How was medicine taught in the past?

Now that I'm well into my clinical teaching (and sometimes get very annoyed by it), I then get to wondering how medicine has been taught over the last 100 years or so, and if it's always disappointed the students in this way.

You see, medical teaching isn't as I expected. Gleaning what little I could from the media and hear-say; (mostly people saying "it'll be really hard and you'll be working non-stop without sleep"), I thought medicine would put me under pressure, which it does, but pressure that I had to answer to someone about. I thought that if I didn't turn up to ward rounds or hadn't clerked 15 patients or read about several different illnesses by lunchtime, it would actually matter. They'd need my history of the patient, or the consultant would be annoyed at me if I didn't do it, or even all the other students would have done it so I'd look bad.

Stories from older doctors, books and films like Patch Adams, or TV programmes like Grey's Anatomy (I have seen the first THREE episodes) or even Scrubs (to some extent) suggest that students are in the hospital all day, then working all night, desperately trying to memorise detailed physiological processes so they don't get their ass kicked at ward round the next day when they can't answer a question. So that's kind of what I thought I'd get in hospital. Being *expected* to do things all day, then having to work all night to meet the deadlines.

You might say here that I shouldn't need someone to *make* me do things, that I should want to learn everything in order to be the best possible doctor in the future (and before that, to pass my exams). Which is true. But this lassez-faire attitude from certain doctors who are supposed to be my teachers leaves a lot to be desired.


I don't understand why this has changed, assuming that it has. Why don't doctors now expect so much of us? Why are we now a hassle, getting palmed off on less senior doctors or being told "we don't have interesting patients today". Why aren't we part of the team, having to make a contribution and having to answer for it if we don't?

The archetypal "scary doctor", sweeping his way around ward rounds, leading a herd of timid medical students, doesn't seem to happen any more. That kind of doctor seems to be dying out, which is not necessarily a bad thing. Certainly from a patient point of view, a less brusque, more sympathetic doctor is generally an improvement, especially if they spend more time listening to patients and being less authoritarian.
Although somewhat unfortunately for us students, those doctors were actually great teachers. I mean, they were scary, and make us feel uncomfortable- I certainly remember last year a certain old-school doctor staring me down when I said something terribly stupid about how beta-blockers work. He went through it with us piece by piece though, and I bloody well understood it afterwards.
I don't mind this kind of teacher, because at least they're teaching us and really making us think. Many of my fellow students don't though, proved by the attendance at his timetabled sessions.

So the kind of teaching doctors feel they have to do may have changed. With the change in medical education towards more "touchy-feely" things such as communication skills and Inter-Professional Education, newer doctors haven't been taught in the scary old style, and the old-school ones are retiring now.
But personally after sitting round and having a group discussion about what kinds of catheters there are, I WOULD MUCH PREFER OLD SCHOOL. I feel similiar about Inter-Professional Education, which was basically bringing together medics, nurses, pharmacists and dieticians and giving us the instructions "now do a presentation... on something". What's the point??
Communication skills I am for 100%, but I refuse to ask a patient while taking their history "What do you think it might be?", for fear of giving the impression that I am completely clueless. Less "reflective discussion", more helpful points and direct answers please.

It's not just the doctors though. Other factors are turning them away from teaching- one in particular being pay. My anaesthetics tutor informed me a few weeks ago that "apprentice-style" teaching, where we are one-on-one with a doctor, shadowing them around ward rounds or in theatre, doesn't count as teaching, so the doctors don't get paid for it. They only get paid for putting on tutorials or seminars, which we get a certain amount of from the university (independently) anyway. Which means that the main thing that us students want from hospitals- clinical observation and experience- is unfunded.

I'm sure that part of it is due to the large numbers of students in our hospitals as well. As one of a year of over 400 students, there are a lot of us around, somewhat fighting to get into clinics and onto ward rounds. I'm currently in a group of about 20 people doing the same rotation, and there really isn't enough for us all to do. I've already mentioned that we get better teaching/more attention in the smaller hospitals- no mean coincidence that there tends to be less students there at any one time. The teaching hospitals I have found the worst for actual teaching, as the doctors are so busy with other things (and bothered by so many of us).

The admin system doesn't help. The college try to limit us from swamping the hospital by assigning us to certain consultants, giving us timetables and even making us sign up for things online... but none of this is actually communicated very well between the college and the hospitals. The timetables are always out-of-date, missing off really interesting/useful things that you inevitably don't find out about until the last week of the rotation.
One rather annoying thing that happened to me was after turning up to a clinic that I had signed up for but hadn't been informed was cancelled, I arrived on a different day to be asked if I signed up online.
"No," I said truthfully, "but my session was cancelled and so..."
"I can only let you in if you are timetabled."
I left, only to realise about 10 seconds later that if I'd said I *was* timetabled in, she'd have had no way to prove it. Damn!