The effects of Southampton’s community experiences on student learningt

K e y \vo r d s : ’I ‘eachi n g / * methods ; C:o ni - inunity niedicine/*educ; Students, medical/*psychol; “Attitude of health per- sonnel; *Education, medical. undergradu- ate; Corninunity-institutional relations; Schools, medical; Curriculum; England

Introduction

The medical education unit a t the Uni- vcrsitv of h u t h a n i p t o n monitor5 the cur- riculum and \ve n o w have J reasonably clear picture of the effects courses have on students’ learning (Coles, 1984a). but what d o our findings say about the influence of the community experiences and what con- tribution d o thcy make to the develop- ment of the curriculum?

Early Medical Contact

I have decided to concentrate here on Early Medical Contact (EMC)-students’ experiences in the very first year of the curriculum of the health-care needs of the seciety for which they are being trained- on the face of it an ideal foundation for a medical course. We carried out an inten- sive survey o f this, going on visits, inter-

t P y w i t c d at the Oslo Conterence ot- tht. Associa- tion tor Medical Education in Europc, 1+1 I Septeni- her 1984.

C:orrrspondence: Mr (1. 11. Colrs. Ikpr t r i ien t o i Medicdl Ediicdtioii, Facultv of Medicine, South Block, Southarnpton <;encrdl Hospital. Trcmoiia Road. Sourlidnipton SO!, 4XY. England.

viewing students not just a t the time but again as a follow-up in their third and fifth years.

At the outset let m e say that the vast majority of students found E M C a very agreeable experience. Seventy-five per cent said it \vas perhaps the most enjoyable part of the first year. One said ‘It \vas lovely. I really enjoyed it . Getting out and ineeting people. You realize that this was the course yo11 came to d o in the first place’. Another said, ‘It made you realize that’s why you were doing niedicine’.

Yet, for many students even their en- joyment \vas limited. O n e said ‘It’s light relief in a way. When you’re bogged down with all those lectures i t \vas a very good thing to have’. Another said ‘It’s a pity that all your work couldn’t be head- ing that way’.

One student summed up the feelings of many by describing it as a kind of oasis, which, of course, tells us something about E M C , but i t tells us even more about the rest of the curriculum a t thdt time. If E M C is the oasis, the rest o f the curricu- lum is a desert! Another student added, ‘The \vhole of the first year is so detached from \That you thought had to d o \vith bcing a doctor. With EMC you don’t learn much but it brings you more in touch \vith what you will be doing in a few years time.’

These. then, were the comments of the 75% of students who enjoyed E M C but what of the remaining 25%? They were

Commirni ty rxpeviencer and student leawing I97

disappointed. Some said that the amount of time devoted to it was less than they had expected. One said ‘It’s not what I thought it would be’. Indeed, when these same students were interviewed a t the end of year five.and asked to reflect on the first year, not one of them even mentioned EMC.

Some students even seemed to resent the time spent going out on visits. One said, ‘It got in the way of doing my anatomy’. In fact, it was quite common for students to say that EMC was not relevant and to be sceptical about its place in the first year. This surprised us. What could be more relevant? Looking into this further it soon became clear that students were using the term ‘relevant’ in two quite different ways. In one respect they felt that EMC was undoubtedly relevant to being a doctor but, on the other hand, it seemed totally irrelevant to being a medical stu- dent. That required sitting in lectures, taking notes, reading books, learning it all up and passing examinations. So EMC was relevant for the future but not for the present.

Effects on student learning of community experience

I t seems, then, that for the planners of undergraduate curricula, community ex- perience may have three functions:

( I ) i t can give students some insights into being a doctor;

(2) it can give students an introduction to being with patients; and

(3) it can give students a basis for learning what they need to learn in the early years-a framework for understand- ing the sciences and social sciences that underpin medical practice.

Our experience is that EMC niay be achieving the first two functions reason- ably well, but the third-providing a basis €or learning the theory being taught- leaves a great deal to be desired. In fact, our students do not see EMC as making any contribution to understanding the theoretical teaching, indeed they see it as

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being quite separate. As one student put it, ‘It’s like being at two medical schools, one is sitting in lectures, the other is seeing patients’. The sad fact is that the first of these-sitting in lectures-is the one that assumes the greatest importance for stu- dents.

Early on in the traditional medical curri- culum we present students with a lot of factual information without making clear the kinds of situations for which this information is required and students have no alternative but to learn it all by rote, with all the disastrous consequences that we know follow from this. However, we now know that if we provide students with some relevant, concrete experience prior to the theoretical teaching then they are more likely to be in a position to understand what they are learning-they can process the information (Mayer, 1979a). To learn meaningfully we must attach new information to something we already know-we need what some psychologists call an assimilative context (Mayer, 1 ~ 7 9 b ) or advance organizer (Au- subel et a / . , 1978), and community experi- ences would seem ideal. Unfortunately, our EMC scheme does not seem to do this. But why? Finding an answer may help others contemplating something similar. We feel that there is now strong support, both professionally and educa- tionally, for basing an undergraduate medical course on the health-care needs of one’s society (Fulop, 1983). I would add that community experiences can also pro- vide the assimilative context students need to understand what they are being taught (Coles, 1984b). But I would also add that great care is needed before introducing community experiences into an otherwise traditional course. In particular, we feel that three points require careful considera- tion:

( I ) Community experience needs to be given sufficient weight and importance in the curriculum, and this means devoting to it much more timetabled time than a t present. And there is a need for greater continuity-it should not just happen on a

few occasions early on but continue throughout the whole of the curriculum.

(2) Communi ty experiences need to be deliberately and carefully planned in con- junction with the theoretical teaching, and the theoretical part o f the curriculum should also be planned in relation to students' community experiences.

(3) The curriculum should provide stu- dents with opportunities to relate the theory they are being taught and their community experiences. And this relating also needs to be deliberately and carefully planned.

Conclusions

So, what of the future! I believe w e should not only be describing curricula as being traditional or innovative, problem based or patient centred, nor saying by h o w much they are community oriented. Ilather w e should be seeing whether or nor a curriculum enables students to learn what we want them to learn in a way w e want them to learn it. O u r experience in Southampton is that there is a real danger in 'grafting on' community experiences to a n otherwise traditional curriculuni: likc organ transplants in medicine, this 'graft- ing on' can result in tissue-rejection. If conirnunity expcricnces are not substantial

and are not planned in conjunction with the theoretical teaching, they are likely to be rejected-perceived by students as no more than oases in a desert. What w e need is not more oases but carefully planned irrigation schemes!

References

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