Surgery in the Undergraduate Curriculum

Irving Taylor
Professor of Surgery
Vice-Dean and Director of Clinical Studies
Royal Free and University College Medical School

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Surgery has traditionally played a major role in undergraduate teaching programmes and is often credited with providing some of the most memorable and influential teaching experiences for medical students. However GMC requirements ("Tomorrows Doctors" ) as well as quality assurance (QAA) appraisals and regular GMC inspections have resulted in the development of new curricula. The acquisition of generic skills and the appreciation of health and disease in the community is emphasised with up to 30% of all clinical teaching taking place in the community setting. Although a community based approach has some advantages in allowing students to emphasise with and appreciate the holistic problems that patients experience as part of the family or community unit, one nevertheless wonders (perhaps cynically) how much has been triggered by the inexorable reduction in the ability of many acute Trusts to provide the necessary resources to maintain a pre-eminent position as a provider of undergraduate medical education.

There is a danger, from the teaching perspective, that the surgical firm could diminish in importance due to factors such as over-specialisation, emphasis on day case or short stay patients, fewer academic surgical staff and increasing pressure on NHS consultants which could inhibit their desire to teach on a regular basis.

In order to ensure an appropriate "surgical" input into the curriculum and high quality clinical teaching, a number of principles must be recognised:

· History taking, examination and acquisition of communication skills can be taught on all surgical specialties eg vascular, urology, GI and cardiothoracic etc.
· Surgery per se is not taught, it is the principles of clinical methods carried out on patients with surgical disorders which is crucial in this regard.
· Consultants in all specialties must be provided with details of the core curriculum and encouraged to ensure that students achieve these objectives on their wards.
· Imaginative and innovative structural arrangements should be introduced so that students rotate between different specialties allowing attachments of a sufficient length of time to ensure continuity.
· All forms of teaching should be utilised to ensure appropriate implementation of the core curriculum - this includes bedside teaching, seminar and problem based learning techniques. The full range of audio visual technology should be made available.
· In the modern hospital environment facilities and resources need to be made available so that stress free teaching can take place in outpatients and day theatre.
· Students must see a full range of emergency admissions and receive education in trauma and the management of critically ill patients. This is best done during the surgical attachments.

Surgical departments should expect appropriate recognition from the medical school for high quality teaching. This should be emphasised at interview committees for Lecturer and Senior Lecturer posts with equal opportunities for teaching/active individuals as for research/active individuals. Perhaps it is now time for surgical teaching fellowships to be instituted.

Academic surgical departments can no longer abrogate or delegate their responsibilities for undergraduate teaching on the basis of excess workload and the lack of "brownie" points associated with high quality clinical teaching. If we wish to ensure that our medical students are exposed to important surgical dilemmas and a comprehensive range of surgical clinical problems then we must re-organise and re-think our strategy, even if this means a reduction in emphasis on basic research. An invigoration of clinical teaching programmes is now crucial.