In the week that York and Hull's new medical school opened, health reporter Rosslyn Snow assesses what impact it will have on health care in the region.

TWINS Sam and Louise Queen make no secret of why they chose the new Hull York Medical School rather than more established institutions to begin their medical training.

What distinguishes Hull York, which this week took in its first batch of students, from other medical schools is that it believes in a hands-on approach to learning medicine. The aim is to produce young doctors who know the theory, but also have the experience and bedside manner to deal with patients face to face.

The 137 students who started this week - 69 based in York, 68 in Hull - were chosen as much for their ability to communicate as for their academic qualities. And within a few weeks they will be meeting and dealing with patients, in hospital and in local GPs' surgeries.

That combination of hands-on experience and the chance to get out into the community attracted the twins, who are 18 and former pupils of Market Weighton School.

"We looked at Newcastle, Sheffield and a couple of others," says Louise, "but this school seemed the most friendly."

"This one seemed really exciting and new," Sam adds. "We knew that experience would be 50/50 in hospitals and in the community, and that it was problem-based learning so if we are learning about broken bones we meet someone with broken bones.

"With other schools you learn about it in lectures but may not come across the problem for years. It's better having hands-on experience because in the end we are going to have to meet real patients, it's better than just learning out of a book."

The Hull York approach to training doctors is relatively new but calls on best practice at other leading medical schools. The 137 students will all have clinical placements at GPs' surgeries and hospitals in or near York and Hull.

They will work in the community from the start of their course and there will be an emphasis on evidence-based treatments, developing communications skills, and problem-based learning.

The approach will include "patient simulators", people who role-play as patients to help medical students develop a good bedside manner and skills in diagnosis.

The emphasis on community medicine is also new. "Hull York is the first school where clinical placements will be split 50/50 between hospitals and the community," says Dr Henry Smithson, a GP at Escrick Surgery and a GP tutor at the medical school.

"Eight GP practices in the York area are taking part and we have eight students in all, split into two groups that visit us on alternate weeks. Those students will be tutored by a GP tutor and by a hospital tutor for the year.

"The tutor has to give up their time to teach but one of the other partners will take on that extra clinical work so patients will have no trouble in making appointments. In fact there should be a few more appointments available.

"This will give patients the opportunity to participate more fully in the education of doctors."

Hull York Medical School is a partnership between the universities of Hull and York and the NHS. The Department of Health, the Higher Education Funding Council for England and the General Medical Council have also played key roles in its establishment.

But while the new school is part of a national effort to increase the number of doctors and to modernise medical education, it looks certain to have a positive effect on health care in the region too.

"The medical school is good for the NHS locally in York and good for the whole region," says Dr Robert McEwan, of York Health Services NHS Trust, who is the new school's project manager in North Yorkshire.

"We are one of the biggest areas that, until now, did not have a medical school. There's evidence to show that a medical school is good for clinical effectiveness, it helps to promote research, it's good for recruiting and retaining staff and it gives us a pool of junior doctors in five years' time.

"At present we get most of our junior doctors from Leeds, they are very good quality doctors and we are very well served. The difference for us in future will be that we will have 'grown' our own, contributed to their education as medical students, and we will know what we are getting.

"There are other schools that have higher requirements in terms of grades but for us, how people interacted and communicated with the selection panel was just as important.

"Hull York was oversubscribed by some extremely bright and intelligent students, from whom we had to pick the best cohort."

Dr Michael Porte, medical director at York Hospitals Trust, says the benefits of the medical school are already being felt for health care in the region.

"NHS staff in hospitals and GP surgeries have had to work closely together to establish Hull York, cutting across the divide of primary and secondary care," he says. "This lays the foundations for more integrated services for patients in the future.

"We have also formed good working relationships with colleagues in the East Riding and Northern Lincolnshire, which is good for professional development."

"The arrival of Hull York will certainly make clinical practice more interesting, because the students introduce an element of challenge and questioning," says Dr Robert Markham, of Selby and York Primary Care Trust.

"Doctors in primary and community care will also be learning as they teach, reviewing their own work more closely and sharing knowledge with other tutors. This can only be to the benefit of our patients."

Good news then - and not only in terms of the quality of health care we're likely to receive in future.

The foundation of the medical school is bound to have a wider economic benefit for York as a whole, says Tony Bennett, assistant director of economic development at City of York Council.

It will further strengthen the city's standing as a centre for science and technology, he says, and could act as a magnet to attract more businesses, especially those specialising in the biosciences and medical science.

"It really puts York on the health care map," he adds, "and it gives us a chance to use it as an economic generator for the city."

All very good, but does it mean that next time patients visiting their GP or who are rushed to A&E could find themselves in the hands of a green, young student scarcely out of school?

No, is the short answer to that - and no patient will have to put up with students watching them being treated if they don't want to.

"That is important for their education and the future of the services, but no patient is obliged to have a student observing their treatment," says Dr McEwan.

"And all the students are very closely supervised. They don't actually get involved in discussing individual patients' conditions or problems until the third year of their course."

Updated: 08:54 Thursday, September 18, 2003