Content area
Full Text
ABSTRACT
The apprenticeship model, which forms the backbone of the current medical education system, has a strong historical precedent (and indeed multiple strengths). It is, however, important to acknowledge that its application to modern medicine is far from perfect, particularly with the breadth and complexity of current hospital systems. Demands on clinician resources, the sheer volume of knowledge our trainees must amass, short attachments and rigorous assessment schedules are all major challenges to a relatively simplistic educational system. Identifying and addressing these vulnerabilities is essential to enhancing the educational experiences of both undergraduate medical students and junior doctors.
Clinical medical education in New Zealand is based, essentially, on an apprenticeship framework. This model (which is applied to our undergraduate medical courses, the prevocational intern programme and vocational training schemes) undoubtedly has strengths: with the medical workforce as the ultimate destination, early immersion in the clinical environment enables the acquisition of practical and applied knowledge. The apprenticeship model sees the trainee become familiar early on with common medical problems and presentations; and facilitates their progress from observation through to participation, supervised execution and then independence. Progressive responsibility is conferred, but ongoing close clinical supervision safeguards patient safety and aims to further refine and develop the skill of the apprentice.1
The apprenticeship model also allows the student to become familiar with the culture, processes and expectations of the medical workforce. It enables them to become comfortable interacting with patients, and to model their own clinical behaviour on that of respected seniors. Professor Tim Wilkinson, in his 2013 reflections on medical education systems, deftly summarises the intent of modern, clinically-based, apprentice systems: "the major challenge of medical education is to integrate formal knowledge with clinical experience and to develop habits of inquiry and innovation. The gold standard of good medical education is where students learn the underlying theory and science of a problem at the same time as they encounter that problem in real life".2
For undergraduate medical students, patient contact is relatively structured and goals are often assessment-driven. The education provider is the responsible university, and there is no expectation of service delivery. After graduation, resident medical officers (RMOs) actively care for patients as part of a wider clinical team. Employed by district health boards (DHBs),...