Sharing and caring at med school

Dr Chris Skinner mounts a case for universities to dare to be different when it comes to their medical curricula. 


Since its inception in 2005, the medical school at the University of Notre Dame in Fremantle has emphasised the holistic development of its medical students. Credit for this focus can be attributed to early school pioneers such as the school’s first dean, the late Professor Adrian Bower, and Professors Jenny McConnell and Mark McKenna.

Dr Chris Skinner

Adrian Bower once wrote in the MJA suggesting that a unique characteristic of the course was a weekly clinical debriefing (CD) tutorial, facilitated by a clinician, where students reflected not only on clinical content but on the doctor-patient relationship and importantly the experience on themselves. 

The aim of CD was to develop the medical student and put flesh on the ‘reflective practitioner’ and critically to inculcate a culture of doctors caring and valuing their own health – quite a transformational dream which itself has become prophetic.

Roll on 15 years and this unique CD characteristic of the medical school remains and, in fact, has grown in content, style and delivery, which is no mean feat given the ever-changing health context and educational tertiary culture.

Let us put this CD focus into a wider educational medical school context. Clinical debriefing is a central part of the Personal and Professional Development Domain (PPD), a domain that covers wellness, ethics and law, reflective practice, professional identity, leadership and management, and the patient-doctor relationship.

Traditional medical educational curricula have often previously only spoken in hushed tones in such areas, if at all. Valuing openness, facilitated discussion and being prepared to explore individual, group/team, and organisational experiences are central.

Through small-group facilitation and mentoring, CD medical tutors are on their toes to address personal, clinical and educational aspects. The importance of what has become known as open space, where students can share and communicate openly, has become central to the evolving CD process. 

For instance, a recent ‘oranges and lemon’ segment has caught on whereby students share one positive (orange) and one not so positive (lemon) as part their 90-minute CD sessions. Of course, it does depend on your positive associations (or not) towards such fruit.

Confidentiality, educational flexibility incorporating balancing structure and process is vital for the success of CD. While the experiential aspects of emotional intelligence, mindfulness and personal case discussion are strongly valued, other more traditional cognitive elements are not forgotten. 

Assessment based on reflective learning, law and ethics vignettes/seminars and in class assessment exercises are part of the PPD curriculum. Increasingly students learn critical facilitation skills in helping steer and lead with their CD medical tutors. 

So what are some of challenges in daring to be different? Acceptance of the importance of the humanities and the integration of new ways of delivering medical education beyond cognitive academic knowledge stand out. 

Integration into a busy clinical medical program is not easy, and humanistic PPD topics can be easily marginalised or shelved. To its credit, the medical school at Notre Dame has been willing to support key initiatives and allow the initial vision of the school to be sustained and advanced.

And what of the next 15 years with ever-expanding clinical knowledge and increasing economic and educational managerialism? 

Understanding and developing the whole student, including both academic and human experience, needs to be fully valued and resourced. Medical educators need to be trained and affirmed in these essential skill sets. Research and evaluation must be increased to validate new learning experiences for future medical graduates. 

Failure to continually value such activities will relegate medical education and future medical doctors to technical but limited real healers. 

ED: Dr Chris Skinner is an Associate Professor at Notre Dame Medical School, Fremantle