Finding and Nurturing Future Medics

During the week, Brighton and Sussex Medical School’s main undergraduate building is a busy place: home to first and second year medical students and shared by other science undergraduates from psychology to medical imgaging students. It’s a hive of university activity and hosts the most popular (and cheapest) cafe on campus, as far as I’m aware. A similar hive of activity is seen all across the Sussex campus during the week with a mix of undergraduates and postgraduates pouring in and out of each academic building. Come saturday however, and campus changes. Campus-dwelling students are either in bed or hidden away in the depths of the enormous library, and thanks to the newly-built Brighton and Hove Albion football stadium next door, campus becomes one vast car park for football fans. Students living off campus no longer come in at the weekend as there’s nowhere to park and the busses are full of blue-and-white stripe clad, chanting spectators.

Look closely though, and you’ll notice an exception. Amongst the long lines of football shirts trapsing noisely across campus towards their sporting holy grail, there’s a small group of keen and excited kids making their way into the medical school building. Shut off to all other students, the building for one day a week is dedicated to these children for a special, but little-known about event. It’s called BrightMed.

BrightMed is a scheme run by BSMS which aims to diversify the future medical profession by widening access to medicine for school children who would never normally consider it as a career. It aims to “seek out young, talented people who have the potential to become doctors” and through a series of structured programmes over a course of up to five years (if the children start in year 9 and continue to year 13!), allows these kids to become “aware of their potential careers in medicine”.

Through good links with schools across the whole of Sussex, kids who are high academic achievers (especially in science) but do not come from a university-level educated family are put forward for the scheme. They can start in year 9 (13-14 years old) and can continue to attend, building their knowledge of the profession and their specific abilities such as history taking and simple clinical skills, until they are able to apply for medical school entry. They then receive help in developing their personal statements and gain valuable interview practice directly from doctors, faculty members and students who sit on typical admission panels. It’s a fantastic scheme that has already produced some excellent medical students and future doctors.

When describing the scheme to outsiders, a common question is often raised:

“What’s the point in teaching clinical skills if the kids cannot use them yet and will learn them again at medical school?”

To answer this, I’m going to describe the very first session our new entry of year 9 kids took part in at the weekend. It was an introduction to history taking and designed to get them thinking about why they are asking certain questions, and what they are going to do with the information gathered. As you will hopefully see, diagnosis and style of questions were not the focus – after all this is what medical school is for – rather, the very reason for taking a history and the nature of thinking about symptoms and how a patient is affected by them became the natural learning outcome for the session.

Around 50 thirteen and fourteen year olds arrived on saturday morning for their first BrightMed session of what could turn into a five-year relationship with the medical school as “under-undergraduates” (my term, not BrightMed’s!). After a short introduction, an ice-breaker tutorial on pulses and how to feel for them allowed the kids to start to bond as they moved around the room trying to feel each others’ radial, brachial, carotid and even foot pulses (not a session for the easily olfactorarily offended!). They were then introduced to the main focus of the day: the medical history. A clear and simple structure displayed in a flow-diagram form was distributed that included only the section heading (e.g. past medical history, family history etc) but without specific questions. Medical student facilitators then rotated through groups of 5-6 kids, each with a different set of fictional symptoms for the groups to uncover. The idea is that the children work systematically through each subheading of a medical history, coming up with their own questions to try and unearth the ‘patient’s’ problems. They were then able to go into the computer suite and research the symptoms (with guidance rahter than simply using Dr Google) to come up with a diagnosis which they could then present back to their peers.

A significant difference between this approach and the traditional one used by textbooks and medical schools is that the children had to work out what to ask. They were of course given guidance (they had never taken a medical history before!) to areas of questioning, but that was all. Without a solid biomedical education underpinning this, they also had no idea what they were looking for, other than vague ideas about common conditions that most lay members of the public would know about. Despite this, amazingly the kids formed all the correct questions (if a little disjointedly!) to determine the important symptoms for each ‘patient’ without any difficulty at all. What’s more, they managed to expand, off cue, to investigate how these symptoms affected the patient and then topped this all off with some ideas, concerns and expectations, apropo of nothing. It was a delight to see. It seems that when left to their own devices, these kids were able to naturally ask all the appropriate questions through pure curiosity alone.

