- Email: [email protected]
Round the World
1030 forward the written and oral parts of the final examination by one year and to use this time, after the main hurdle of the final examination is passed, to run a junior houseofficer programme. With an integrated undergraduate teaching programme and continuous assessment procedures already in existence, it was possible, in June, 1967, to set both 5th and 6th years the same written final examination in medicine, surgery, and obstetrics and gynaecology. The results are set out in the table. The criticism may be made that the standard attained by the 5th is not so good as that of the 6th year, although it is interesting that in the objective part of the surgery paper (all the other questions were essay types) the results show little difference between the two years. In any case, a somewhat lower level of performance by the 5th year is acceptable since, as will be seen, the opportunity for further learning under supervision is built into the junior house-officer programme. For the great majority there is a much greater degree of freedom of choice and experience than that which obtained under the old-style sixth year: the weaker brethren can be brought up to strength by directing the elective period (you can have any colour so long as it is black) to those areas in which they have proved
wanting. This was done by dividing the time into five periods, each of eight weeks, and the 90 students into five equal groups, rotating in turn through a junior house-officer post lasting eight weeks for medicine, eight weeks for surgery, four weeks for obstetrics and gynaecology, four weeks in child health, and eight weeks for each of two elective periods. The elective periods were spent in subjects and departments of the person’s choice and covered the whole range of the medical curriculum and several, such as hospital administration and medical illustration, which were not. For about 10% of the year one or both periods were used for directed electives, as indicated by the final-examination results. After each eight-week block in the clinical subjects (not in the electives) each junior houseman in his sixth year was examined by an internal and external examiner to see how they had advanced in their clinical work. This sixth year, in no wise repeated fifth-year work. If any of these junior housemen (and, after all, there is only one per ward) had been found to absent themselves or to be in any way unsatisfactory in the performance of their work they might have been referred for a further period. The main period of referral, however, should be at the end of the fifth year when they have their written final examination. failure in all fifth-year subjects might lead us advise a further year of study. A lesser degree of failure in, for example, one or two of the fifth-year subjects would be covered by a directed elective(s) and the candidate would resit in the December following the June failure. If satisfactory then, he could proceed to his junior houseman appointments and graduate with his year in the A
complete
under the old system. If the process of referring a student for a further period of study, after unsatisfactory performances in the final examination, could be done away with, apart from preventing wastage of manpower, it is likely that the saving to the country would be in the region of E250,000 per annum. With the system proposed, the only decision to be made is whether the individual is ready to go on to the next phase of his training, with the certainty that this can be so styled as to remedy his weaknesses. Further evaluation goes on during the junior houseman year, just as it goes on at present during the preregistration year all over the country. If the performance is not satisfactory the individual may have to repeat the block of clinical work in which continuous evaluation shows the individual to be poor. Three times a year the external examiners take part in these evaluations of clinical competence. Regardless of the directed element in elective time for the minority of students, all have the opportunity of carrying out the junior house-officer attachments; hence all have had a preliminary sample of clinical work not from the student viewpoint but as a " postgraduate ". During 1968-69, this sampling is being extended by incorporating, in addition to the above, four weeks as junior house-officer in the clinics and wards of the department of mental health and four weeks’ attachment to the
university general practitioner unit. Valuable as these vignettes of clinical " postgraduate experience are, the greatest benefit for the greatest number is the elective time. Many students now go to "
other countries and other medical centres, but a more formal system of attachments can be worked out in this scheme. This has been done so that during the first year of the new-style programme, two-thirds of the year spent time at other medical centres and a sixth went overseas,
mostly by winning competitive scholarships, to Fiji, Malaya, Norway, Sweden, Yugoslavia, the West Indies, Zambia, and the U.S.A. This tends to produce a sophisticated type of embryo postgraduate who has a much clearer conception as to what goal to aim at. Travel in the younger sort is a part of education; but it is more-next to acquiring a wife, children, and a sizeable bank overdraft, travel is
excellent conditioner of the mind towards education if only as a means of bringing home postgraduate the bacon. an
I thank all the teachers involved in this scheme, and I am most indebted to Prof. H. Fullerton and Prof. I. MacGillivray for allowing me to use the examination results in medicine and obstetrics and
gynaecology.
to
following June. A particularly valuable result of this provision has been that at the end of this first " post-final " year (i.e., graduation in July, 1968) there were no referrals. If this was the only result of the scheme it would be worthy of consideration, particularly since it seems that over the twenty-five medical schools in the U.K. there is an average referralrate in the region of 20% in the final examinations. Going on figures for the past decade in this school, out of 90 students it might have been anticipated that some 9 or 10 would have been referred for a further period of study
Round the World India A substantial part of India’s fourth national plan (1969-70 to 1973-74) is concerned with population control. The country’s family-planning programme was instituted in 1955, but has faced major difficulties because, out of the 100 million couples in the reproductive age-group, 80 million are not accessible to the mass media. Nevertheless the programme of contraception and sterilisation has probably prevented about 10 million births so far, and the new national plan aims within the next ten years to prevent 13 million births annually, reducing the birth-rate to 23 per 1000. The death-rate is also likely to fall, as a result of the planned improvements in health services to rural areas, better water-supplies and sanitation, and extended immunisation schemes.
