Friday, 6 July 2012

Some aspects of studying (Medicine) in Cambridge

After two years of studying in Cambridge, I’ve made some observations about the learning experience here. I can’t help that it will be a rather negative post, but I am sure you can find plenty of articles praising Cambridge for its amazing education elsewhere.

In fact, I think the many purely positive reviews can set students up for disappointment once they identify an aspect of Cambridge education that isn’t ideal, and I’ve seen a few of the more critical students doubt themselves and feel isolated in an environment where criticism is not welcome (They ask themselves: If Cambridge is one of the best institutions in the country, how can it be that I am unhappy?).

Today, I will mention four issues I’ve identified. Some of them came as a bit of a revelation to me. Understanding what it was that bothered me and why I was not enjoying certain aspects of the course definitely helped me do something about it, or just accept the facts and get on with it. Perhaps it will help others as well.

1.     Lack of a grand vision
In terms of the overall medical course, there does not seem to be any grand vision, guiding philosophy or master plan on how to teach medicine in the best possible way. If it does exist, it is definitely not communicated well enough or not obvious in itself.

In general, there should good reasons for why and how every element of the course is taught in order to avoid inefficiency. Strategic thinking and more intense feedback from the medical profession on course structure could yield a more concise syllabus. 

As a particular example for the lack of overall structure, the different pre-clinical subjects are taught alongside each other independently, rather than in a complementary way. There is definitely need for more cross talk between the different faculties ensuring optimal timing of subjects throughout the year and lack of redundancy.

In terms of clinical teaching, there seems to be even more of a piecemeal approach and scope for inefficiency. We are often told that “medicine is an apprenticeship”, but this statement also seems to serve as a convenient catchphrase to hide behind when criticism surfaces. I am convinced that systematic approaches to teach medicine do exist and I am sure they are employed by other leading medical schools in the world. In fact, I am determined to find out more about this and will write about this topic again in due course.

2.     Convolution of information
As I already mentioned in an earlier post, information is often presented in an undigested, incoherent and badly organised format. Unless one wants to pass exams by rote learning random facts, one has to reorganise all the information. This represents an enormous time investment for each cohort of students and I am not sure if it is an important learning experience in itself.
If the building blocks of medicine could be presented in a more logical and concise manner, students could grasp the information much quicker and would have more time to really indulge in in-depth knowledge, leaving them with a firmer grasp of the subject and a better foundation for the future.

This also has practical aspects, some of which are hilarious. We all know that many components of the medical curriculum aren’t rocket science, and sometimes one almost suspects intent behind the fact that access to simple information is made difficult in some way, so that the ultimate challenge is not to know the information for the exam, but to have jumped through hoops in order to get to it.
For example, content of many physiological subjects is displayed on departmental posters during restricted viewing times. These posters are older than most of the students on the course (they have been typed on a typewriter!!) and are not available electronically. Therefore tens of students crowd in front of them at any time, scribbling down the information presented. It is almost farcical.
Another example is the clinical school’s online resource, one of the least intuitive platforms I have ever come across. People joke that once you have found something on this system once, you will never find it again, and sadly this has been true on many occasions. 

It is interesting that very few Cambridge learning materials are available to the public. Some people are convinced that if they were, the differences between Cambridge and other leading universities would become obvious very quickly.

3. Large difference in what is provided and what is expected of the students
On accepting the shortcomings of some of the teaching that is on offer, one is then struck by the great discrepancy between the leniency of the course organisers towards themselves and their teams, and the utter perfection that is expected of the students.
In my opinion, it is a major cause of demotivation, as inspiring a feeling of inadequacy among the students does not foster a desirable environment for learning.

4. Constant assessment leaving no room for learning
This is another point regarding the environment for learning. Learning obviously requires processing and understanding of the information to be memorised. At some point this processing has to take place because learning (at least of the more complicated topics of medicine) is not an instant event.

However, the questions associated with this process of learning aren't generally welcome. Too often, the answer to a question is judgmental rather than explanatory. Even though proper exams only take place at end of the academic year, students are constantly under assessment, even when they encounter facts for the first time and need some time to absorb them.
As a result, there isn’t actually much time for learning in the presence of university teaching staff, both in the departments and the colleges. While some supervisions may present an exception, in general they also take more of an inquisitive format.
What remains is for the student to do the actual learning in their own time. With a full schedule, the time for this is scarce, especially on the graduate course. If nothing else, this is another unnecessary source of inefficiency.

The more I think about it, the more I realise that Cambridge often confuses teaching and learning with assessment. But assessment alone is just not enough....
In my opinion, the atmosphere would greatly improve if there were also some protected times when students can go through and enjoy the process of learning without constant external pressure.


Anyway, these were some of my impressions over the past two years. I think Cambridge will definitely have to address some of these issues if they want to compete internationally in the long term.

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