In any particular country, there may be fairly strict laws about becoming a health professional, such as a nurse or occupational therapist. These laws may describe quite precisely the type of education required for a profession. For example, a student may be required to study certain subjects, such as anatomy, physiology and so forth. In such instances, all of the students wishing to enter a profession, such a nursing, may all have a similar style of education. Also, the style of education within a country or region may be governed by local customs. For example, in some cases, men and women may have to study separately.

In other countries, however, the laws concerning the education of health professionals may be rather vague. This may be unintentional, and may be because the legislation was written a long time ago. On the other hand, sometimes the laws concerning educational requirements for health professionals are deliberately vague. This may be done to allow freedom in education, and to encourage experimentation which leads to improved methods of learning. Hence, there can be many styles or "models" of education.

If we have only known one model of education in our own country, then it may be surprising to learn how our colleagues are taught in other countries. We may even doubt the quality of their education if we do not fully understand the historical and cultural context in which it developed. It is useful to appreciate the spectrum of models that are used in health care education, and also to understand that health care education is undergoing continuous change. It is important for the welfare of our patients to examine our own education and think about how we can make it better.

One way of thinking about educational models is by reference to the "SPICES" model. This places certain characteristics of educational programmes on a spectrum. One end of the spectrum is generally thought of as representative of more traditional schools. The other end of the spectrum is generally thought of as representative of more liberal schools. The word "SPICES" is an anagram which stands for:

* Student-Centred vs Teacher-Centred
* Problem-Based vs Information Gathering
* Integrated vs Discipline-Based
* Community-Based vs Hospital-Based
* Electives vs Standard Programme
* Systematic vs Apprenticeship-Based or Opportunistic

Situation 1: Two chiropractic students are discussing their schools' programmes.

Tsuyoshi: I've heard that chiropractic college is pretty tough in Europe.

Niels: Well, you are expected to work hard, but it's really interesting. I really enjoy the problem-based approach.

Tsuyoshi: What do you mean by "problem-based"? I've heard of it, but I don't know what it means.

Niels: Well, we don't have a lot of formal lectures in things like anatomy and physiology. Instead we are given clinical problems to solve, you know - cases, and we are expected to find the information that we need to solve the problems.

Tsuyoshi: If you don't have lectures, how do you know what to study for examinations?

Niels: We don't study to pass examinations. We are expected to study to learn what we need to help real patients. Don't you find that you learn a lot of useless information in lectures?

Tsuyoshi: Well, sometimes, but you have to know it to pass exams. Anyway, I've heard that you don't really find out about patients until you become an intern.

Niels: Well, we begin working in the clinic in our first week of school, so we have to deal with real patients right away. Also, we don't have examinations in most of our courses. Usually, we are marked on projects and evaluated by our peers.

Tsuyoshi: What do you mean by "peers"?

Niels: You know - the other students.

Tsuyoshi: I've heard that! You mean the other students in the class really decide your mark! How can that work? Isn't there cheating and stuff like that?

Niels: Not really. Once you get used to it, it works pretty well.

Tsuyoshi: I prefer to have examinations and have the teacher decide the marks. At least that way, you know what is expected of you.

Niels: I understand. I used to feel that way, but now I prefer our system. I guess different people are comfortable with different systems.

Patterns:

* I've heard ... of it
... that
... that chiropractic college is pretty tough in Europe
... that you don't really find out about patients until you become an intern

* You are expected to work hard@
* We are expected
... to find the information that we need
... to study

* What do you mean by
... "problem-based"@
... "peers"

* I prefer
... to have examinations
... our system

1. What does "problem-based learning" (PBL) mean? Have you ever used this style of learning?

2. Do you think that you could learn the basic sciences that you need without having lectures?

3. What are the good and bad points about being evaluated by your peers?

4. What are the good and bad points about having first year students work with real patients in a clinic or hospital?

5. Do you think that every student in your course should study the same material and use the same study methods? Why?