There are some dates one shall never forget in their life. In my lifetime, they were the 22nd of November 1963 (a long time ago, I was only eight), the assassination of JFK in Dallas, 9/11 in 2001 when the Twin Towers went down in New York, and of course, the 21st of March 2020. On that day I was lecturing at the University. The last day of a tiring cycle of lectures I was giving once a year. The dean’s secretary phoned me and announced that all classes must be discontinued immediately. I should return to Holland as soon as possible as the country will be locked down because of the COVID-19 pandemic, and soon nobody can get in or out of the country. I took a taxi and went to the airport to catch my plane.
At that moment, like at all other moments I mentioned before, I had the feeling that since then, everything will be different, as that’s the breaking point. Soon, I realized that something has ended and something new has begun. The University moved my lectures to the Internet. I needed to get familiar with yet another communication platform; this time, it was Teams. Well, lecturing to an audience you do not see, and you do not even know what they are doing in front of the screen, is one, but how on earth did they want us to examine our students online at the end of the semester? My group of students counted 120 persons, and it cost me many hours to get them all examined both their knowledge and way of thinking.
Suddenly, I realized that this was not only a nuisance but also a chance to do something new and maybe more interesting and better. I borrowed this idea from the University of Oxford, where I was lecturing occasionally being invited by Professor Twycross some two decades ago. According to the idea from Oxford, I invited the students to write a scientific essay on two pages excluding the references. I asked them first to indicate the areas they are interested in that are connected to the main subject of palliative medicine. This could be pain and symptom control, end-of-life ethics, cardiology, anaesthesiology and communication. For each student, I was inventing a new topic to write on. The issues needed not to be straightforward. One student asked to be able to write on the bedsores. No, nothing like this. This is a type of topic to be copied and pasted from the internet. I will not even be able to discover this. To write on the topic, the students should read literature and more often, solve a clinical puzzle. Thus, I asked the student who wanted to write on the bedsores; “Why do some bedsores ache and others do not?” The answer could not be short. Like “yes” or “no”, but not too long either.
Many of my topics proposed to the students were related to patients of mine from the past 30 years of practice in palliative care. I remember a boy of 18 with a history of glioblastoma and devastated after five years of taking dexamethasone. He was suffering immensely because of returning infections, muscle wasting and aches, fatigue and episodes of delirium. He knew he could not ask for euthanasia, “but is there anything else?”. We discussed “the ins and outs” of the futile or persistent therapy with dexamethasone. Is palliative sedation a suitable solution for such a patient? Yes, this was the subject the students needed to think about: comparing the idea of euthanasia with discontinuing futile therapy.
The students were allowed to contact me through Teams and ask me questions, and propose ways of their thinking. At last, I was getting more personal and face-to-face contact with the students! And I started to like it. They were allowed to send me a draft of their essay, and I was glad to suggest changes and/or improvements. They had two months to complete the task. I promised them we should work together on the best essays and try to publish them.
It is my third year using this “scientific essay exam”, only for the students who volunteer to do this. Other students must pass an exam by answering ten clinical questions in writing. In both kinds of exams, the students are allowed to use all scientific sources (except popular ones). In the essay, they need to give references to every notion they are bringing up. The enthusiasm was always great. Approximately one-third of students opted for the essay each year. Every time I am positively surprised by the students and how fascinated they were by clinical thinking, using evidence from the literature, interpreting statistics, comparing articles and methodologies etc. For many of the 5th-grade students of medicine this was the first encounter with the world of science and evidence.
Every year I publish some of these essays as mini-
-review articles. This year the quality of the pieces was outstanding, and we managed, together with the students, to submit four articles. They will be subjected to the usual peer review as all other submissions.
If published, the students will receive some additional points, which they can use to their benefit while choosing the place of their residency training.
In the coming issues of Palliative Medicine in Practice, you will notice some of these articles with the student’s name as the first author and mine as the second. A great honour to me and the students who were stimulated to do something like this. I hope for you as a Reader this must also be a pleasure to read these short but important and practical divagations.
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