LAUSR

We noted with interest the article by Bharamgoudar and Sonsale (2017) offering advice for medical students on ward-based learning. We recognize the value of their suggestions but feel that they do not adequately consider how the clinical environment has the largest impact on a student’s ability to learn effectively from their placement. We believe that current hospital environments are not conducive to learning. Students advised to “get involved” are unable to do so without a degree of guidance. In a system with few formalized teaching arrangements, the quality of teaching received on the ward is essentially pot-luck and is entirely dependent on the doctors present on the attachment. We disagree with the authors’ statement that there is a “multitude of healthcare professionals ... willing to aid medical students”. Every student could tell you about a doctor who went out of their way to show them how to put in a cannula or explain a pathology but these doctors stand out as the exception, venerated because they took the time to teach you something. A more common experience for medical students is to be ignored, to stand at the back of the ward round and to be made to feel like a nuisance when asking questions. It is important to note that this is generally not the fault of the doctors. There is, ultimately, no incentive for them to teach. They usually are not being paid extra and they do not get time out of their working days to do so. They are doctors struggling to meet the demands of their busy jobs who have medical students thrust upon them and it is a situation that frequently benefits no one. These attitudes can only have negative outcomes. They are a natural effect of the pressure on the NHS to save money and increase productivity – there is simply no time nor funding to properly teach students on the wards. It is a short-sighted outlook as poorer teaching leads to poorer doctors and worse patient outcomes. We feel that significant changes to incorporate teaching into the roles of doctors are required before students can truly make the most of their ward-based learning.