Professionalism

A common thread running through both medical courses is a focus on reflective practice. Indeed, there is a strong similarity between Australia and the UK regarding the emphasis being placed on this aspect of the training. I can appreciate the importance of ensuring that doctors in training have an understanding of the importance of self-awareness, but I suspect I am in the minority among my student peers on that.

One difference, however, is the almost absolute lack of formal "professionalism" lectures and assignments here in Australia. "Professional behaviour" was almost fetishistically followed in the UK. Whether Australia considers professionalism to be a no-brainer, or whether the previously discussed lack of a Shipman means that the importance of teaching this formally is not appreciated, is hard to say. Perhaps later in the course we will get lectures on this but I can't see anything in he course outline so far.

Unlike reflective practice, the case of drumming professionalism into young medics is, I think, rather less clear cut. By formalising the process of ensuring professional behaviours, by providing all and sundry with the "unprofessional" stick with which to beat 18 yr olds, the importance of such behaviours is eroded. Further, certain parties, including peers, have a tendency to conflate "professional behaviour" with "doing as I say and shutting up". Here are a few examples of "unprofessional behaviour" as defined in UK:

• Not putting hand up prior to speaking in a public forum having been requested to ask a question.
• Not wearing a tie for a social work client encounter having been told previously that wearing a tie would intimidate their clients.
• Ditto another student being reported for wearing trainers which turned out to be smart casual leather shoes.
• Not using Vancouver referencing system correctly (that is, missing out on a comma or two).
• Forgetting to hand in a marking guide cover sheet on an assignment.
  

And on it went in all its nit-picking glory.

Cheerfully, currently the Australian course seems rather more relaxed as to whether the cover sheet on your assignment is 12 or 14 point font. Perhaps this is not setting the right standard up front and perhaps this course will turn out terribly slapdash students who will be unable to recite the 12 or so Duties of a Doctor (the number is hard to pin down because the list isn't MECE and is very hard to fit into a mnemonic). Or perhaps it means that sanctions can be saved for less trivial errors and oversights.

Who is the leading figure in British medical education today?

Prior to heading to med school, if asked which person would feature most often in the early stages of British medical education I would probably have guessed at Galen, or possibly the PM or health minister, or perhaps a local medical hero. Here in Australia, I would have plumped for Victor Chang or Fred Hollows. Most other laypeople would probably give a similar response and name someone who made a significant contribution to the progress of medicine, someone who will control your future progress, or someone inspiring.

Following the Dean's ten minute introduction on Day 1 at my UK med school, the next academic to speak spent most of his allotted time standing in front of a full-screen picture of a bearded and bespectacled GP from northern England. This motif continued throughout my time there: the presence of Harold Shipman was never away from an ethics or "professional behaviours" lecture either implicitly, or indeed explicitly via a full screen picture and another re-telling of his terrible story. A high-level read around the subject of Modernising Medical Careers now reveals how often his example is invoked by those who set the educational agenda.

So far here in Australia the medical role (or anti-role) models encountered have conformed to my expectations. Whether it is because the medical school is saving the pleasures of "new" professionalism for a later date, whether they do not think that Shipman was such a problem, or whether they did not experience Shipman first hand and so do not acknowledge potential poisons in the Australian mud is hard to say.

There's a lot in the MMC approach to education which is long overdue and will, I think, improve the quality of med school product. However, I must say that it is refreshing to see the medical students being allowed to be inspired by medical practice before being clobbered repeatedly by the examples of practice gone awry.