Clinical experience of UK medical students

Sir—I C McManus and colleagues (March 14, p 802) argue for a decline in medical training in the UK, based on a trend of decreasing exposure of medical students to medical conditions, surgical operations, and practical procedures. I will not comment on the surgical cases or the procedures, but wonder whether the downward trend they show with regard to “acute medicine” would apply if the medical conditions were more appropriate to what we actually see referred to a tertiary care hospital. I would argue the category of acute medical conditions should include ventricular failure, exacerbation of chronic obstructive airway disease, pneumothorax, status asthmaticus, drug overdose, central chest pain, altered mental state, syncopal attack, stroke, acute gastrointestinal bleed, unilateral swollen leg, acute oliguria, acute arthritis, and complications of drug addiction. The spectrum of medical disease is changing. Can one expect an average medical student to see meningitis, diabetic ketoacidosis, hypothermia, subarachnoid haemorrhage, and acute glaucoma these days? I think not. Possibly, the goal posts should be changed before we use the data provided by McManus and co-workers to argue for a decline in medical training in the UK.