Summary: In this latest blog, Professor Harden discusses the current model of medical training and reflects on the SPICES model he described 30 years ago. Description: The current model of medical training should be changed fundamentally suggests Sam Leinster, writing in the Journal of the Royal Society of Medicine (2014, 107(3); 99-102) ‘It is the product of tradition and evolution rather than empirical design.’  He notes that the undergraduate medical course is predicated on the concept that graduates must have a broad understanding across all medical disciplines, although on graduation many will focus on a narrow area of practice.  He argues that they may not need such a broad training in order to do this.  He proposes that doctors may first train for a specific function within the health care team and that because the training would be focussed it could achieve a greater level of competence in a shorter time.  Some individuals may choose to practice their speciality for their entire career, while others may practice for a time and then choose to take further training and broaden their scope of practice.  I find these suggestions attractive.  Personally I would have in medicine from the outset of training two tracks, one aimed at generalists which would require a longer period of training and one for specialists in one of a number of different areas.  I suspect with the natural conservatism of the medical profession, however, it will be some time before we depart from the current traditional model of training.

From an international perspective it is interesting looking at the visits to MedEdWorld from different countries.  The figures for January, February and March show that five of the six most represented countries have remained the same over this period – UK, US, Singapore, Canada and Australia.  The sixth country represented in January and March was India and in February, Saudi Arabia.  Other countries appearing in the top ten are the Netherlands, Brazil, Malaysia and Thailand.  Another interesting finding was that while the majority of visitors accessed the MedEdWorld site via a laptop or desktop computer, the number of visitors using mobile or tablet devices has increased to 20% compared to 12% a year ago.  Of these 9% used tablets and 11% mobile devices.  

It is now 30 years since I described in Medical Education the SPICES model of educational strategies.  I have been impressed how it has proved valuable in a number of different contexts, both in curriculum planning and curriculum evaluation and I am always interested to read papers published on this topic.  John Dent describes in the Korean Journal of Medical Education (2014, 26(1); 3-7) the use of the SPICES model to develop innovative teaching opportunities in ambulatory care venues.  While the basic elements of the model are I believe as true today as they were in 1984, there are perhaps some differences in the emphasis as I highlighted in my recent text with Jennifer Laidlaw, Essential Skills for a Medical Teacher. Student-centred is moving in the direction of personalised or adaptive learning, problem-based learning now takes a number of different forms, integrated curriculum may include integration with other health care professions and not just within medicine, community-based education may be now a formal part of the curriculum and include rural communities, electives now are a means of achieving core learning outcomes and the systematic curriculum relies heavily on the development of learning outcomes and curriculum mapping.

I have just left for the Ottawa Conference in Ottawa and am looking forward to an interesting programme.  I will try to report some of the highlights in my next blog.  We will be publishing a few of the key papers from the conference in Medical Teacher later.