Undergraduate medicine in Prague

Traditional didactic methods of teaching, like those still used in Prague, provide a solid foundation for the clinical years, thinks Jonathan Menon

Recently, I met up with friends from medical schools around the United Kingdom. A lively debate ensued about undergraduate medical education in the Czech Republic and the UK, both of which are members of the European Union.

I am a third year medical student at Charles University, Prague where medicine has been taught since 1348. The traditional six year course is made up of three years' preclinical sciences and three years' clinical subjects. My British friends were shocked that we studied basic sciences for a full three years before the clinical rotations. Anatomy, physiology, biochemistry, histology, embryology, genetics, and pathology are all covered in detail, and pharmacology is studied in years three and four. I was surprised that my friends in the UK had a much reduced exposure to basic sciences and that factual information was kept to a minimum to encourage the self directed learning process. Why this aversion to knowledge?

Does teacher know best?

In Prague, traditional courses adopt a didactic teaching approach that is frowned upon in the undergraduate curriculum in many, but not all, UK universities. This approach, however, provides a solid framework for the medical course in the formative years of the young undergraduate. Weekly seminars are held, which are interactive; students are encouraged to discuss problems, and learning opportunities are abundant. For seminars and practicals, attendance is mandatory and failure to attend may place you at a considerable disadvantage. Unsatisfactory attendance can lead to you being barred from taking exams. Self directed learning is encouraged and complements the traditional teaching methods. Anatomical dissections are a core part of the preclinical training and lectures are held in a grand amphitheatre, which epitomises the link between anatomy and clinical medicine. Dissection of the human body lasts for 18 months and finishes with an examination. Under the guidance of professors, some senior students are invited back to the anatomy department to help junior students. As a preclinical medical student I would have found it very difficult to fulfil my learning needs in basic clinical sciences solely by self directed learning.

Examinations

The examination format in Prague is also different. Examinations consist of a written, practical, and most importantly, an oral component. The belief is that if students are able to express basic clinical science problems to a professor in a pressured situation then they should in due course be able to explain clinical problems to patients. The oral examination is a random process, and usually three or four questions from a pool of 100 to 200 are selected by the student on the examination day. Within a few minutes students are expected to use their communication skills and answer the questions orally. Students in the UK may find this quite daunting in comparison to the objective structured clinical examination. The randomness of the examination system at Charles University reflects the randomness of clinical problems faced by doctors in any healthcare system. Interestingly, within certain limits medical students can choose when to take their examinations. Students plan many months in advance and sign up to examination dates online. This approach challenges the student's time management and organisational skills, including the ability to prioritise.

Extracurricular activities are encouraged

It is necessary during the course of the year to gain additional credits, which are necessary to progress to the next year of study. Extra credits are ascertained through medical activities such as additional anatomical dissections and teaching, and non-medical activities such as skiing and adventure courses. Physical education is compulsory in the preclinical years, and two hours each week are set aside for this in the scheduled timetable. There are many activities available to students, ranging from football and basketball to rowing on the Vltava river, and skiing. At the end of their second year, students must spend two weeks on the wards learning various practical skills and simple nursing procedures such as managing intravenous infusions, dressing surgical wounds, and managing catheters. Students are assessed by the nursing staff.

Czech the language

Studying abroad brings the responsibility and enjoyment of learning a new language and culture, and working in a different healthcare system. The Czech language has been described as impenetrable—try pronouncing “mám dobré zprávy,” which means, “I have good news.” There are three hours of compulsory Czech language a week in the preclinical years. Patient contact begins in the middle of the second year when we regularly take patient histories. Noticing the cultural changes comes with time. The excellent beer, by far the best cultural change, has led to the occasional missed lecture. Early starts are frequent, and many practical sessions begin at 7 30 am, which is particularly challenging when travelling to university by tram and metro in temperatures of minus 15ºC.

