Special study modules are the most tantalising, intriguing, and occasionally disappointing part of a medical school's curriculum. As Peter Cross discovers, you can expect totally different placements in different schools

What are special study modules (SSMs) and how can you get the best out of this part of the medical student timetable? In 1992, the UK General Medical Council produced a historic document called Tomorrow's Doctors.¹ It recommended that students should be allowed to follow their own interests beyond the core curriculum, and so SSMs were born. Since then they have become part of the furniture of the medical course and have really taken hold.

Nationwide, the range of courses is mouthwatering. But how, for example, do you decide between a placement with a maxillofacial surgery team or a specialist infectious diseases unit? And would you get either if you applied? Eleven medical students from around the United Kingdom filled me in.

SSMs offered include courses on health care for refugees, medicine and the police, medicine in the classical world, dermatology in Denmark, sports medicine, and autopsy and histopathological correlation. At one London school, medical students can take themselves off to the Slade School of Art for life drawing classes.

Popular choices get snapped up quickly, but really resourceful students design their own. Do it yourself SSMs include a course in Arabic and a different student researched the needs of sex workers with drug addiction.

Most students seem to think that SSMs are a good thing, but many have reservations. Some feel that excessive time spent in this type of learning could be detrimental to core subjects, nuts and bolts teaching, and clinical experience that will make medical students competent doctors.

The scope of SSMs

Joanna Clark from Nottingham has just finished her fourth year. "Nottingham is part of the IFMSA [International Federation of Medical Students' Associations; www.ifmsa.org] international exchange programme. This allows 20 to 30 students each year to complete a clinical attachment in a range of European countries--for example Malta, Italy, Estonia, and Germany. This costs the student £150 (S242; ¤213) and they must provide their room for the exchange student while they are away. Places are drawn out of a hat but in practice roughly the right number of students usually apply. Unlike electives, students are not free to arrange their own placements unless they wish to study a subject not covered by the choices available. A student wishing to study diving medicine would have to arrange a placement in a specialist centre elsewhere, and gain permission from the undergraduate associate dean."

THE KOBAL COLLECTION

Subjects can be as esoteric as drawing classes

First choice

Selecting SSMs can be a scramble for exotic choices as Brenda Manoharan, third year student at Barts and the London recalls, "There was an SSM about emergency medicine, which included opportunities to see HEMS [helicopter emergency medical service], our air ambulance and also being part of the rapid response team. This resulted in most of the year putting this down as their first choice, but ultimately only a few randomly selected individuals got this choice."

Brenda was placed in an SSM she had not chosen, " It was a microbiology SSM," she recalls, "And I hate lab work. I was stuck in a lab for two weeks with an exam at the end. I knew from that moment I would never become a microbiologist."

Some medical schools have introduced web based selection to make allocation to SSMs fairer: "Personally I think the web based system is ridiculous," says Claire Bairsto at Newcastle, "I understand it would be a nightmare to have everyone bidding for different options. But it seems unfair that places on courses are decided on how quickly candidates click a mouse." Newcastle medical school estimates 95% of students get their first or second choices by their web system. Claire did not get either of her first or second choices nor did many of her friends. Maybe they are the unlucky 5%.

How are SSMs assessed?

At Barts and the London, tutors decide the mode of SSM assessment, explains Brenda Manoharan, "There are many ways to assess including an essay of 2000 words, an oral presentation, poster presentation, work book, or written examination. Attendance is also taken into account."

"In Nottingham," says Joanna Clark, "assessment varies, and this is detailed in our placements catalogue. Most consultants require case presentations, rarely a project. In order to pass, good attendance is expected. To pass an SSM abroad, students must obtain confirmation of attendance from the consultant and write up an attachment report."

"SSMs have very arbitrary mark schemes," says Guys, King's, and St Thomas's student, Bella Dave, "Sometimes marks are given for attendance while others are marked purely on essays and presentations, although attendance is also compulsory."

Vittal Katikireddi, a fourth year student from the University of Edinburgh, explains a novel method of peer assessment, "The finished product that the group produces is marked by examiners, but these marks are often modified by peer marking. Each student assesses their colleague's contribution. Those who have given more than most have their mark boosted, and vice versa."

R G WILLIAMSON/REX

SSMs can be like a lottery

Special interests

Charlotte Allan, third year student at Leeds, was able to pursue her interest in sexual health. "I did SSMs on sexual health and drug use, an ethics project based on domestic violence, and for my year three summer SSM I am doing a project on HIV and asylum seekers that I designed myself." Charlotte feels designing a project from scratch has helped her acquire new skills.

Vittal Katikireddi had a particularly enjoyable fourth year SSM. "I was carrying out research about health care for refugees with the professor of public health and Lothian Health Board," he says, "It gave me a very different view of health care from the clinical experience we normally get."

How much of the curriculum should be devoted to SSMs?

The GMC recommends that 35% of a medical student's curriculum should be spent pursuing SSMs. Is this too much or too little? Bella Dave has strong views: "Personally, I feel that this is way too much. Learning stuff on the wards is more important. Learning how to function as a doctor instead of spending a stupid amount of time writing an essay on the molecular genetics of some rare and obscure disease which you are probably never going to see."

"I think the GMC is being a little too generous," agrees Brenda Manoharan, "We need to be certain of our core subjects before we delve into the specialties of specialties."

Charlotte Allan disagrees: "I remember very little of the factual knowledge taught through anatomy or biochemistry, but have learnt useful skills in SSMs for my future career. Using a large amount of time to work independently on projects has helped me develop 'thinking' skills rather than cramming in facts."

"I think it would be great as long as there was an effective and fair system for assessment," says Claire Bairsto. "And some way of making sure that everyone was getting the basics."

Things I wish I knew before I picked my first SSM

"Think about how much work you want to do and chose accordingly," advises Charlotte Allan, "And only write down choices of projects you would like to do."

"If you are passionate about something, arrange your SSM so you can study it and get hands on experience," says Brenda Manoharan. "However tempting it is to just write an essay in one day and then take two weeks off may seem, try and get yourself somewhere you can learn and also enjoy new aspects of medicine."

Deborah Cohen, finalist at Manchester, has advice for students embarking on SSMs: "Do something you enjoy and feel that would really contribute to your education. Don't be put off by faculty members who try to stop you doing something you really want to do, rather explain to them your standpoint and don't give up. If you have other interests, such as a language or literature or medical engineering or anthropology, try to find a tutor who will support you. It's a golden opportunity to enjoy yourself and learn or develop skills. Don't waste it."

Top tips

• Start early
• Read information carefully; email tutors to clarify
• Think about how much time you want to or can give a placement
• Only request choices you want
• Do not be put off by people attempting to stop you doing what you want
• Do something that you will enjoy, that will also further your medical education
• Find a tutor who shares your special interest
• Do something original
• Go into an SSM with an open mind
• Do not be disheartened, your fifth choice could be just as rewarding