Problem based learning, pleasant patients, and pub crawls

German medical student Alexander Quass decided to spend his clinical years in Manchester. Here he explains why he came over, and some of the good things about studying medicine in the United Kingdom that we might take for granted

Having spent a year in France at boarding school, a year in Italy for national service, and a year at a Harvard lab for research, I thought that the clinical year in Manchester could hardly impress me. Three years later, I'm still here and about to take on a house job at Manchester Royal Infirmary provided I don't fail miserably in my finals. How did it come to that?

Medicine at Manchester

Having done preclinical years in Berlin, I had a head full of basic medical knowledge waiting to be applied to actual patients. We had had some optional groups for problem based learning (PBL) in Germany, but they were organised by keen students and weren't part of the actual curriculum. In these, however, I realised how much easier it was to remember information if it was related to a case. Being a scholar of the German National Merit Foundation, which has good links with British universities, I applied for a year at Manchester University Medical School because the PBL course sounded good on its website.

When I started there, I did find the PBL groups very useful, but I found other aspects of the course were even more impressive: the small group sizes, the excellent care for the students by the undergraduate centre, and the hands on clinical work on the wards and in general practitioners' surgeries.

I was kindly given permission to stay until the end of the course and haven't regretted this decision for a single moment. I've found the friendly teaching environment in Manchester and the north west very motivating. In addition to that, I liked the diversity of the course. In the final year, for example, I started with an eight week teaching hospital attachment in Manchester, returned to Boston (Brigham's and Women's Hospital) for my elective, then spent two months in a district general hospital on the Isle of Man before returning to the Manchester area for eight weeks in general practice. In the practice, I was actually allowed us to see patients independently, which was a very useful experience.

When I compare the course here with the one in Germany, the only downside may be that there is less emphasis on theoretical textbook knowledge and basic medical science. Personally, however, I prefer to learn a good approach to a patient with, say, diarrhoea, then cramming 26 rare causes for it and forgetting them again after the next night out.

I was surprised how pleasant and supportive the vast majority of patients are. I vividly remember the elderly lady in the third year who said "try the other one" after three failed attempts of venepuncture on one arm, and the times I have heard the phrase "all the best for your career, doctor" are countless.

Impressions of the city

Even people from Manchester will admit that the first impression of the town is a bit depressing. It usually rains, the predominant colour is probably grey, and (especially German) visitors may note that it's not exactly the cleanest of places.

But after a while in Manchester one learns to appreciate the advantages of it: an international multiethnic population, an active cultural community, about 40 000 students, two major football teams, and a vibrant nightlife. In addition to that the image of the city is changing rapidly, partly because of the Commonwealth Games this year.

"A Kraut in England"

You could say that I did not live in England at the best time in its history. Several "crises" hit the country while I was here: the foot and mouth crisis and the petrol crisis; in addition, many people speak of "crises" of the transport and health systems. But at the same time, Britain was enjoying a good economy, a strong pound, good education (as shown in the Pisa study) and a 5-1 victory against Germany in football! As a German in England, I have to say that I am very thankful for the way I was treated during my time here so far. I have experienced strong anti-German feelings in many countries (and there are good historical reasons for it), but in England the rivalry was mainly limited to the football pitch. So when I saw Bayern Munich play at Old Trafford, people sitting next to me shouted: "Same old Germans--always cheating!" but at the next minute quite happily handed me their binoculars to have a better view of the game. And when I sat in the middle of some "hardcore" England supporters to watch David Beckham score the last minute goal against Greece (which put Germany in second place) I preferred to just cheer with them! After all, England deserved some revenge after we had beaten them so many times on penalties!

Student life

Watching football fortunately isn't the only pastime for a medical student in Manchester. I found that British medical students have a very active extracurricular life. I had a lot of fun playing hockey and being involved in the Marrow project, which recruits students as potential bone marrow donors. In addition, there seemed to be a party almost weekly, and the pub crawls in pyjamas, scrubs, or Christmas outfits are something that is completely unheard of in my home country (maybe it would be worth a try--German beer is quite tasty!).

I am not sure how much longer I will stay in Britain, but I know for sure that the (at least) four years have had a great impact on my medical and personal formation. I am grateful to have been given this opportunity.

Alex Quass, final year medical student, Manchester University
Email: alex-quaas@hotmail.com


studentBMJ 2002;10:215-258 July ISSN 0966-6494