Thursday, 28 July 2011

Responsibility and the growth of future doctors

I met the class of 2012 for the first time today, and I rather enjoyed myself. It was refreshing to spend an hour with a group of people who are excited to be learning new skills, and who, in their final year at medical school, are having to grapple with the very real prospect that they will soon be newly qualified doctors.

I guess starting one’s final year at medical school is one of those moments when it becomes real that, however long the training goes on, we all go through the process so that we can become doctors at the end of it. During my six years at medical school there were certainly times when I felt like I was a career student, and those moments where the responsibility of medical practice became real were powerful ones.

I often wonder how well we prepare medical students for life on the job, and much of my thinking about this is tainted by my experiences. Very few of the doctors whom I came into contact with offered me the kind of nurture and guidance that I thought I could do with. In fact, there was really only one consultant who took interest in me as an individual, and I ended up following her into her specialty. I haven’t quite decided whether this was cause and effect, or affinity derived from my pre-existing attraction to her specialty; some questions are unanswerable.

Medical students are tagged on to the bottom of the medical hierarchy. I have never seen this hierarchy in print, but it exists - believe me, it exists. At the bottom (that is the bit we are interested in today) there are house officers, followed by female medical students, followed by male medical students. The distinction between genders is often referred to, and I think derives from the observation that male medical students are felt to be less mature than their female counterparts. This may sometimes be true, but the idea that it is pervasive and universal warrants challenge. But it is the overall attitude to medical students that I would like to throw light on.

At the end of the session I was running today, one of the students piped up and asked whether I would mind signing his attendance sheet. Let me repeat that  - his attendance sheet.

I would have choked on my tea, but no one had made me one. One of my mantras at medical school was that there were high yield learning events, and there were low yield learning events, and life was too busy to waste time in the low yield ones. It turns out, however, that these days, medical students are not granted any autonomy over how they spend their time, and they are not allowed to tailor their own learning to their own specific styles. It doesn’t matter which seminars and tutorials a student turns up to, what matters is how they develop as a doctor in training. Having the time and space to develop as an individual is crucial to one’s growth as a doctor, and that incorporates being able to choose how one learns and develops.

When I graduated, the thing that I missed most was the loss of choice over how to spend my time. As a house officer on a Band 3 job working 90 hours a week, much of my time was given over to the hospital. In particular, I really missed the Wednesday afternoons, when I would usually go and play hockey for the medical school team (if you’re lucky I’ll tell you about my infamously ineffective team talks sometime) - those afternoons meant a lot to me. These days I often say to medical students that they should make sure that they use their Wednesday afternoons wisely - they should takes themselves away from the hospital; they don’t have to play sport, but they should do something other than medicine that really interests them. The best doctors I know have to something to offer away from medicine, and those habits start early.

People expand into the responsibilities they are given. With autonomy, there is great scope for learning, and their is great scope for learning from mistakes. The challenge is to choose the right pace of responsibility, and to offer the right kind of support. This is central to growth as a future doctor, and if our medical schools are not taking the chance to allow their students to take responsibility for themselves and to learn from their mistakes, then they are missing a trick.

It might seem like a small thing to get students to sign into to every learning event they go to, but to them it creates the impression that they cannot be trusted. And these people will be doctors in a year’s time.

I am now going on holiday for a couple of weeks, so I probably won't be posting for a little while. See you after the break!

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