Special of the week; Issue 6-71

Emily you are the national educational radio network presents special of the week. The General Assembly of the United Nations has set aside 1970 as international education year and today a special program is devoted to an aspect of education of particular interest to doctors of tomorrow and their patients. The training of doctors and other medical personnel. In these international education your message Mr. Rennie Malou director general of your Nesco has pointed out that in many countries at the present time both the forms and the content of education are being seriously a challenge. Instead of indulging in the illusion that controversies and passions we eventually die down we shall do better to make a board the time to understand then grapple with the crisis a crisis in which we should Moreover

discern not so much the threat of unthinkable collapse as the premise of it much needed erroneous songs in today's program we hear from people who have already faced this crisis in a positive way and reorganize the medical schools of Newcastle and Nottingham universities. And later we should also hear from representatives of the developing countries about the particular problems that face them. To begin with then we have from Newcastle University Professor George smart to medical Dean Professor Martin Ross a psychiatrist and professor John Bercow whose field is community health and from Nottingham University professor Maurice Bakhit concerned particularly with the health of the community. Professor smart in the last 30 years or so the world has seen astonishingly rapid developments in most scientific fields. How has this affected doctors and those who are responsible for training them essentially before their time.

The medical curriculum of all the medical schools in this country was very similar indeed. And all schools have increasingly become dissatisfied. The reason is that the rate of a drop in some progress in medicine and the rate of acquisition of medical knowledge. Has become more and more rapid as time has gone on. Whereas 50 years ago if you trained someone as a doctor. The. Pattern of his activities would continue. Without a very great deal of training as for the rest of his professional life. Now however we can be certain of that. He will have to do entirely new things or he will have to grasp mentality of concepts and problems many times over during his professional life.

Therefore he has to be able to cope with this sort of change. So these undergraduate training. I must have as one of its main aims. The feeling that he must continue to keep abreast with the rapidly changing and progressing subject Professor worker with regard to your speciality community health. Do you feel that the training of doctors today is adequate. Well yes and no I think that in the scientific and chemical fields doctors are being trained now as never before that highly competent they're able to use many of the scientific tools which are now available. But if you ask me Are we able to do as much as we would in understanding the patient's emotional psychological and social needs. Are we doing as much as we ought to be in the field of preventive and social medicine the answer would be no. Medicine has naturally developed along

scientific lines with increasingly narrow specialists taking a more detailed look at that individual branches of medicine inevitably because they are so successful. The diseases with which they deal are becoming less common and they're being replaced by a whole range of new diseases over which medicine hasn't such immediate control. I think that because people are living longer there are more people with chronic degenerative diseases which are very important but don't excite doctors because by and large they can't be cured as many of the simpler and more acute diseases can that mental disease is now more obvious because the community at large expects to feel well instead of just surviving as they used to. That there are many problems that in fact are of our own creation. For example it's been estimated that one fifth of all the deaths in the United Kingdom are at least affected or influenced by the smoking of

cigarettes. On top of that we have a substantial number of deaths and an even larger number of. Injuries due to the way we drive on the road and so on are really the achievements of medicine are tremendous. But we've reached a point at which future achievements depend not so much on doctors alone but on the whole community on a lot of engineers and salary workers nurses physiotherapists teachers. Television Producers the whole range of improving medical care a future depends as much on other professions as it does on medicine. Professor Brackett How do you see the new trends in medical education today. If you're thinking right across the world then I suppose we can let ourselves go and say that the new trends in medical education can be seen as having two or three main parts. First the turning outwards of medical education from the hospital towards the communities and the community's needs

including the needs of rural populations. The second thing I suppose is to look at the old traditional structure of the subjects of medicine and say well the hell with it what does it matter let's put all these subjects together. So these two main trends looking out from the hospital and the integration of subjects I would say are the two big things that are happening across the world. And a subsidiary or rather a small aspect of that is the turning of medicine to the social sciences. And the third thing that we must do is to break down departmental barriers so that instead of having blocks of teaching Internet to me in physiology we have teaching in integrated wholes in themes and for example in this school here we hope to have early teaching in three main themes the themes would be first of all the cell. You know the biology of the cell. The second theme ma'am. The

biology of the individual. The third theme the community the biology of the community. And so you can think of it like this. You can say that as in the old days the student was forced to look at the anatomy and physiology of the individual. Today he is asked to do something else as well. He looks at the anatomy and physiology and of course the biochemistry and pathology of the individual. But he also looks at the anatomy and physiology and pathology of society of the community in which he's going to work and how the new methods of teaching be different. The needs. Of medicine have changed since traditional curricular started. Now how have they changed they have changed because there has been an increasing emphasis particularly on what we call scientific medicine. That is the application of scientific methods to every aspect of medical care.

