Senior doctors are naturally concerned about the proposal to shorten basic medical education (Plans to shorten medical training put quality of NHS care at risk, doctors say, 30 June). But my experience as a clinical teacher and doctor makes me sceptical about the claim that “softer skills” such as communication will suffer if the course is cut from five years to four.
The zero-sum logic behind this complaint is that the softer stuff must be squeezed out because the amount of technical material a student needs to learn is irreducible. But is it? The idea that basic medical education should require five years goes back to 13th-century Salerno at least. What has changed since then is not so much the quantity of material students learn as its usefulness.
It is difficult to gauge which information will be generically useful to a future doctor. I would rather my doctor did not know the dosages of drugs by heart – safer to look them up. Rather than memorising lots of anatomy, why not learn what you need when it becomes clinically relevant? So perhaps some “hard” information could in fact be dumped.
As for “softer” skills, few can be learned in the classroom. It isn’t enough to sit in a seminar room learning to look empathic, and you cannot learn how to understand individual experiences of illness – or disability, pregnancy or dying – in a vacuum. Empathy, understanding and imagination are not soft skills. They are far harder to learn than, say, the diagnostic criteria for pneumonia. But then, learning to actually diagnose pneumonia is very different from producing a textbook checklist of its signs and symptoms. Many key medical skills are best supported by rigorous, reflective supervisors who work alongside practising doctors – a process that could almost be called apprenticeship.
Chris Ward
Emeritus professor of rehabilitation medicine, University of Nottingham
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