Medical Students in the Practice: A Perspective

Medical students are generally considered to be at the earliest stage of the medical career pathway [1]. In medicine, it is not just theoretical training but practical hands-on-work that makes a confident doctor [2-4]. Being a product of medical education system in the Kingdom of Saudi Arabia, I strongly feel that the existing shortcomings in the training of medical students cast a downward trend and need attention for the following reasons:

Many medical colleges and schools in the Kingdom leave their students in the clinic without assigning a supervisor: During clinical clerkship and internship, all efforts should be made to ensure that students get basic clinical principles right. It is of utmost importance that their work is supervised at this impressionable stage of their career. If these young impressionable minds imbibe improper techniques, it will be a larger effort to correct them. Although the intentions of the ruling institutions in opening new medical colleges are likely to be noble, they often fail to adequately address the shortage of good medical educators. Presence of good teachers form the backbone of any institution and good teachers can only be trained over a period of time and not ‘manufactured’ quickly on demand.

The number of students in each clinic may exceed the capacity of the room: The teacher to student ratio should be such that the student can get personal attention in the clinics and that the teacher is in a position to supervise students adequately. A smaller group of students will also benefit patients as they will feel more respected and will not have to get examined by a large number of medical students.  At the same time, it is also important that every student gets the ample opportunities to examine patients so that they can hone their clinical skills.

Many students lack the basic theoretical information which is required to practice clinical training: Before starting clinical clerkships, students should have mastered theoretical aspects of clinical examination so that they can comprehend the history and clinical findings based on which they can make a diagnosis. Different modalities available for the treatment of a disease should be known and the best treatment for common diseases should be known.

Students also lack good communication skills with patients: Students should be encouraged to learn the local language spoken by the patients and familiarize with the local culture. This will help in obtaining a correct history as well as in building rapport with patients.  It is also observed that confidence can be won when the patients can be spoken to in their own tongue and their culture values are respected.

Lack of the appropriate training like infection control guidelines and safety measures may subject the students to serious risks like getting HIV infection: Often senior residents show off by firing the glove like a rocket so that it reaches the bin. The consultants should set an example by disposing soiled materials in accordance with infection control guidelines. They should also demand that residents and students follow such guidelines. This would make it a habit for students only to discard in the appropriate bins and save them from preventable infections including AIDS.

The institution should ensure that students do not prescribe as they are not qualified medical doctors: No prescription should be entertained unless signed by a registered medical practitioner and the registration number of the medical council should be mandatory for the issuance of medicines [5].

Some patients may have concerns about the presence of students in the clinic which need to be addressed: While patients should be encouraged to allow medical students to examine them, if a patient refuses, his/her right to privacy should be respected.

On occasions, students may need psychological support as they may be exposed to new mental stresses such as seeing a dying patient or bleeding patients: Some of the students may develop Medical students’ disease which is a condition frequently reported in medical students, who perceive themselves or others to be experiencing the symptoms of the disease(s) they are studying [6].

In conclusion, the question remains as to how medical students are integrated into clinical service. Needs of medical students must be reviewed and policy and procedures should be established to make this period a memorable experience. Today medical students may be the learners but tomorrow they will be the leaders.

1. Williams RG, Klamen DL, Hoffman RM. Medical student acquisition of clinical working knowledge. Teach Learn Med 2008; 20:5-10.
2. Brennan N, Corrigan O, Allard J, Archer J, Barnes R, Bleakley A. The transition from medical student to junior doctor: today’s experiences of Tomorrow’s Doctors. Med Educ 2010; 44:449-58.
3. Helmich E, Bolhuis S, Laan R, Koopmans R. Early clinical experience: do students learn what we expect? Med Educ 2011; 45:731-40.
4. Vivekananda-Schmidt P, Crossley J. Student doctors taking responsibility. Clin Teach 2011; 8:267-71.
5. Smith SE, Tallentire VR, Cameron HS, Wood SM. Pre-prescribing: a safe way to learn at work? Clin Teach 2012; 9:45-9.
6. Hunter RC, Lohrenz JG, Schwartzman AE. Nosophobia and hypochondriasis in medical students. J Nerv Ment Dis 1964; 139:147-52.