wanting. This was done by dividing the time into five periods, each of eight weeks, and the 90 students into five equal groups, rotating in turn through a junior house-officer post lasting eight weeks for medicine, eight weeks for surgery, four weeks for obstetrics and gynaecology, four weeks in child health, and eight weeks for each of two elective periods. The elective periods were spent in subjects and departments of the person’s choice and covered the whole range of the medical curriculum and several, such as hospital administration and medical illustration, which were not. For about 10% of the year one or both periods were used for directed electives, as indicated by the final-examination results. After each eight-week block in the clinical subjects (not in the electives) each junior houseman in his sixth year was examined by an internal and external examiner to see how they had advanced in their clinical work. This sixth year, in no wise repeated fifth-year work. If any of these junior housemen (and, after all, there is only one per ward) had been found to absent themselves or to be in any way unsatisfactory in the performance of their work they might have been referred for a further period. The main period of referral, however, should be at the end of the fifth year when they have their written final examination. failure in all fifth-year subjects might lead us advise a further year of study. A lesser degree of failure in, for example, one or two of the fifth-year subjects would be covered by a directed elective(s) and the candidate would resit in the December following the June failure. If satisfactory then, he could proceed to his junior houseman appointments and graduate with his year in the A
complete
under the old system. If the process of referring a student for a further period of study, after unsatisfactory performances in the final examination, could be done away with, apart from preventing wastage of manpower, it is likely that the saving to the country would be in the region of E250,000 per annum. With the system proposed, the only decision to be made is whether the individual is ready to go on to the next phase of his training, with the certainty that this can be so styled as to remedy his weaknesses. Further evaluation goes on during the junior houseman year, just as it goes on at present during the preregistration year all over the country. If the performance is not satisfactory the individual may have to repeat the block of clinical work in which continuous evaluation shows the individual to be poor. Three times a year the external examiners take part in these evaluations of clinical competence. Regardless of the directed element in elective time for the minority of students, all have the opportunity of carrying out the junior house-officer attachments; hence all have had a preliminary sample of clinical work not from the student viewpoint but as a " postgraduate ". During 1968-69, this sampling is being extended by incorporating, in addition to the above, four weeks as junior house-officer in the clinics and wards of the department of mental health and four weeks’ attachment to the
university general practitioner unit. Valuable as these vignettes of clinical " postgraduate experience are, the greatest benefit for the greatest number is the elective time. Many students now go to "
other countries and other medical centres, but a more formal system of attachments can be worked out in this scheme. This has been done so that during the first year of the new-style programme, two-thirds of the year spent time at other medical centres and a sixth went overseas,
mostly by winning competitive scholarships, to Fiji, Malaya, Norway, Sweden, Yugoslavia, the West Indies, Zambia, and the U.S.A. This tends to produce a sophisticated type of embryo postgraduate who has a much clearer conception as to what goal to aim at. Travel in the younger sort is a part of education; but it is more-next to acquiring a wife, children, and a sizeable bank overdraft, travel is
excellent conditioner of the mind towards education if only as a means of bringing home postgraduate the bacon. an
I thank all the teachers involved in this scheme, and I am most indebted to Prof. H. Fullerton and Prof. I. MacGillivray for allowing me to use the examination results in medicine and obstetrics and
gynaecology.
to
following June. A particularly valuable result of this provision has been that at the end of this first " post-final " year (i.e., graduation in July, 1968) there were no referrals. If this was the only result of the scheme it would be worthy of consideration, particularly since it seems that over the twenty-five medical schools in the U.K. there is an average referralrate in the region of 20% in the final examinations. Going on figures for the past decade in this school, out of 90 students it might have been anticipated that some 9 or 10 would have been referred for a further period of study
Round the World India A substantial part of India’s fourth national plan (1969-70 to 1973-74) is concerned with population control. The country’s family-planning programme was instituted in 1955, but has faced major difficulties because, out of the 100 million couples in the reproductive age-group, 80 million are not accessible to the mass media. Nevertheless the programme of contraception and sterilisation has probably prevented about 10 million births so far, and the new national plan aims within the next ten years to prevent 13 million births annually, reducing the birth-rate to 23 per 1000. The death-rate is also likely to fall, as a result of the planned improvements in health services to rural areas, better water-supplies and sanitation, and extended immunisation schemes.