Summary: This month Professor Harden discusses The New Norm: A changed role for students, and Reducing the length of medical training Description: The New Norm: A changed role for students
The 2021 International Medical Education Conference (IMEC 2021) held as a virtual conference 12th-14th March had as its theme The New Norm for Health Professions Education. I chose as my theme for the opening plenary presentation “The New Norm and a Changed Role for the Student”. I argued that a major development at present in medical education and over the next decade is the greater engagement of students as partners in the medical education process.

To introduce the theme I told the story of Sam Levine as reported in the book “A School of Our Own”. Sam returned with his friends from school one day and complained about the school curriculum and how it was delivered. His mother challenged him and the other students to do better. After negotiations with the School Board and Curriculum Committee it was arranged that the students would run the school curriculum and assessment programme for a semester. This proved to be a great success.

As described in Catherine Bovill’s book Co-Creating Learning and Teaching there are powerful advantages to be gained if students are partners in the education programme. These include Increased student academic achievement and the student’s development of skills, including creativity, critical thinking, innovating, and negotiating.

In a recent personal view in Medical Teacher Sharah Kapadia (2020) wrote “Students as partners? This might raise some eyebrows! After all aren’t teachers there to teach and students there to learn? Well, I have found that this could not be further from the truth. I experienced the benefits of student-staff collaboration when I participated in a two-week project at the Imperial College School of Medicine.

I described in my IMEC presentation the changing role of the student as an information processor and seeker, as a facilitator of learning, as a curriculum collaborator, as an assessor of competence, as a teacher and mentor, as a manager, as a scholar, and as a professional. I am exploring these roles further in a book to be published by Elsevier along with Jeni Harden as co-author and input from students.

The increasing engagement of students in their education is reflected in students’ authorship of manuscripts submitted for publication to Medical Teacher, in 2000 2% of papers had students as co-authors. This rose to 9% in 2010, and 15% in 2017 (Harden et al 2018).

Writing on the subject of student engagement in the 5th Edition of a Practical Guide for Medical Teachers, Ambrose et al (2017) writes “The more that students can be involved in the creation of the design of the curriculum and engaged in quality improvement of the course, the more the student gains a sense of ownership for their own learning.

I moved from Glasgow to Dundee in 1972. One of the challenges was to reinvent the medical school curriculum which had been seriously criticised by the General Medical Council. The Dundee students had written a detailed critique of the curriculum and made suggestions as to how it could be improved. On taking up my post in Dundee I established a committee of enthusiastic teachers like Alec McQueen, Peter Stoward, Arnold Moran, and Bob Pringle for a new Dundee curriculum which, when introduced, became widely recognised as a forward-looking approach to medical education, incorporating a range of innovative educational strategies. On looking back, however, I have a serious regret. I wish that we had been bold enough to leave it to the students to develop the first year of the curriculum, giving them support as necessary. It would have been interesting to see the result.

At IMEC 2021 I concluded my presentation by challenging the audience as to whether they would give students the responsibility for curriculum development and to develop “a medical school of their own”. I included a poll which asked about their view as to a medical school run by students with three options:

  1. Farsighted and merits consideration. Explore feasibility and possibility of a trial
  2. Unlikely, but further thought required. Explore the core concept through a series of focus groups
  3. Outrageous! Would not work. Dismiss the idea
To my surprise the votes of 324 participants were 1 – 49%, 2 – 45%, 3 – 6%.

In looking to the future, we will of course recognise a new norm that includes a greater emphasis on the use of technology and online teaching and learning. We should not, however, ignore the importance of the changing role of the student with regard to the education programme.

Bovill, C. 2020. Co-creation in learning and teaching: the case for a whole-class approach in higher education. High Educ. 79, 1023-1037.

Harden, R.M., Lilley, P.M., McLaughlin, J. 2018. Forty years of medical education through the eyes of Medical Teacher: From chrysalis to butterfly. Med Teach. 40(4), 328-330.

Kapadia, S. J. 2020. Perspectives of a 2nd-year medical student on 'Students as Partners' in higher education - What are the benefits, and how can we manage the power dynamics? Med Teach. Epub: https://doi.org/10.1080/0142159X.2020.1779922

Reducing the length of medical training
I have argued in previous blogs the need to reduce the length of the medical training programme. In the US the standard programme is four years of undergraduate education and four years at medical school. Woodson and colleagues (2020) describe in Medical Teacher the Tulane accelerated physician training program. This allowed undergraduate students to complete two years of undergraduate studies followed by a mandatory year of public service prior to four years of medical school. The programme was judged to be successful based on its ability to attract, retain, and graduate students into medical residency programmes. The shortened timeframe needed was associated with significant cost savings for students. Education outcomes were not different between students in the traditional and in the accelerated curriculum.

The year of public service was introduced because of concerns about the maturity of students entering their clinical training. This does not appear to be a problem, however, in the UK and other countries around the world where students enter a five or six year medical school programme directly from high school.

Woodson, M.J. 2020. The Tulane accelerated physician training program (TAP-TP): A novel combination of scholarship and service. Med Teach. 43(2), 320-324.