Spotlight on Dr Richard Harrington
23 March 2021
For this term’s “Spotlight Interview”, Dr Richard Harrington (Associate Director of Graduate Entry Medicine) discusses the drama of medicine and the very fine art of clinical teaching.
How long have you been an undergraduate GP tutor?
I’ve been involved with teaching medical students since I came to Thame in 1990, when the Year 5 placements were just two weeks long. It was great to see the attachment move to three days per week over six weeks, but given the central role of primary care in the NHS I believe we should look to expand further the amount of time students spend in general practice. It’s a wonderful environment in which to learn about all aspects of medicine from the molecular to the biopsychosocial… and that applies to me to.
Tell us about the Graduate-entry medical course (GEC) and your involvement with it
The four-year ‘fast track’ GEC was set up in 2001 initially with a very small intake; there have been several expansions, most recently last year to the current intake of 35 students. One of the key features of the GEC is early clinical exposure, with one day a week in the first year spent alternating between GP practices and DGHs. The students are asked to follow a particular patient over the course of six months in Primary Care and have to submit a commentary as part of a formative assessment. This is otherwise an intense pre-clinical year and students have a huge amount of enthusiasm for clinical days. I have been Deputy / Associate Director since 2005 and during this time I’ve organized the GE1 clinical placements, contributed to ethics and behavioural sciences teaching and various aspects of course management and pastoral care.
You video some of your patients for teaching purposes – how does that work?
Running clinical problem-solving seminars is the part of my role I relish the most, and I’m grateful to Tim Lancaster (previous Director of Clinical Studies and GP) for helping me learn this craft. In my practice I quite often find myself wanting to share a clinical scenario with students. I therefore started experimenting with making videos of patients talking about their experiences of health care or describing their symptoms, with the appropriate consent. Over the last 15 years or so, I have developed a collection of short videos which illustrate various clinical presentations, aspects of the doctor-patient relationship or experiences of health care.
Any stand-out videos in your collection?
Well, several come to mind. For example, a stoical elderly man with back pain and difficulty in walking - ‘my legs flap about … it’s a matter of balance’ he says as he hauls himself out of his wheelchair on to two walking sticks. Helping him on camera is the Year 5 student who drove him up to the West Wing where the disc causing his cauda equina syndrome was later removed…The student is now a GP.
Another is of a teenage boy with his mum off camera, together describing months of profound thirst and marked weight loss. He was later diagnosed with central diabetes insipidus and now ten years on has just qualified in Medicine. One of the upsides of teaching on Zoom is the opportunity to invite patients to join in with clinical problem seminars, which both the students and the patients seem to appreciate.
How do the Graduate Entry students compare to Standard Course students – are there more differences or similarities?
How very binary! It’s impossible to generalise. The grads come with the generic issues facing all medical students, but bring with them layers of complexity and curiosity perhaps greater than in an ‘average’ standard course student (if there is such a person). However, the grads are a diverse group. Some have moved seamlessly from school through a natural sciences degree to join the course in their early 20s. Others are in their 30s and moving away from varied and established careers where they have carried significant responsibility; they are giving up a great deal to study medicine and seek to make the most of every opportunity, in the best possible way.
You offer some ‘words and pictures’ sessions at the end of your seminars – what goes on in these?
I started using snippets of poems or prose to fill up white space in the GE clinical course handbook, then invited students to share favourite poems or pictures at the end of my seminars. Slightly to my surprise some students have now started asking for these … I don’t need much encouraging. I call it ‘words and pictures’ to avoid mystification.
Do you think your first degree in Drama and English makes a difference to the way you approach General Practice?
You’re asking me questions I can’t possibly know the answer to! All I know is that at Medical School my favourite activity was sitting in outpatient clinics and seeing the next patient come in the door. Happily, that joy [sorry] remains with me. There are parallels with the theatre of course, the curtain in effect rises just as my consulting room door opens and a drama of some sort unfolds. Sometimes I am the audience, at other times part of a two-handed play or take a turn directing.
Ah, you’ve shown me I do know the answer after all, you are indeed a skilled interviewer.
So, you’ve been in the same practice for over 30 years now, that’s a bit dull isn’t it?
I think I’ve just answered that. Sorry no more questions.
Richard Harrington was talking to himself.