculed by the most distinguished men in the profession, including Simpson. Over ten years were required to persuade the majority of British surgeons that Lister did actually achieve the results which he claimed and that it was possible for a competent surgeon to do equally well, if only he would take the trouble. This book shows that a great many factors interacted in delaying the introduction of these new ideas. The almost wholly unscientific nature of British medical education and practice before 1860 or 1870, detailed in the first chapter, was one factor; rivalry and distrust between London and Scotland was another. Genuine disadvantages in the new methods were not unimportant either, while personal animosities failure to face the facts, and fear of the unknowable consequences of change all played a significant part.

An Experiment in Curriculum Evaluation: Monitoring the New, Shorter Clinical Medical Course at Cambridge University

Abstract A new clinical medical school has been established at the University of Cambridge. The school has decided to employ two educationists to monitor and evaluate the new course. In British medical education, this represents a most unusual and radical decision. The background to the evaluation is described in this paper, which then considers possible methods and problems, and outlines the planned strategy: the proposal includes measures of the school's ‘ethos’, the teaching/ learning process, aspects of its cost, and the quality of its ‘product’ — the medical graduate. Initial experiences ate reported, including some perceptions of the ‘evaluators’ as to their developing functions.

Basic Medical Education.

This monograph attempts to present the problems associated with British medical education and to unify the approach to curriculum changes based on the premise: all... variations on the theme of medical education derive from the same basic idea, and most differences between the systems are due to differences in the way... these ideas are translated into action. The title of the book, Basic Medical Education , was taken from the term applied by the British General Medical Council to the preclinical (basic science), clinical, and preregistration years of British medical schools. However, this is misleading since most of the book is spent discussing the problems and changes associated with the preclinical years. This might be expected since the author is Regius Professor of Anatomy at Aberdeen. The beginning of the book is devoted to a history of British medical education from the 16th century to the present. It is interesting that

Reforms for British Medical Education

The report of the Todd Commission, published last week, is certain profoundly to influence the character of medical teaching in Britain. What follows is a summary of the principal proposals.

British medical education and the General Medical Council.

British medical education and the General Medical Council.

A New Departure in British Medical Education.

London, N. W., Jan. 5, 1899. <h3>To the Editor:</h3> —The medical year in England has been marked by three most significant developments. They may indeed be described as epoch-making, although they will scarcely even be mentioned in the "Annus Medicus" or the year books. First and most important is the founding of the London Polyclinic and Medical Graduates' College; second, the establishment by the Government of the School for Tropical Diseases, and third, the magnificent gift of $1,250,000 by Lord Iveagh to the Jenner Institute of Preventive Medicine (videJournal, January 21, p. 146). These are not only important in themselves, but significant of profound changes in public opinion. The Polyclinic is the first formal and adequate recognition on the part of the profession of the value of post graduate instruction in English medical education. The School of Tropical Medicine is a partial recognition of the long ignored duty of