medical education: Sending medical students into primary schools to give lessons about health provides them with early experience of working with children and improves communication skills. Mary Seabrook reports

How do you stop children from being scared of hospitals? How can you persuade them to eat fruit rather than chocolate? And how can you tell a child about the dangers of smoking without making them worry about their parents who smoke? These are some of the questions that medical students from Guy's, King's and St Thomas'medical school have grappled with during a project to link them with local schools.

The project was set up to give students experience of working and communicating with children and to develop links with local schools. Students can choose to take part by selecting it as one of their 'special study modules' - elective courses which are part of the new curricula in all British medical schools following the General Medical Council's recommendations of 1993.

At Guy's, King's and St Thomas', each course is studied for one day a week for 12 weeks, and students can choose from a range of subjects. The teaching module is offered in the second year of the medical school course.Many students say they choose it because it offers a contrast to the rest of their week, which is spent in lectures and laboratory work.

Students on the course spend half their time in school and the other half in college or in private preparation. The course is led by former primary school teachers, who brief the students on the national curriculum, teaching and learning methods, suitable health topics and classroom management. It was set up in collaboration with the social and health education adviser for Southwark, and school nurses from Optimum Health Care trust, who contribute to the programme. Nine schools and 40 students have taken part.

Students are allocated in pairs to a local primary school and attached individually to a class. They negotiate with the class teacher what topics they should cover, based on the needs of the national curriculum.Dental hygiene, healthy eating, and smoking, alcohol and drugs are just three of the subjects which have frequently been covered.

Students are encouraged to use their imagination in planning lessons and to make use of stories, songs, games, worksheets and experiments. They use a variety of resources to interest the children, including life-size models of the human torso, skulls and skeletons borrowed from the students' anatomy teachers, 'lungs'made from empty plastic bottles filled with cotton wool to demonstrate the effects of smoking, and sheep's hearts bought from the local butcher for an anatomy demonstration.

So what exactly have the students learnt from their experiences? 'I have learnt a lot more about communicating with other people during this course than any communication skills lessons could ever hope to teach, ' said one.

Another said: 'I had to develop new ways of explaining how I wanted things to be done in clear and logical ways. I also realised the need for using visual methods of teaching.'Other students commented on the need for sensitivity to the children's backgrounds and the difficulty of trying to promote healthy lifestyles when the children were not necessarily in control of these aspects of their lives.

For their assessments, students have to submit a portfolio containing the rationale for their lessons, lesson plans, examples of the children's work, and their evaluation of the lessons. They also provide an overview of the course and how it has affected them.

Students were amazed at the amount of work required to prepare a lesson, and gained a new respect for teachers. 'When I began this course, ' said one, 'I was completely oblivious to the effort that was required.'Another said: 'I wasn't aware how much work was involved in planning lessons. Keeping the attention of 21 six to eight year olds is not easy.'

The importance of providing health promotion at an early age is widely recognised. In Southwark and neighbouring Lambeth, projects to link healthcare staff from general practices to schools are under way as part of the government's education action zone initiatives.Doctors and nurses visit schools and lead sessions with children. It is hoped that students who have taken the special study module in their undergraduate courses will increasingly see such links as an integral part of their job.

Mary Seabrook is senior lecturer in medical education, Guy's, King's and St Thomas' School of Medicine.