Is a relationship a necessity for MBBS students?

gms | German Medical Science

In the meantime, initiatives to reform medical education are planned and already implemented at many medical faculties. The focus of the efforts is the early networking of theoretical knowledge with practical application in order to enable differential diagnostic and differential therapeutic learning in context. The establishment of practice laboratories for learning clinical techniques, so-called skills labs [1], the use of computer learning programs for differential diagnostic training [2] or the establishment of entire reform courses such as in Berlin [3] or Heidelberg [4], [5] should help medical Improve training. In addition to the size of the group, the continuity and didactic qualification of the lecturers are of central importance for the quality and effectiveness of teaching [5], [6], [7], [8]. In our opinion, everyday life at German universities is still very different. In the clinical section, the course does not currently shine due to its practical relevance. Many universities still offer face-to-face teaching in front of more than 200 students. In the accompanying internship, up to 10 students should examine a patient. If the lecturers are badly organized, the course takes place without sick people, the studios examine each other listlessly. How to deal with the sick and needy or inform the relatives of a seriously ill or dying person is often not taught in six years of standard study time. Such poorly trained students do not quickly turn into good doctors. At the same time, the deficits in the training are the reason for a large part of the weaknesses of our health system that are widely complained about: a lack of practical experience, hardly any quality controls, insufficiently speaking medicine. “Good” teaching is also made more difficult by the multiple workload for doctors at the university clinics, who are involved in research projects in addition to patient care, their further training and qualifications and who are supposed to conduct committed student teaching at the same time. In our opinion, this is one of the many reasons for young doctors to leave Germany and work in Scandinavia, Switzerland or England because they hope for better working, teaching and learning conditions there. Every year we lose fully trained doctors who would potentially be available for teaching to our neighboring nations. A good teaching can only be achieved if it is practiced across the board and not just by a few. Ways to implement it become apparent when we remember our own student days and ask ourselves what we wanted back then:

Small groups with a maximum group size of 4 students per lecturer.
Very experienced, committed lecturers in their subject who enjoy teaching, who are happy to share their knowledge and who have enough time to concentrate on teaching.
A concentrated learning atmosphere with an interactive, equal dialogue between student and lecturer (no teaching “from above”).
Practice-relevant topics that are worked out on the basis of patient case studies, if possible with direct patient contact.
Practical learning media for self-study (e.g. learning CD).

These and other teaching objectives are aptly summarized in a workshop report [9]. If you look at the large number of post-doctoral doctors who work outside of the university, a relevant resource of academic teachers emerges that is currently not being used adequately by our higher education system. Although there is a teaching obligation of 1-2 semester hours per week for every university professor, this is often not or cannot be performed adequately. Different difficulties arise for the universities and the external university lecturers from the current situation. External university professors often have to cover a long distance between their current place of work (practice, hospital) and the university. At the same time, they often have to leave their place of work for a whole day because of 2 hours per week; this means loss of time and earnings and, if necessary, the need to find a substitute for the time of absence. At her university, many things have changed in the years since she left that directly affect teaching and make it more difficult: The lecturer no longer knows the patients personally. Colleagues, nurses, laboratory staff are no longer there or transferred to other positions. The occupancy, equipment and functionality of lecture halls or seminar rooms is often not clearly visible. Because of the sporadic presence, the lecturer cannot “advertise” himself sufficiently to the student body; a relationship cannot therefore be established. External university lecturers are seldom meaningfully integrated into the teaching curriculum; they do not know which learning content is taught before and after their "lesson" and so cannot optimally apply their teaching. It is also important to remember at this point that only 3% of the patients are seen at the university clinics in terms of incidence [10]. A broad spectrum of common clinical pictures cannot be taught at university hospitals alone. With our block seminar we give an example of how external university lecturers can teach meaningfully and effectively at the location of their medical work. The evaluation of the block seminar by the students resulted in excellent grades, whereby it must be noted that this is a selected student asset (those who volunteer and those who are willing to “sacrifice” a weekend). Based on the positive experience of the last few years, we are planning to establish our block seminar as a curricular event within the internship in internal medicine at the Johannes Gutenberg University. By teaching in one's own practice (hospital), all the disadvantages just discussed are no longer present. For lecturers who like to teach, it is possible to create a learning atmosphere in which learning is "fun". At the same time, learning outside the university broadens the student's horizons. From the perspective of the university, both personnel and financial relief can take place through our teaching model. We hope that our teaching model of interactive student teaching will find enthusiastic supporters in Germany and that it will be accepted and further developed by other medical faculties and external university lecturers (see Figure 6 [Fig. 6]).