The negatives ofe-learningNeel Sharma, Lewisham Healthcare NHS Trust, London, UK

The UK’s General MedicalCouncil (GMC) principles ofGood Medical Practice state,

‘Teaching, training, appraisingand assessing doctors and stu-dents are important for the care ofpatients now and in the future’. Itconcludes by stating that as doc-tors, ‘You should be willing tocontribute to these activities’.1

The academic year has longstarted and medical students havebegun to grace the wards withtheir presence in vast numbers. Inaddition to registrars and consul-tants, junior doctors are alsoinvolved in overseeing studentlearning requirements, spendingtime seeking out patients thatmay be suitable for history taking,examination, and even certainprocedural skills such as vene-puncture and cannulation. Setting

aside the usual ‘no-show’ type ofstudent, or the ‘I have a dentistappointment so can’t attend theward round’ type, there nowseems to be a new modernresponse that is frequentlyuttered by students during allo-cated teaching sessions. Forexample, having enquired aboutwhether anyone has examined anabdomen or taken a history from apatient with asthma, the latestresponses are ‘Yes of course, I’vejust downloaded a podcastregarding that…’ or ‘I’ve justdone an online module on thattopic, so it shouldn’t be a prob-lem’. With their new-found confi-dence I have often asked mystudents to then demonstratetheir skills, with the end resulthighlighting the significantnegatives of e-learning. Too oftenI observe either an over the top

theatrical performance or a mun-dane robotic approach towardspatient examination, with littletime spent actually attempting totruly look for particular signs, butrather simply stating what it isthey may be looking for, or his-tory steps being recited wordperfectly with no real thoughtinto why they are asking suchquestions and the significance ofthe patient’s response.

E-learning in medicine isbecoming increasingly popular,and even more so in view of theever rising increase in smartphones. And it is even apparentthat some medical schools aretaking advantage of such a meansof teaching with a subsequentreduction in tutorials, lectures andbedside teaching. It may seem anovel way to learn, but as the old

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142 � Blackwell Publishing Ltd 2011. THE CLINICAL TEACHER 2011; 8: 142–143

Chinese proverb goes ‘I hear, and Iforget. I see, and I remember. I do,and I understand’.2

REFERENCES

1. The General Medical Council. The

GMC’s principles of good medical prac-

tice. Available at http://www.gmc-uk.

org/guidance/good_medical_

practice/teaching_training.asp.

Accessed on 7 December 2010.

2. Chinese proverb by the Chinese phi-

losopher Confucius. Available at http://

en.wikipedia.org/wiki/Confucius.

Accessed on 7 December 2010.

Corresponding author’s contact details: Dr Neel Sharma, Lewisham Healthcare NHS Trust, University Hospital Lewisham, Lewisham High Street,London, SE13 6LH, UK. E-mail: neel_sharma1@hotmail.com

School was more difficultthan studying medicineAndrew Wright, Department of Medicine, The Medical School, University of Sheffield,Sheffield, UK

‘No longer do I have severalpieces of homeworkto complete for the

next day.’

As I entered my final year ofmedical school, I reflected backover the last four and half years.Do I feel as though I have workedextremely hard? No, in fact Ibelieve the hardest working timesin my ‘academic career’ cameduring my time at school. Thiscertainly contradicts the ‘over-worked medical student’ stereo-type my friends and familyseemed to have before I set offfor medical school.

I am not saying that studyingmedicine has been easy, I just feelas though I was not pushed asmuch as I was in school. Orperhaps it is because I have not

had to push myself as hard. Afterall, a medical degree is essentiallyweighted the same, whether youcome first in the year or last. Incontrast, it was essential to strivefor the highest grades in GCSE andA-level subjects, principallybecause of the firm competitionapplying for competitive under-graduate courses.

At university I found that therewas less structure on a day-to-daybasis and less contact with teach-ing staff. Furthermore, the examsare at the end of each year: henceallowing for large periods of downtime. In my GSCE final year I had22 separate exams in the summer.The vast amount of revision andpreparation required for theseexams was perhaps the pinnacleof my academic performance!

However, I have welcomedthe more relaxed times atmedical school and university. Itallows for socialising, participat-ing in sports and pursuing otherinterests. Medicine is a longcareer, so having reduced periodsof stress now can only be a goodthing!

The reality of starting as afoundation doctor is equally asexciting as it is daunting.However, the opportunities tocontinue learning new skillsand increasing my medicalknowledge is a stimulatingprospect.

I conclude with the phrase:‘The hardest thing about doingmedicine is getting in to domedicine’.

Corresponding author’s contact details: Mr Andrew Wright, Department of Medicine, The Medical School, University of Sheffield, Beech HillRoad, Sheffield, S10 2RX, UK. E-mail: mdb06aw@sheffield.ac.uk

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