Introduction

In recent years, medical schools have been faced with tremendous educational challenges caused by rapid changes in the healthcare scene. With the explosion of medical information and advances in medical technology, medical students are now expected to acquire large amounts of knowledge and skills. In addition, owing to increased affluence and the universal availability of medical information on the Internet, today’s patients are better informed about their illnesses and tend to have higher expectations of their doctor’s ability to advise them appropriately. Given such an environment, we, as medical educators, have to ensure that our medical graduates not only acquire the requisite knowledge and skills to have a sound scientific basis to practise medicine, but our students must also acquire the ability to communicate well with their patients and colleagues, and develop appropriate professional attitudes and ethical principles.

Educational Outcomes of Learning

For almost 100 years, our medical school has been producing highly competent doctors. Our graduates are recognised by the General Medical Council of the United Kingdom for full registration. They have done extremely well whenever they go overseas for specialty training, thus earning international recognition for our high standard of undergraduate and postgraduate medical education.

Although we are recognised internationally, traditional medical education has focused mostly on the development of cognitive and psychomotor skills to ensure that the end product is a technically competent doctor equipped with the desired knowledge and skills to practise medicine. Today, the ‘complete doctor’ needs to have more skills to be able to relate well to his/her patients. The educational outcomes of learning as applied to medical education can be classified within three learning domains:

• Cognitive (knowing) domain: Focusing on knowledge acquisition and intellectual skills and abilities (e.g. the diagnosis of disease, strategising treatment options).

• Psychomotor (doing) domain: Relating to skills that require varying levels of well-coordinated physical activity and precise manipulative procedures (e.g. simple suturing of an open wound, performing an endoscopic examination, performing sophisticated surgical procedures).

• Affective (feeling) domain: Dealing with feelings, emotions, mindsets and values, including the nurturing of desirable attitudes for personal and professional development (e.g. allaying the concerns and fears of patients, displaying empathy for the relatives of a patient who has just died, displaying mutual trust and respect in working with members of the healthcare team, upholding high ethical standards in practice).

Changing Needs and Changing Paradigms

In this digital era of information explosion and rapid advances in medical sciences and medical technology, it is imperative for medical educators to reappraise and to review the undergraduate medical curriculum to match the changing educational paradigms. The traditional role of the medical teacher as the ‘sage-in-centre stage’ and as the ‘fountain of knowledge’ who simply transmits much factual information through abundant lectures is no longer tenable.

“Today, imaging techniques, colour reproduction, cheap printing, computer simulations, video-taping, computer databases, and Internet facilities provide students with excellent opportunities to learn without requiring a teacher to transmit the available information. Students may no longer rely on a teacher’s knowledge as the main source of information.” (Bohuijs, 1998)

The medical teacher now needs to take on additional roles; he/she has to be the designer and manager of the learning environment who facilitates, guides and optimises student learning through nurturing the intellectual and learning process.

“An academic who only presents facts is not a teacher; a teacher is one who nurtures the learning process and thereby modifies behavior and patterns of thinking for a lifetime.” (Woosley, 1997)

Thus, the educational paradigm needs to shift from highly teacher-centred instruction to student-centred learning. Such a shift would require students to take on greater initiative and responsibility to direct and to manage their own learning as well as their educational, personal and professional development. This poses a major challenge to medical teachers to ensure that the desired student attitudes and mindsets to learning are nurtured and developed during the educational preparation of students in medical school. Thus, medical education today needs to foster and nurture the development of self-directed learning skills that will lay the foundation for students to want to engage in life-long continuing self-education so essential to medical practice, especially in this millennium.

Communication, Professionalism and Ethics

“Attitudes of mind and of behaviour that befit a doctor should be inculcated, and should imbue the new graduate with attributes appropriate to his/her future responsibilities to patients, colleagues and society in general.” (General Medical Council, U.K., 1993)

The nature of doctors’ work and their work environment requires them to interact closely with members of the healthcare team and their patients. Since patients today are better educated and are generally more informed about diseases and health matters through the Internet, the dynamics of the doctor-patient relationship has therefore changed. Patients now expect, and may even demand to know more about their sickness, the treatment options available and costs involved. In other words, there is now an even greater need for doctors to be able to effectively communicate with and display a much more caring attitude in the management of their patients. A commentary in the May 2001 issue of the Alumni Newsletter clearly highlights this point:

“As medical students, we are taught and taught a voluminous amount of knowledge that has been acquired through the practice of medicine. We learn all this and we think that we are now well equipped to pass examinations and to proceed to practice as physicians, dental surgeons and pharmacists. But what we need most as practitioners of our profession is communication, and this is never taught to us. …We learn to communicate better with our patients with the passing of time and our patients appreciate us better as we communicate and explain to them their medical and dental problems and purpose and function of the drugs in their prescription. The problems faced with in the practice of medicine are often related to the lack of communication between the doctor and his patient. This lack of communication often is the cause of misunderstanding that could lead to unnecessary litigation.”

In the educational preparation of medical students then, it has become more important to ensure that students acquire skills required for their professional development. It is also crucial that the students practise dealing with more demanding patients and learn to communicate better when interacting with members of the healthcare team. Medical education today must therefore foster the development of interpersonal, communication and teamwork skills that are essential for doctors to earn the trust, respect and cooperation of patients and members of the healthcare team.

Recent advances in medical knowledge and the increasing interest in biomedical research has brought about new challenges to the doctor. It is now extremely important for doctors to have a good working knowledge of medical ethics as well, so that the patients’ rights can be protected and their safety ensured in the clinical setting.

Conclusion

In the educational preparation of today’s medical students to become competent and caring doctors of tomorrow, the quality of medical education that we provide needs to ensure that the end-products (graduates) of our education acquire not only the desired knowledge and psychomotor skills required of a technically competent practitioner, but also the desired attitudes and mindsets to learning. In addition, our graduates are expected to show a more caring attitude in their patient management and interaction with members of the healthcare team. For this reason, enhancing learning is the affective (feeling)—yet another testimony to our continued quest in promoting professionalism and excellence in medical education in our medical school domain, is now a significant feature of our recently revised undergraduate medical curriculum.

References

Bohuijs, P.A.J. (1998). ‘The Teacher and Self-directed Learners’ in Medical Education in the Millennium, Jolly, B. & Rees, L. (Ed.). New York: Oxford University Press. pp. 192–198.

General Medical Council, U.K., (1993): Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education. (http://www.gmc-uk.org/med_ed/tomdoc.htm). (Last Accessed: 29 April 2003).

Woosley, R.L. (1997). ‘Foreword’ in Integrated Pharmacology. Page C.P. et al. (Ed.). London: Mosby. pp iii.

‘Communication’ in Alumni Newsletter. May 2001, pp. 1.