MEDEV

School of Medical Sciences Education Development

Introduction

As part of a previous Subject Centre funded project on disabilities, we were introduced to the idea of limited licensure. This is the concept that disabled individuals are admitted to medical school but when they qualify will only be able to work in certain areas of medicine, depending upon the nature and degree of their disability. So, for instance, someone with poor fine hand coordination would not be allowed to do surgery but could do public health.

If one develops this idea then it may be possible to conceive that these individuals need not undertake all aspects of the undergraduate medical course. Further development of this theme leads one to consider that maybe medicine could be “deconstructed”. So if a student knew, on entry to medicine, that they wanted to do child psychiatry then the student would only be required to undertake study in those appropriate areas. Consequently in any one medical school some individuals who were uncertain of their final career choice would do the whole 4/5 year course whilst others would be doing certain “modules” only.

Using this novel approach one might conceive that shortages in patient care could be addressed. To many members of the profession this “deconstruction” of medicine would be an anathema. However, to a hard pressed government trying to meet the demands of a health conscious public it might be viewed as salvation.

The profession needs to openly debate this (and other areas) in a professional and transparent way or they may find themselves being reactive to government proposals rather then proactive to patients’ needs. Consequently issues like this need to be the subject of an inclusive debate amongst the rank and file of doctors as well as the great and the good. These areas are not often aired and when they are, the common format is a one day meeting in a distant large city. The individuals at the meeting tend to be enthusiasts with time to attend. Meetings like this are expensive, a one day meeting in London can cost £300 when rail and registration costs are added together.

As part of this project we proposed that we could provide a web based platform to facilitate debate on “deconstructing medicine”. This would take the form of video/audio presentations from representatives of bodies such as the General Medical Council, British Medical Association, Council of the Heads of Medical Schools and the Department of Health. Members of the profession and even possibly the public, will be able to access these comments and then subsequently to post their views and opinions on the website. However it is important that this does not become a free for all and consequently the rules for engagement will need to be carefully drawn up. It is planned that the website will be kept live for approximately three months after the start of the debate so that arguments are able to be developed. After that time the debate will be closed and a summary posted on the website for interest. The use of a number of experienced moderators is essential to facilitate this process.

Proposed outcomes

The debate will hopefully provoke innovative and creative thinking with respect to the future of medical education in a changing and challenging NHS, while the experienced gained from setting up this e-debating system could be used by others for similar discussions.

Progress so far

We have enlisted the support of an ecommunications expert – Gilly Salmon, author of numerous books on e-learning (such as “E-moderating: the key to teaching and learning online”) and director of ‘All Things in Moderation’ a web-based school of e-learning.

Three individuals have been trained in ‘e-debating for democracy’ and gained certification in this area. We have discussed the idea with key/influential medical organizations and individuals and had favourable responses. We are in negotiation with an influential international medical journal about hosting the website and are awaiting the outcome.

Where next?

We need to confirm the website host and then approach individuals to start the debate by agreeing to take part in a filmed interview. The interviews will then be streamed on the website and the debate open to include different medical groups. If you are interested in help or participating in the debate contact either t.e.roberts@leeds.ac.uk or k.a.m.boursicot@qmul.ac.uk