Helen Salisbury: Mind the training gap
The BMJ (British Medical Journal)
Learning to be a good doctor is a complicated business, one that doesn't end until the day we retire. As well as understanding how bodies work and go wrong, and what can be done to put them right, we also need to learn many practical skills-how to listen so that patients feel heard, how to examine an abdomen or stitch a wound. While some of this knowledge is found in books or delivered in formal teaching sessions, a huge amount of medical training remains an apprenticeship where we learn from
... ere we learn from others who already know how to do it. The problem I currently face is the gap between what I'm trying to teach and the experiences of the people I'm teaching. We're training our juniors in the skills we value: how to listen with full attention, how to sensitively inquire about psychosocial details that may influence a patient's presentation. It's only after gaining the trust of the slightly aggressive man with high blood-pressure and a fractured metacarpal that we might hear about the disintegrating marriage, the precarious employment, and the use of alcohol as respite. Once we know this, we may be able to offer more help than a sick certificate and blood pressure pills. But when do we get a chance to model these skills? And more crucially, beyond the protected 20 minute consultations of the training period, when will our juniors get to use them? During an event on shared decision making, some despairing junior doctors described how the skills they'd enthusiastically learnt as students, and practised through role play, were now atrophying. Nowhere in their hospital had they seen the theory put into practice, and they were reluctantly concluding that little of it was applicable to the real world.