Hostile teaching hospitals and friendly district general hospitals: final year students' views on clinical attachment locations.

Context: The NHS Plan has indicated the need to increase the number of doctors in the NHS. To accommodate the substantial increase in student numbers in Birmingham, clinical teaching will need to expand from its traditional base within established teaching hospitals (THs) to district general hospitals (DGHs). Previous studies elsewhere have suggested the experience of students who undertake clinical attachments in DGHs is different from that of students attached to THs. We sought to investigate whether such differences exist in the West Midlands region and to explore the opportunities and problems such differences may present to educators and students alike.
Methods: A questionnaire-based survey of the TH and DGH experiences of all medical students in their final year (2000/01) of undergraduate training at the University of Birmingham Medical School was carried out.
Results: A total of 80% of students responded. Respondents indicated that both the identification of learning objectives and the provision of teaching to meet such objectives were likely to occur in TH and DGH settings equally. However, other differences emerged, suggesting that DGHs offer a friendlier and more supportive learning environment, with greater opportunities for the acquisition of hands-on practical experience.
Conclusions: At present, the popularity of DGHs derives from the attitudes of staff and the opportunities for hands-on experience. However, as student numbers increase, DGHs may be required to take on additional teaching commitments. Will DGHs be able to retain their existing educational characteristics or will they take on those associated with established THs?