Pre clerkship teaching: Are we missing an opportunity?
Before you read this article, close your eyes and reflect on medical school and that sentinel moment when you decided to pursue a career in anesthesiology. It is certainly easy to remember the influential mentors and coaches from residency, but after years in practice, try to recall that moment in undergraduate medicine when your career thoughts turned to this specialty and changed your life forever. In this month's issue of the Journal, Hamlin et al. report on their survey regarding the participation of Canadian departments of anesthesiology in undergraduate education. The authors focus their report on the pre clerkship curriculum and express their concern that the absolute volume of teaching to our year 1 and 2 medical students falls far below the ideal. The authors contend that we are jeopardizing the future of the specialty by failing to capture the early interest and imagination of the best and brightest students and, in so doing, that we are hindering the development of future educators, researchers, and leaders in our specialty. Critics will question the validity of the survey data by highlighting an incomplete return from every stakeholder. They may wonder whether the data truly accounted for all the interactions, or they may ask why our traditional role in one to one teaching during clerkship should be discounted. Indeed, many readers may experience the Kubler Ross stages of grief when reviewing this manuscript, namely, denial (there is no problem) anger (the data are wrong) bargaining (different metrics are needed) depression (it's harder for anesthesiology) and finally acceptance (a change needs to occur) In acceptance, our specialty will acknowledge that, while measuring and interpreting these data may be imperfect, they clearly put forward a signal for discussion. It is noteworthy that the present work is a follow up to the 2001 survey that first raised concern regarding our specialty's engagement in the undergraduate curriculum. Optimists will anchor themselves in the significant improvement in teaching hours per anesthesiologist compared with the previous survey. Pragmatists will argue that our specialty is unique in terms of service obligations, and therefore, the results are 'not that bad' So how important is a specialty's involvement in the undergraduate curriculum? What influence does exposure to a specialist have on the ultimate selection of a specialty career? Is 'not bad' the same as 'good enough' or should we be striving for 'better' and 'great' Clearly, these questions are complex, and it would be inappropriate to suggest that exposure is the single most important variable that contributes to career selection amongst medical students. What we do know is that most medical students move toward their preferred specialty well before their clerkship rotations. This should come as little surprise to recent graduates, as competition for preferred residency positions has become more intense. To compound this challenge, the application process for clerkship electives (still the best opportunity for medical students to be noticed for selection to a program) has become more standardized and centralized in recent years in order to improve fairness. The unintended consequence of this process is that medical students need to be even more certain about their elective requests well in advance of their clerkship years. Medical students are aligning themselves towards a V. N. Naik, MD, MEd, MBA, FRCPC Department of Anesthesiology and Pain Medicine, University of Ottawa, 1053 Carling Ave, Room AM 48, Ottawa, ON K1Y 4E9, Canada e mail: vnaik@toh.ca
Canadian Journal of Anesthesia/Journal canadien d'anesthesie