Survey of training in toxicology in medical schools - replies
Extracts from replies received from medical schools:
- Barts and the London
- University of Oxford, The John Radcliffe
- University of East Anglia, School of Medicine
- The Hull York Medical School
- University of Bristol
- University of Nottingham, Faculty of Medicine and Health Sciences
- Kings College London, Department of Medical Education
- University of Liverpool, Department of Pharmacology and Therapeutics
Barts and the London
In common with most Medical Schools in the United Kingdom, we have as recommended by the GMC 'a core plus options course'. We define core as the knowledge skills and attitude that a newly qualified doctor requires to practise satisfactorily. The options are course components which are selected by the students largely through their own interests, the latter contribute to the higher education of these students.
We are under considerable pressure from the GMC to cut down the burden of factual knowledge that our students require at the time of qualification. The concentration on the core knowledge and skills is a way in which we can do this. I would contend that an in-depth knowledge of toxicology is not core knowledge within the definition that I have given above. Certainly our students come into contact with clinical problems during their course which may have a toxicological aspect but we currently do not have any plan to increase teaching in the basic principles of toxicology or the science and law relevant to pesticides. I would contend that this is more appropriately taught in the post-registration period.
In an age when patients expect that our medical students would be thoroughly trained in 'new' disciplines such as communication skills and ethics, something has to be left out of the undergraduate curriculum. I am afraid that this means that I am often only able to reply negatively to the rather large number of special interests groups such as yours who expect their particular area of interest to be crammed into an overcrowded curriculum.
University of Oxford
Taking the different areas of the course where these issues are covered, I judge that about ten hours of toxicology are delivered as core to the students. As it happens, we have recently appointed an international expert in organophosphate poisoning to our faculty, so I anticipate that this topic will receive more attention in the future.
On a more general note, as a medical educator I would have an alternative perspective from yours towards the level of requests for information that your network receives from doctors. The volume of knowledge in medicine is expanding so rapidly that we do not view covering all important topics in medicine as an achievable, or even desirable, objective of our medical course. Instead, we hope to equip our graduates with the skills to search for and identify information when faced with new problems during their careers. We would be very pleased if our graduates, faced with a toxicological problem, recognised the limitations of their knowledge and turned to resources such as yours for help. In my view, providing access to high quality information is an excellent way to improve the care of people suffering from poisoning, and probably more effective than trying to increase the amount of didactic teaching that medical students receive in this area.
University of East Anglia, School of Medicine
The purpose of the undergraduate medical course is not to provide individuals with all the knowledge they need in order to practise medicine in the modern age. It is apparent that knowledge is expanding rapidly and the problems which doctors face change from time to time.
Clearly, organophosphates are an important source of problem at present, but one can conceive that good sense will prevail and the organophosphates will disappear from use in due course. The information the students have on organophosphates will, therefore, become redundant.
We, therefore, attempt to teach the students principles of recognising when there is a problem which they do not understand and tracking down reliable information on it, rapidly and efficiently. I am, therefore, not horrified by the thought that doctors contact your organisation for up to date information. I would regard this as minimum best practice. Having said that, we do have a Professor of Health Protection and we do throughout our course emphasise the problems of environmental pollution and toxic chemicals. Situated as we are in a rural community, it is very likely that the students will come into contact with patients suffering from the effect of toxic chemicals throughout their course.
We have a highly integrated course and the students start clinical teaching in first year. In the first unit we emphasise health in the community and health at work, and in both of these modules the students are introduced to the idea of environmental pollution as a cause of illness. We have lectures and seminars dealing with both the basic principles of toxicology and the law in relation to toxic chemicals. The remainder of the course is system-based and whenever chemical exposure is relevant to a given set of symptoms or diseases, the matter is re-visited.
It is difficult to specify the number of hours that this occupies. We do not actually calculate our exposures in terms of hours, but rather in terms of learning outcomes. In other words, we are not interested how long a student has listened to lectures on toxicology, we are more interested that they are able to recognise and deal with patients whose problem is potentially due to toxic chemicals.
The Hull York Medical School
Basic principles of Toxicology are in the developing curriculum of our programme. Our first cohort of students started only four months ago and although the programme is a fully integrated one the actual allocation of time for the later years is not yet completed. I should, however, make it clear that the undergraduate medical degree teaches basics only. Therefore while I certainly agree that teaching time of less than ten hours cannot equip a medical student to practise in this chemical age, I would challenge the assumption that much more than ten hours would be appropriate in an undergraduate programme. Rather, it should be a highly visible part of the graduate training programmes provided to trainees in a range of specialties particularly general practise and internal medicine. That will be our approach, but I can assure you that the basic principles will be in the curriculum and that students who wish to look at toxicology in more depth will also have that opportunity, over and above the basic core curriculum.
University of Bristol
Within the Community Orientated Medical Practice Unit in Fourth Year, issues of global warming, pollution and exposure to toxic substances within developing worlds and from factories is discussed in broad outline but not in detail.
In clinical pharmacology, a number of opportunities are taken to discuss this issue throughout the third year of clinical training. These include some specific lectures on toxicology where matters including the causes of drug toxicity, the chemicals which can produce toxicity including drugs and industrial exposure, the main sources of such exposure and the likely effects of the drugs and pollutants to which an individual might be exposed. Other lectures on acute drug poisoning are also included.
The amount of time that is given to this is necessarily limited because this is an undergraduate curriculum. However, these issues are covered in separate plain recession days spread out over the year and their separateness emphasizes the importance of the material that is being covered.
University of Nottingham
We have recognised that Toxicology teaching is not as extensive as we would wish it to be. Indeed the teaching of Therapeutics needs to be rationalised on our course. Accordindly we have now produced a strategy of Therapeutics teaching for the whole five years which is integrated and which will address the issue of Toxicology.
Kings College London, Department of Medical Education
As you know we have the Medical Toxicology Unit at Guy's and St Thomas', which delivers clinical care to poisoned patients (including tertiary assessment of organophosphate poisoned patients at our clinical toxicology clinic), advice to clinicians (as the National Poisons Information Service) on the management of poisoning, and a huge number of teaching and research activities. One of our consultants (Dr Karalliedde) is an International authority on organophosphate poisoning. We have strong links with the University, both at undergraduate and postgraduate level and indeed are looking towards the creation of a fully integrated GSTT/ KCL toxicology centre very shortly.
Our 86 staff in the Medical Toxicology Unit have input into all years of the medical school curriculum at GKT, teaching basic toxicology right through to special study modules. Students in occupational health attend our toxicology clinics for training. We have a number of students on clinical attachments. We also deliver approximately 68 courses each year to health care professionals allover the UK on the management of poisoning and there is strong support for such educational outreach activity from the Department of Health. It is impossible to say how many hours all this teaching represents, but it represents a substantial component of teaching for each of the staff in the Medical Toxicology Unit. We also write books, and chapters on books of medicine on clinical toxicology, to improve knowledge and expertise in the subject... As Director of the MTU, more than many I suppose I recognise the need to develop teaching and training programmes for toxicology across the UK.
University of Liverpool
We have an integrated new medical curriculum, which focuses on the life cycle from conception to old age. There is no specific module on toxicology, but students may come into contact with poisoning (drugs, chemicals etc) during certain modules such as drug misuse and the psychiatry modules.
The students currently have a one-hour plenary on drug overdose, where some environmental chemicals will also be covered. Apart from this, I am not aware of anything more formal. As stated above, students may come into contact with these areas in some of the modules listed above, and will certainly come into contact with patients who have taken overdoses, or attended with pesticide poisoning, as part of their clinical attachments.