Knowledge is power

I am enjoying my medical education at Charles University and am well supported by the teaching staff. The fundamentals of basic clinical sciences are critical to understanding clinical medicine—imagine a musician performing in an orchestra without any knowledge of the instruments. Factual information is important in medicine and best acquired in the early undergraduate years. The information can then be used, improved upon, or discarded in latter years. Having very little or no information about basic medical sciences would make the interpretation of various investigations such as haematology tests, biochemistry tests, endocrine tests, and various radiological investigations difficult.

The General Medical Council clearly states that a doctor should provide a good standard of practice and care. In the context of informed consent it is imperative that doctors are able to provide patients with good quality information about clinical care in a way that patients understand. This should be underpinned by having a solid core of medical knowledge. Communication skills and empathy are clearly important, but if these skills are not backed up by knowledge it may lead to confusion and mistakes in patient care.

As they say in Prague, “No learned man has fallen from the sky.”

       

           

	LIFE Undergraduate medicine in Prague       Jonathan R Menon (July 2006)
	DAVID GWYNFOR SAMUEL (July 16th, 2006)       3rd year Medical student, Cardiff Unviersity welshsledge@hotmail.com
	I read with great interest the life review in July's sBMJ on medical education in Prague. It highlighted the similarities in educational experiences I have been fortunate to gain by studying at Cardiff University. We follow a traditional 5 year course where the majority of the first 2 years is focused on installing the basic sciences and anatomy. I feel highly privileged to have been able to complete a full body dissection over the 2 years which gave me an invaluable insight into the diversity and unique make up of the human body. While, the course was heavily laden with lectures, we also had the opportunity to complete a number of PBL style group assessments which developed the important skills of team work and communication skills. In addition, regular tutorials were held on specific teaching panels which allowed us to re-enforce our learning, where ideas with our peers, discuss more diverse topics with tutors and also reflect on our learning and identify areas of weakness. We also had exposure to the clinical environment from a very early stage and completed one day attachments in year 1, 2 weeks of foundation clinical skill training with a medical team and one weeks nursing experience in year 2, in addition to having the opportunity to experience further clinical attachments during SSC blocks. Our year 3 assessments also include OSCE examinations as well as communication skills assessments, in addition to written exams on each of our theoretical panels. I believe this structure is a perfect balance for ensuring that the medical knowledge of students is adequate before encountering clinical medicine on the wards as well as marinating the clinical elements of medicine and developing interpersonal skills. I have learned to work independently and, although the knowledge has been largely provided through lectures I feel I have the ability to study independently. The early clinical exposure has also helped develop the confidence of students at Cardiff and my friends now feel confident in approaching a patient and discussing their condition, even if we are not ready to accurately diagnose. A traditional style course can work in harmony with PBL style courses as the Prague system had shown and I feel my own experience at Cardiff reinforces this belief.

	LIFE Undergraduate medicine in Prague       Jonathan R Menon (July 2006)
	Rajasherkar.B (July 15th, 2006)       Senior Grade Lecturer,Department of Biochemistry,Melaka Manipal Medical Sciences, International Center for Health Sciences raorajashekar@rediffmail.com
	I do agree with Mr.Jonathan R Menon that traditional didactic lecture is one of the best modalities from which students learn the study objectives. But it has its own strengths and weakness .One of advantages of didactic lecture is that it can cover number of study objectives in a limited amount of time to large number of students. The weaknesses include, during didactic lecture student assumes a passive role and his interaction is limited. It also makes the students to memorize things as the informations are given in ready-made form. In today's competitive world to be a good medical practitioner, it is important that students should have good cognitive skills. One of the lacunae in the didactic lecture is that it does not in any way help the students to develop cognitive skills such as information gathering, information processing, correlation of topics, working memory, problem solving ability, assimilating concepts and deep processing skills. Keeping this in mind modern day educators are experimenting with different types of teaching techniques such Self Directed Learning (SDL), Problem based learning (PBL).These techniques have benefited students in many ways and at the same time they have their own set of disadvantages. So it can be said that a blend of traditional didactic lecture to teach the basics of the subjects and this is followed by other types of teaching methods such as SDL, PBL will go a long way in developing the cogitative skills of the students.