Having seen this wonderful process before at BrightMed, and knowing how smart these kids usually are, when I was asked to be a ‘patient’ for one group, I decided I’d see how far I could push them. Through my own feverish curiosity, I wanted to find out if the kids had an idea of what a ‘symptom’ actually is and why the person in front of them is determined to be ‘ill’. Of course, as in most situations, I turned to twitter. I threw out the question of what condition to have with some hilarious responses, which I’ve Storified.

I couldn’t decide what condition would best test the kids’ understanding of the very purpose of a medical history and what they are actually enquiring about. At the time, in my own learning I was on a mental health placement. Initially I disregarded a psychiatric presentation as I was struggling with adequately taking this specific history myself, but after deciding against leprosy or the black death, I returned to a psychiatric presentation for a second thought. It was perfect. No real need for a physical examination in the first instance to at least guide diagnosis, and for a patient with no insight there wouldn’t even be a ‘presenting complaint’. An acute presentation of psychosis would force the kids to think about the very nature of a symptom, and a patient who had difficulty answering straightforward questions would mean the kids would have to infer answers and decide for themselves what was wrong, if anything, with the ‘patient’ in front of them.

What followed was simply astonishing. My ‘patient’ (which I thoroughly enjoyed acting out) was placed in front of a group of six year 9 students for their final history taking of the day. The other ‘patients’ had presented with anything from gallstones to migraines, via constipation and angina. The kids had competently managed to gather enough information that when entered into approporiate medical websites would provide them with a diagnosis and management plan. Now they were faced with me, a nervous and muttering wreck; suspicious of everyone and convinced I was fine. How would they cope with this? I thought I’d probably pushed them too far.

My character was essentially presenting with acute psychosis that quite purposefully could be due to a number of conditions. Schizophrenia was the leading diagnosis in my mind, but other causes of psychosis were entirely possible, and I was careful to to include any symptoms that would rule out causes such as a major depressive episode with psychosis. The that end, my character was essentially a young man convinced he was on a special mission as the chosen one to kidnap TV’s Dermot O’Leary. The mission was of course given to him by Zeus who he could hear talking to him from outside his room.

After initial confusion from the kids, they quickly determined my mission and who had given it to me. They’d even established, without any guideance or knowledge of psychiatry, that my auditory hallucination was an external voice and in no way ‘in my head’. They then tripped me up by asking all about how these problems were affecting my life, and I quickly had to come up with answers to unexpected questions about my sleep patters, diet and social life. My family history and social history were delved into, and I had to invent a back story about smoking cannabis since I was 14 and entertain a storyline about my troubled childhood. The kids seamlessly linked all of these facts togheter and forced me to develop a rich history and current picture that would still fit neatly into a set of differentials that they could easily research.

A couple of hours diving into the world of mental health and differentiating between conditions by symptom and presentation online, and the kids had come up with a perfect set of differentials which they presented to the whole cohort. Two of the boys in the group intially refused to present as they feared they’d come across ‘dumb’ compared to the other ‘boffins’. Reassurance that they were in fact phenomenal and a quick tweet for excellent feedback from actual doctors convinced them they were brilliant. They presented the case fluently and insightfully. It was fantastic to watch.

I can honestly say it was the most enjoyable and inpsiring clinical exercise I have ever been part of, and made me reaslise that without any specific psychiatry or even medical teaching, these children were perfectly able to think about what it is to be ill and see how a doctor could help someone in such a situation. As one doc said on twitter, our future set of doctors is looking bright.

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3 comments

  1. amcunningham · November 27, 2012

    So why don’t we take this approach to teaching medical students? Or do we?

    • fakethom · December 1, 2012

      I’m not sure we do – probably because everyone takes histories all the time. It’s the fundamental basic of medicine so everyone used to telling people exactly how’s best to do it. All very well at to teach it comprehensively eventually but should be room to let students explore early on, to get a proper feel of why they’re doing it and what they’re looking for. Only then can they really learn the best way to hunt for clues.

  2. Pingback: BrightMed: BSMS’s Widening Access To Medicine Scheme | The 5th Leg

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