What they don’t teach you at medical school

Professor Robert Lechler, vice principal, health, and dean, School of Medicine and Dental Institute at Guy’s, King’s, and St Thomas’ Hospitals, King’s College London

Authors: Hannah Peters 

Publication date:  26 Feb 2008

When I left medical school I had to relearn much of what I had been taught. In those days, the medical curriculum at Manchester was highly compartmentalised. Biochemistry, anatomy, physiology, and so on were taught as distinct subjects. This made it quite hard, for example, to apply knowledge of pharmacology to therapeutics.

I was taught little or nothing about communication skills. Some people are naturally great communicators and others are less good, no matter how much teaching they receive. Role play and video recordings of yourself are undeniably useful tools that I had no access to as a medical student. Often you do not realise how you are perceived. If lessons in communication skills achieve nothing else, they should at least make students conscious of the importance of good communication. Similarly, the use today of surrogate patients and volunteers for students to practise clinical and communication skills on makes compellingly good sense. When I was a student, you did not know whether you had been too heavy handed or not heavy handed enough when, for example, you examined a patient with a palpable liver. A balance needs to be struck, however, between teaching communication skills and basic science. I do worry that the science grounding of medical students today is inadequate. Medicine is changing faster than ever and you need to be reasonably scientifically literate to understand why a new technique, diagnostic or therapeutic, is better, or not, than what is already available.

I have stopped saving lives now because I do not have enough time to devote to being a safe doctor. I am in charge of five health schools at King’s and supervise a research group. Being a leader of a medical school is a bit like being the manager of a premiership football team. My greatest challenge has been to move King’s up the rankings. My ambition is to make King’s a medical school that is a centre for excellence, turning out the clinical academics of the future. I am committed to exposing all students to the process of research. That happens only if you mobilise the best researchers to be engaged in teaching. What tends to happen, however, is that the best researchers think they do not have to dirty their hands with teaching, and the less good researchers have too much teaching put on them, and find themselves ground down. At King’s we are trying to ensure that the top researchers are involved in teaching, as they are best placed to communicate the excitement of research to those who have aptitude in that direction. We are also likely to make a BSc [bachelor of science degree] mandatory. I am hoping these changes will help capture the great clinician scientists of the future.

Medical school absolutely did not prepare me for what I am doing today. Since leaving medical school I have had only one day of leadership training. Historically, leadership training is not provided in medicine. While to some extent leaders are born and not made, it is not an excuse for failing to provide leadership training. We need to take the exercise of leadership much more seriously, without returning to the ‘bad old days’ of the despotic consultant. There are people with leadership roles in medicine who have conspicuous flaws that no one has mentioned to them. People simply accommodate them and let them get on with their jobs.

The great thing about medicine is that it gives you a passport to do such a wide variety of things. It is important for young doctors or medical students to think about what they are best at and to build their career around those strengths. In my day, there was an element of haphazardness about the way people found themselves heading down a certain career path. A job arose and they fell into it. You should decide what really turns you on, and ask yourself where you are going to make your biggest contribution. Then go for it.

Hannah Peters third year medical student St George’s, University of London

 m0502023@sgul.ac.uk