Is there a better alternative to special study modules?

Perhaps not, but there are weaknesses in the current system

In order to reduce factual overload, Tomorrow's Doctors attempted to define a core curriculum—the minimum level of knowledge and skills essential for practising medicine safely.1 It also introduced special study modules (SSMs), which allow students to study in depth areas that they are particularly interested in beyond the immediate requirements of the preregistration year. The core curriculum and special study modules are both compulsory, and should occupy about 70% and 30% of the entire medical course respectively. However, schools are allowed to decide the number and duration of special study modules.

What is the purpose of an SSM? According to Tomorrow's Doctors, it is to “promote a constant questioning and self-critical approach to medicine.” It aims to create diversity between medical schools and allows students to express their individuality. In the proposed update of Tomorrow's Doctors, research skills, self directed learning skills, problem solving skills, and presentation of your own work are highlighted. 2 Special study modules are not primarily intended to influence specialty choices.

Tomorrow's Doctors anticipated that the majority of the subjects actually studied in the SSMs would be directly related to medicine. I recently browsed through the SSMs offered by the medical schools and can confirm that this is indeed the case, with slightly more basic sciences than clinical topics. The proposed update of Tomorrow's Doctors further stipulated that at least two thirds of the modules undertaken by each student should be in the medically related fields, and it suggested that schools may require students to undertake at least one module from each of a number of subject groupings.

There have been a few innovative SSMs in the published literature which were well received by students. An SSM in medical informatics for the first year at Queen's University Belfast seemed to provide support for those students less confident in the use of information technology.3 The complementary and alternative medicine SSM in Southampton resulted in significant change in students' belief in medicine and approach to health care, 4 although its sustainability is doubtful due to uncertainty in funding.5 A similar complementary therapy course in Birmingham was also popular, with beneficial effects.6 There are also novel SSMs involving academic disciplines outside medicine: the art and medicine SSM at London medical schools involved students' production of their own artwork.7 At Glasgow, medical students and art students studied moral and political philosophy together for an SSM.8 Unfortunately, these innovative modules form only a small proportion of SSMs currently offered.

There are several weaknesses in the current system for SSMs. Firstly, medical schools differ in the proportion of the three types of SSMs: individual research projects, taught modules, and specialist clinical attachment experience. While some schools offer a healthy balance of the three types, others offer almost exclusively individual research projects. The latter approach tends to appeal mainly to the academically inclined students, 9 and the former approach may be better in addressing the educational needs of a wider spectrum of students.10 While research projects can be of great educational value, it is debatable whether students with interests mainly in hands.on clinical experience should be compelled to carry out several such projects. The recommendation in the proposed update of Tomorrow's Doctors that a range of projects should comprise a substantial component of the SSMs may well exacerbate this trend. The objectives for SSMs broadly duplicate those for the intercalated degrees, and it can be argued that intercalating or graduate students should be exempted from SSMs. In addition, the objectives for SSMs are largely transferable skills which could be acquired by studying subjects outside the traditional basic and clinical sciences disciplines. Application of other academic disciplines—for example, art, literature, law, philosophy, management—to medicine helps to broaden medical training, but medical teachers often do not have the necessary knowledge and skills to deliver such a curriculum. Experience of studying with students from other disciplines—for example, the humanities— would help students to appreciate and communicate with people from other disciplines and would avoid the tendency to an exclusively positivistic approach often adopted by doctors. A large number of SSMs run exclusively for medical students may not represent effective use of staff time and available resources. Finally, it is often difficult to carry out fair and robust assessment of SSMs given their widely different objectives each involving a small number of students.

Can we learn from other professions? Professional bodies responsible for law, teaching, and psychology have also defined their “core” curriculums, but students are free to complete their degrees by choosing any modules offered by their universities outside this core. While students may choose to complete the entire degree in their main subject, they are often encouraged to obtain hybrid degrees—law and languages, psychology and philosophy, etc—as long as they reach satisfactory academic standards overall. This helps students to develop their skills and acquire transferable skills in other areas, which may augment their professional roles later on in their career. There are no convincing reasons why medicine is any different, and this model may well help to overcome the current weaknesses of the system for SSMs.

Wai-Ching Leung, honorary lecturer in public health medicine, University of East Anglia
Email: w.c.leung@uea.ac.uk


studentBMJ 2002;10:1-44 February ISSN 0966-6494

1. General Medical Council. Tomorrow's doctors. London: GMC, 1993. www.gmc.uk.org/med_ed/medcd_frameset.htm (accessed 6 Nov 2001).
2. Catto G. Tomorrow's doctors—the next decade. studentBMJ 2001; 9:221. (July.)
3. McGlade KJ, McKeveney CJ, Crawford VLS, Brannigan P. Preparing tomorrow's doctors: the impact of a special study module in medical informatics. Medical Education 2001;35:62.7.
4. Owen D and Lewith GT. Complemetary and alternative medicine (CAM) in the undergraduate medical curriculum: the Southampton experience. Medical Education 2001;35:73.7.
5. Lewith GT, Owen D. Complementary medicine: the Southampton undergraduate experience. Complement Ther Med 2000;8:202.6.
6. Greenfield SM, Wearn AM, Hunton M, Innes MA. Considering the alter. natives: a special study module in complementary therapy. Complement Ther Med 2000;8:15.20.
7. Weller K, Lempp H. The visualization and modification of the body in art and medicine—how an innovative special study module explored the humanity of medicine. Medical Education 2000;34:947.58.
8. Downie R, Macnaughton J. Should medical students read Plato? Med J Aust 1999;170:125.7.
9. Mohammed A. Special study modules are not a waste of time. studentBMJ 2001;9:34. (February.)
10. Payne G, Thompson A, Flood C. Special study modules must be more diverse. studentBMJ 2000;8:468. (December.)