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Allied
Health & Medicine
Allied Health & Medicine is a vast field of
specialised practice, study and research, which is mainly
aimed at the graduate level.
 Although
a high demand for traditional programs such as nursing
exists, there are many courses seeking undergraduates
within a real practice environment, such as Hospital
based clinical subjects and pre medicine courses. Alternatively,
more specialised, niche courses such as osteopathic
medicine, Chiropractics and acupuncture are widely available.
During the last decade general medical education has
changed dramatically and most of the medical schools
in countries such as the United Kingdom have radically
reorganized their courses.
Many factors have contributed to this change. In part
the change has been a natural evolution as new teaching
methods have been adopted, a process aided by modern
technology. In addition new solutions have enabled increased
numbers of students to be trained to existing standards
while fulfilling student requirements in the face of
increased diversity of educational background. The  major
impetus for change however has been the progression
to lifelong learning within medicine and the inclusion
of much more post-qualification training within the
career. Thus, unlike a generation ago, on graduating
the student is no longer expected to know all that is
necessary to undertake the duties of a doctor. Instead,
the medical degree is expected to provide a solid foundation
of relevant core knowledge associated with a thorough
training in the skills necessary to become a lifelong
learner.
So what has changed? The General Medical Council of
Great Britain in their publication ‘Tomorrows Doctors’
identifies three aspects: Knowledge, Skills, and Attitudes.
Regarding knowledge, the expectation is that factual
information should be taught in a context relevant to
clinical medicine, thereby ensuring that the learning
process is meaningful and memorable. Rather than allowing
the knowledge base to expand in line with advances in
medical science the curriculum is limited to core components
of essential knowledge. Skills encompass both the generic
abilities required for future self-directed learning
and the specific skills for clinical practice. These
should be observed and learnt under supervision and
then appropriate competency demonstrated. Attitudes
relate to the personal development of, and reflection
by, the student in terms of what behaviour is appropriate
in a doctor and in their relationships with patients
and other colleagues.
 How
is this achieved? Each medical school has a different
approach, however there are many common similarities.
Limiting factual knowledge has been achieved by reducing
didactic teaching (formal lectures) accompanied by clearly
defined and simplified learning objectives; the expectations
of the examiners matches these objectives. The material
is commonly delivered in an integrated fashion often
using a systems-based approach. For example, at Bristol,
we teach all aspects of the cardiovascular system together,
with different disciplines contributing. Normal functioning
of the system is addressed first in relation to the
structure (anatomy), function (physiology) and molecular
basis (biochemistry), followed by consideration of abnormal
function (clinical cases), the underlying cause (pathology
and microbiology) and therapeutic intervention (pharmacology);
the problems of the individual can then be put in context
of Society as a whole (social medicine and public health).
Many variations are possible but a common alternative
method used by other schools is to start with a clinical
scenario; this is often used in “Problem Based
Learning” strategies.
 The
teaching of clinical skills has undergone major change.
While it is of course necessary to practice and develop
these skills with real patients the initial training
is now undertaken in a theoretical environment. Clinical
Skills Laboratories, with a range of lifelike models,
allow students to learn the basic procedures and gain
confidence in a non-threatening and well supervised
environment before proceeding to the clinic. Computerised
mannequins such as the ‘Patient Simulator’,
which is used in the teaching of anaesthetics at Bristol,
can provide very realistic dynamic scenarios in which
the model can even react to drugs which have been administered.
Similarly, training in communication skills has been
revolutionised by the use of actors who take on the
role of patients. Often these sessions are recorded
on audio or videotape to allow students to reflect on
and to learn from, their interaction with the simulated
patient. Actors, or professional patients, may also
be used in OSCEs (Objective Structured Clinical Examinations)
which are commonly used to test clinical competence,
and where standardised patients are desirable. Although
many students when they come to university are very
competent in other generic skills most medical schools
provide additional training. The further use of these
skills is encouraged by substantial components, such
as project work and problem-based learning strategies,
which are student centred and directed.
 What
is required of you? Obviously you need to be academically
strong to cope with the intellectual demands of the
course. More important however in view of the long training
is a high level of motivation. It is essential before
applying to medical school to investigate the structure
and demands of a clinical career and ensure that it
is what you desire. Similarly, medicine is very involved
with people and it is important that you have a confident
but caring personality and that you enjoy working in
a team. As stressed above good communication is paramount
and you must have a good command of English if it is
not your first language. Finally, competition is strong
for places at medical school and you may have to apply
more than once.
Contributed by:
Geoff Clarke
Deputy Director,
Medical faculty,
Bristol University
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