Second there has been a quite fascinating increase in our understanding of the way society works and so the student must know about the behavioral sciences and must know about how the community works. After all he's going to be a community physician isn't me. How can a doctor but begin to treat his patients unless he knows what it's like for example to be a mynah in this part of the world one in eight of our population works down a mine in the coal fields. How important it is for a doctor not only to know about the biochemistry of respire disease but also to know about the economic significance to a mind of having respiratory disease. How does it alter his work. What kind of life does he live. What is his family like what is the housing like in which they live. These are all desperately important new aspects of medicine. I believe you are also incorporating family planning into your curriculum. What are the influences behind this. Until a very few years ago everybody but the doctors

believed that medicine had an impact on society. But really you know until a very short time ago medicine was pretty impotent couldn't do much for anybody except smile sweetly and lay hands on the patient and be sympathetic. But then medicine suddenly acquired an enormous amount of power. Antibiotic power drugs of various kinds great new surgical advances and so on. And one result of that is this fantastic explosion of the population. So we should explain this to our students show them the trends and then try to deal with the problems that arise from this population explosion. Nutrition. The problem of protein malnutrition and above all the problem of family planning and what emphasis do you lay on etiology the causes of disease. Nowadays in Britain something of the order of 60 percent of all mortal diseases that is all serious disease which is going to kill is too far advanced to be treated properly by the time that it is

diagnosed. Now the impact of that kind of statement is enormous on medicine. It means that the clinician is frustrated with it by the time he sees a cancer. By the time he sees cardiovascular disease it's too late. So most of our research and much of our teaching is concerned with how do you make early and better diagnosis. How do you alter the style of life the patterns of diet the smoking habits of this population. How do you alter all these things in a population. And what is the role of the doctor in this area. Professor Roth you are in charge of the psychiatric department at Newcastle and I think I'm right in saying that the psychological aspects of disease are given greater importance nowadays than used to be the case. There is. An increasing demand for care for purely psychological disturbances in medicine today. In F1 societies people are less prepared to put up with emotional discomfort but severe

unhappiness and they have been in the past so neuroses present. In medical practice to increasing extent. Of course we have a very large burden of more serious forms of mental disorder. Now the second reason why psychological aspects of myths loom so large today is that more and more of the disorders with which the Doctor in all branches myths and deals are not just acute episodes of illness but chronic disturbances which make demands upon the individual's powers of and jordans the individual's emotional resources to deal with handicap with long term disability. Take some examples. Coronary thrombosis. High blood pressure cancer. To live with these disorders that demands emotional resources and some people of course become emotionally disturbed. Now the third group of reasons for the importance of the psychological aspect is that we are becoming increasingly aware of a whole

range of problems that are of importance both for mits and society. Suicide attempted suicide. The link Quincy drug addiction alcoholism or other forms of dependence. Accidents on the road have a very important psychological aspect. For example they are linked both with alcohol consumption on the one hand and to some extent with antisocial behavior on the other. These are impinging to an increasing extent upon the medical field and anybody who came to work in contemporary medicine must be well informed. On all these matters. Have you abolished the traditional subjects of the study programme at Newcastle. Professor smart I don't know about being a totally abolished but they've certainly been cut down from topographical anatomy much less time spent on top of graphic anatomy they have other aspects of anatomy and of course it's very important that they should have some aspects of anatomy. But this is been decreased. In

fact it's very difficult to be precise in our curriculum because when you come to the clinical stages. We don't in fact have separate courses of lectures in the different subjects. We have no lectures in internal medicine or in surgery or media tricks or psychiatry but they're all run together so that this is what I mean by training people to solve medical problems. When we have a course of instruction. Theoretical course of instruction on. Saving a responder Trist system. Physicians surgeons physiologists anatomists pediatricians psychiatric nurse everybody and Community Medicine people all join in at appropriate points in developing the understanding of diseases of the respective system. PROFESSOR ROSS What part does psychology play in the training of the general physician today. I believe that every general physician and every specialist ought to be

trained in psychiatry both theoretically and by practical experience in psychiatric wards. I believe also that every physician should have some knowledge of behavioral science that is of disciplines of psychology and sociology and adjacent disciplines. Because wherever he goes when he goes into pediatrics or he goes to cardiology or the endocrine disease he will every day in his practice find people. Who are emotionally disturbed. Some of these. Have psychological disturbance as their primary complaint. In other cases the psychological disturbance is secondary to the physical illness perhaps but nonetheless a very important phenomenon for him to understand and to be able to help with and I imagine that most of the cases of mental disease the practitioner meets are not in the psychiatric ward. The simpler cases

are encountered in everyday family practice to an increasing extent. Estimates vary from 15 to 40 percent of the proportion of family practice that's constituted by psychological disturbance. Some of these disturbances are far from mild or simple. A substantial proportion of them are the early manifestations of more serious disturbances at a later stage or the manifestations of serious disharmony in the family which he has to take note of. He must not wait until a stage in the development of emotional disturbance which even the policeman can recognise as dangerous he must be able to detect the more subtle early warning signals of more serious matter just mental emotional difficulty. Professor Bakit May I now ask you to sum up and tell us what sort of doctor you are knotting and other teachers elsewhere hoping to produce in future as a result of this reformation in medical education.

