Making it matter

One of the most enjoyableaspects of refurbishing along-established medical

course is that a great deal ofaccreted curriculum content can bejettisoned to make room for morecontemporary materials andmethods. Unfortunately, it is eas-ier to graft on new content than itis to prune the old. Every tiny twigof teaching is held dear by at leastone person in the faculty, who willwarn of dire consequences if theirbit is not taught.

Really new ideas are rareenough that their arrival causes afrisson of excitement amongstthose who are redesigning thecurriculum. Even more exciting,however, are ideas that bring abrand new aspect to medicaleducation while also providing auseful service to the community.Educational activities that imme-diately lead to improved patientoutcomes are at the pinnacle ofwhat we are seeking to achieve.In Kirkpatrick’s well-known four-stage model,1 a medical coursethat achieves direct results forpatients (rather than just equip-ping students with knowledge,skills and attitudes to use in theworkplace) is to be celebrated.

So it is somewhat ironic thatone idea for clinical educationthat is gaining traction in Aus-tralia is neither particularly newnor anything much to do with themedical curriculum. It is the vol-unteer student-led clinic.

At this point, North Americanreaders will let out a snort ofderision. Student-led clinics arenothing new in the USA andCanada, with just over half of USmedical schools being associatedwith at least one of more than100 such clinics.2 In many cases,student-led clinics provide theonly services that disadvantagedgroups can afford. Studies areemerging that show patients whoattend these clinics do no worse –and in some cases do better –than others from similar disad-vantaged backgrounds, or eventhan those with health insurance,on some measures.3,4 Patients aresatisfied with the service thatthey receive,5 and students learnan enormous amount about in-terprofessional health care andhow it is delivered.6,7 Becausewhat they do actually matters.

Student-led clinics do notappear to be prevalent in the UK’s

NHS, although they may well havehad their origins in such compas-sionate ventures as Lettsom’s Gen-eral Dispensary in London’sAldersgate Street, or Sir AndrewDuncan’s people’s dispensary inEdinburgh in the 1770s.8 Thesedispensaries were driven byremarkable doctors, however,whereas today’s student-led clinicsare notable by their reliance on thestudents themselves to set themup, navigate the minefields ofindemnity insurance, recruitvolunteer supervisors and takefrontline responsibility formanaging patients. It is clearthat those involved in establishingastudent-ledclinic learnmanyvitalprofessional skills before the firstpatient even crosses the threshold.

Interprofessionalism isanother new concept in mostmedical curricula, and it strugglesto find purchase when taught inabstraction. Role-plays, simulatedemergencies and interprofessionalteam challenges are all worth-while learning activities, butnothing compares with actuallyworking in an interdisciplinaryteam of students that is directlyand solely responsible for a realpatient’s health care.

Editorial

� Blackwell Publishing Ltd 2011. THE CLINICAL TEACHER 2011; 8: 73–74 73

It is early days yet for theclinic that is forming inMelbourne, but I was struck by ane-mail from a newly qualifiednurse who is playing a leadershiprole in pulling it all together.

...from an interdisciplinarypractice perspective, I havefound that I have developeda greater awareness for thecommunication strategies Iuse with students of differ-ent disciplines, based ontheir professional and socialvalues, in order to achievethe various outcomes wedesire. This is a valuableskill for interdisciplinarypractice – and we haven’teven opened thedoors...yet!

Steve TrumbleEditor in Chief

REFERENCES

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ing. In: Craig RL (ed.) Training and

development handbook: A guide to

human resource development. New

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3. Ryskina KL, Meah YS, Thomas DC.

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run free clinic. J Health Care Poor

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4. Liberman KM, Meah YS, Chow A,

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Quality of Mental Health Care at a

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and Privately Insured Populations. J

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5. Ellett JD, Campbell JA, Gonsalves WC.

Patient satisfaction in a student-run

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Student-run health clinic: novel are-

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systems-based practice. Mt Sinai J

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74 � Blackwell Publishing Ltd 2011. THE CLINICAL TEACHER 2011; 8: 73–74