What is missing in our clinical education?

Andrew Zhou – University of Cambridge, Year 6 Medical Student

  • Equal Second in Creative Enquiry

Holistic care is about treating the individual as a whole, incorporating aspects of the body, mind, and spirit. Over the past decade, we have progressed toward a more holistic, patient-centred medical education. However, this has regressed during the pandemic through depersonalising online teaching, which heavily focuses on diagnosing and treating the condition. The pandemic has put unprecedented pressures on medical students who have had to adapt their learning under difficult circumstances. Many have missed out on the opportunities to experience holistic care in their clinical education as COVID-19 disrupted clinical services. At the peak of the pandemic, medical students were able to develop clinical knowledge but missed out on fundamental communication skills and interactions with patients, and the opportunity to transfer their knowledge to actual patient care.

Throughout the pandemic, the constant streams of online, didactic lectures and assignments made many students focus on the outcome rather than the process itself. Online teaching lacks patient presence. Even if we interact with patients online, it can be awkward and unnatural, also connection issues can also be very disruptive. Undoubtedly, this can cause one to forget the true purpose of being a doctor and thus forget the critical aspects of what is required to become a good doctor. Needless to say, I fell into this negative spiral and failed to recognise the process for many months during the pandemic. My experiences during the pandemic made me fall out with medicine. I found it difficult to appreciate the human aspects and non-technical skills, (such as communication skills, kindness and situational awareness) through this pandemic didactic teaching, which I thoroughly enjoyed at the start of my clinical training before the pandemic started. However, the reintegration of in person learning through shadowing my supervisor on my elective made me realise that medicine is about enjoying the process and rarely about the outcome, which applies to all aspects of care. In an ideal world, we would all like to have good outcomes. However, many factors are out of our control, and therefore all we can do is try our best through kindness and hard work. While technical skills are pertinent to a clinician, we must not neglect our mission and purpose as doctors which is provide high quality care which includes not just treating the condition but taking a holistic approach to patient care.

Those who underwent clinical training during the pandemic missed out on crucial bedside training, which ultimately helps medical students provide a better picture of patient care by creating a better opportunity for patient engagement and building relationships. This was an ongoing problem even before the pandemic struck. However, the pandemic has highlighted how easy it is to return to our old habits, and this problem is continuously underappreciated in the current medical education system1,2. I am pleased to see a positive change in the medical education system, moving to incorporate aspects of diversity, equality and inclusion (DEI), sustainability, and communication into the curriculum3. However, the current medical education system focuses very little on these overlooked aspects and is still under-addressed in the current medical education programme. By creating the illustration above, I hope to highlight essential aspects of holistic care that are often overlooked and raise further awareness of this problem in medical education systems.

This illustration depicts the disparity between what current medical education focuses on and what is missing from the current system, especially during the pandemic and even before the pandemic. Here I present a medical student studying in the hope of graduating one day. With reference to the illustration, I have highlighted the current focuses of medical school on the left and depicted through the lighter background. These aspects include research, biochemistry, diagnosis and treatment, physiology, and anatomy.

On the right, I have highlighted the neglected aspects, depicted using a darker background. These aspects include kindness, communication skills, work ethic, patient-centric care, sustainability (including career sustainability for doctors), and DEI. Communication and patient-centric care are often neglected in current clinical practice 4–6. A recent large-scale UK cross-sectional study reported that only 50% of a patient cohort agreed that they were always treated with dignity or respect, 56% of participants felt they did not receive enough information and did not feel listened to, and 44% did not feel involved in the decision-making process regarding their care 4. More importantly, only 18% got all the answers to the questions they had about their care 4. This study highlights how neglecting essential non-technical skills in medical education and forgetting the essential tenets of medicine can translate to future doctors failing their patients. This study further reported that these poor markers of patient care led to more unsafe behaviours from patients, such as self-medication without medical advice4. Evidently, this could have been reduced or avoided if doctors showed more kindness and moved towards more patient-centric care and listening to their patients4. Although all the neglected aspects are essential, I would like to end by sharing a phrase from a senior doctor which resonated with me “kindness and hard work can take you a long way, and everything else will fall into place”. This phrase succinctly emphasises the key take-home message from this article, as employing the correct mindset will allow an individual to appreciate the other holistic aspects of medicine that are commonly overlooked such as DEI and career sustainability to avoid burnout, resulting in better patient care.

I hope that this illustration can raise awareness of this ongoing problem, and we can promote the other aspects of holistic care which are commonly forgotten.


  1. Gupta, D., Shantharam, L. & MacDonald, B. K. Sustainable Healthcare In Medical Education: The Student Perspective. https://www.researchsquare.com/article/rs-820307/v1 (2021) doi:10.21203/rs.3.rs-820307/v1.
  2. Forrest, N. et al. Femoral head viability after Birmingham resurfacing hip arthroplasty: assessment with use of [18F] fluoride positron emission tomography. J. Bone Joint Surg. Am. 88 Suppl 3, 84‐89 (2006).
  3. Medical schools come together to support inclusion and diversity in undergraduate training | Medical Schools Council. https://www.medschools.ac.uk/news/medical-schools-come-together-to-support-inclusion-and-diversity-in-undergraduate-training.
  4. Tyler, N. et al. Patient Safety, Self-injection and B12 Deficiency: a UK Cross-sectional Survey. Br. J. Gen. Pract. (2022) doi:10.3399/BJGP.2021.0711.
  5. Communication problems are top of patients’ concerns about hospital care. NIHR Evidence https://evidence.nihr.ac.uk/alert/communication-problems-are-top-of-patients-concerns-about-hospital-care/ (2019) doi:10.3310/signal-000758.
  6. Engle, R. L. et al. Evidence-based practice and patient-centered care: Doing both well. Health Care Manage. Rev. 46, 174–184 (2021).