Will you be a specialist a general practitioner or what all medical teachers or people interested in medical education have a different idea about what it is that they seek. Now my own feeling is that we must sweep the slate clean and we must get a new idea based upon the needs of our populations rather than on any preconceived notions about what a doctor should be. And so when you ask me that I give you a personal answer. What I want in a doctor is a man who can appreciate needs who is skilled in measuring needs who knows about how to meet the needs of populations whether these be in the Far East or in Latin America or in Britain. He has to know about population needs and demands as well of course. But if you ask some of my more traditional colleagues what they want they talk about a doctor who is potentially

a medical scientist a man who above all can use the new techniques of medicine. In his clinical work. I would like to add to that the third dimension. The notion of a man who understands the society in which he lives understands the families of his patients understands the psychological and the community aspect of his work as well as he does the biochemistry professor Bakhit has just referred to the necessity for doctors to meet the needs of population in whichever part of the world they practice. And of course the problems in Europe are very different from those in areas where the shortage of doctors will remain acute for a long time to come. Dr Alfred Quinn I'm w a regional director for Africa estimates that even by the year 2000 64 percent of the population in his area will still have less than the minimum level of coverage. The only solution he says is to innovate. Professor why he. You are director

general of the Indian Council of Medical Research in New Delhi and in India too you are faced with a severe shortage of personnel. What form does medical education take in your country and what steps will you be taking to innovate the medical education in our country is based to by and large on British Medical Petron and to my mind this is not boost your time and village. It has not permitted flexibility to adopt to the changing pattern of society. So why the society is changing. Medical Education is 20. We have adopted some reforms. We have shortened the course. We have introduced a compulsory internship system. We have adopted an indicated approach to training and really a great emphasis on preventive and social medicine. We are taking the steps do not as the scope of clinical training from the warden the outpatients of a teaching hospital to pedophile services

and this is specially necessary to enable the student to. Be directly involved in the community health care program with the hope that this approach would provide him with the necessary motivation to serve as a little community. Developing countries should refrain from adopting the pattern which are foreign to other cultures and each sized city must prepare out a blueprint for its own people. The doctor alone today cannot to meet the health needs of an issue mainly due to the shortage of medical men power both in developed and developing countries. Training of as their personnel is one way by which you can meet the growing demand because they would give this necessity support to the fully trained staff and even replace them if necessary in simple functions which could be delegated to them. It is essential that the various health personnel doctors nurses public health engineers should work as a team. With

the medical man as a team leader and this cooperative approach to the provision of health care is the only way really sure satisfactorily the health care program. The time has come when we should create faculties of Health Sciences and replace the traditional faculties of medicine. Today a faculty of medicine which trains the doctor should in future trade all the medical paramedical in all survivors are you sure a team approach to the communities had problems. Thank you Professor while he and now finally we have Professor G alimony Coso director of the University Center for Health Sciences at Yale and the common room. Your problems in Cameroon are much the same I think Professor Monaco so as regards the training of auxiliary personnel and the necessity to prepare most medical workers for jobs in rural areas. It is true that many faculties of medicine especially in Africa already undertake in addition to the training of doctors. The training of various other types of health

personnel. But this has generally been done. Each group you know solution even though they might be on the same campus and this in hospital. The objective of the new concept is to design training programs so that the specific skills of each member of the team is clearly defined in advance. Then that course is docketed as much as possible so that they would have the best courses in common. Depending on the level of education and attainment. Finally they are brought up together within this environment and in the practical assignments in the field especially different members of the team work as students together so they learn together so that when eventually they qualify and they work in the public service they would not be strangers to each other. They would understand and respect each other's objectives and aspirations. And with regard to doctors in particular how do I am training towards the particular needs of your country.

They would be trained on this but given a good fundamental scientific education. A very practical clinical training so that they can undertake it wide range of skills which medical graduates in advanced countries. Do not require to have since they have a large number of specialists at that disposal. They would learn the details of exactly what one does in a rural area to improve sanitation nutrition modern child care etc. and also to supervise and work with other members of the health team likenesses have technicians leveraging technicians and various other isolated president. The objective of that training will be in this context for them to be leaders of such multi purpose health teams which would work not only in the city but also beyond the city. And finally they would be oriented in such a manner that we hope that they would wish to work in the rural areas

for at least a good part of their professional life. Thank you Professor moniker so and so we come to the end of this special program devoted to new trends in medical education and training which are enabling the doctors of tomorrow to develop an attitude to medicine which is a blend of the scientific and humanitarian to understand better the effects of environment on health and to appreciate the responsibility of that profession not only for the Cure but also for the prevention of disease. This is the national educational radio network.