The Hospital Curriculum through the eyes of a Medical Student – A Message to Mentors and Doctors

Being the interchanging medical student that I am, I am frustratingly back in hospital as the impatient inpatient again.  Another morning ward-round has just been and gone, and I’ve witnessed yet another bunch of thumb-twiddling medical students shuffle silently behind the lead Consultant.  Not once does the doctor break their own dialogue to ensure his students are following, let alone the patient, and so the students, many of whom are familiar faces from my own medical school, remain puzzled and tongue-bitten by another set of patient notes.  My patient notes.  So, after the doctor leaves, I call them over and offer the time for a more thorough history, and a bit of psychosocial insight into something they can then go away and look up, clinically. 

Instead, I sit here in a hospital bed, strung to more IV lines and drips, writing down my to-be motion in the alternative form of an article, or blogpost, instead.  And what a convenient place to be writing this in – the hospital curriculum, and a message to mentors and doctors on how to not teach your future medical students.  Pretty bog-standard stuff really, no?

Most, if not all, doctors will remember their first real day on the wards.  Those first days are always twinged with a kaleidoscope of emotions – fear, nervousness, determination, confidence, renewal.  The list could go on.  Only, when I come to reflect back on my first day as part of the beginning to my clinical years as a medical student, it couldn’t of been more different, unexpected.  I was sat down by a senior doctor, who went on to ask me, after no more than two minutes of knowing me: “Imagine you are a patient.  Would you want a disabled doctor treating you?  Absolutely not!”  I was then sent home. 

A few days later, I was back at the hospital on another ward when I was reprimanded by another senior consultant in the middle of a staff meeting, pre ward-round.  I was verbally battered for ‘taking up’ the last chair in the room – the chair that supposedly belonged to the FY2, who was running late.  20 minutes later, the rather delayed FY2 turned up to the meeting and a finger was pointed straight at meI was forced to give up my seat and stand in the corner, with no glaring exchange of thanks whatsoever.  Nothing.  Why me?  Because I was ‘below’ the rest of us, I was at the bottom of the pile.  The so-called hierarchy pile.  Little did they know that I had in fact only been discharged off of ICU a few weeks before, so every moment of perching down on the edge of the seat was precious, if I were to fulfil my learning for the rest of that day.  Yet, that’s not the point.  I was dismissed because I was not a well-respected part of the team.  I was just another nuisance medical student flung onto their ward as this week’s burden.  Next week it would be another medical student. 

Going back to the purpose of being there to learn, you then might ask, but what learning?  Our consultant, our supposed teacher, was obnoxious, arrogant and simply ignorant.  Not once were we acknowledged, and in fact, later that same day, the consultant teaching us told us not to even bother attending teaching that afternoon, because it was “far too beyond” our ‘level’.  When I politely asked whether I could run through a clinical skill that was in our skills logbook provided by the medical school, under the supervision of an available staff member when time suited, I was spluttered and laughed at.  Again, a senior doctor bellowed at me, in front of many other staff members on the ward, “and why on Earth would I let you do that?!”

Not once was I, nor the other medical students, acknowledged, respected or involved in anything going on through these teaching weeks.  This tainted experience got us wondering exactly what the purpose was of being there in the first place.  We weren’t learning anything and we certainly were not welcome.  And the most awkward thing out of all of this? – the patients noticed.  If patients continue to observe senior doctors treating medical students in the way that they are doing, then those patients will never find the trust or reassurance in having a more junior doctor treating them.  And, if this becomes the case, then medical students will never develop the necessary communication and problem-solving skills to progress to being an efficient junior doctor, in the same way that those junior doctors will then fail to progress in becoming an efficient senior doctor.  And when I say efficient, I mean non-aggressive, observant and not ignorant, and above all, a good mentor and teacher to the next generation of medical students that will ultimately follow them. 

At a time where I am beginning to explore what I like and don’t like in the multitude of medical specialties, I have actually found that the fields that I have so far enjoyed most have been the fields where the doctors are the best tutors.  These tutors have been the kindest, more patient and more informative and inclusive doctors, regardless of what the clinical compositions have been behind each.  In other specialties, on the other hand, the one or two senior consultants that blatantly disapprove of our presence makes our learning and progression a distasteful one.  And this has to change.  This rather bullying and ignorant culture amongst mostly older, more traditional-generation doctors is only setting a bad example upon the rest of us.  In this concept, it is almost setting us the example that in order to be a successful and highly-respected senior doctor, it is expected that you treat everyone else around you as if you are above them in every way?  Wrong

Don’t get me wrong though, I have had some fabulous clinical teachers in my time on placement so far.  Yes, we were interrogated by many of these consultants, but we very much welcomed this interrogation.  It was encouraged learning in a supportive environment.  And that’s all we desire.  And, for those doctors who were simply too busy to help us, that was also fine too.  Because they were apologetic and told us straight “I’m sorry but I’m just too busy today”, rather than receiving the ‘palm in the face’ from others.

If other staff members in the clinical environment see us medical students and doctors working together, it immediately creates a much more respectful, trustworthy and friendly environment where teamwork becomes core to the motto. Teamwork, however, does not come about from the stale, old culture of hierarchy.

A breakdown in the culture of hierarchy between more senior doctors and medical students needs to thus begin, don’t you agree?  In order to change this rigid structure of social hierarchy in place, we need to share the message on how medical students truly feel when they are plunged into the dark depths of a new clinical environment and how much really they are gaining from it.  Because for me, so far, I’ve come home on more than a few occasions seriously reconsidering whether Medicine would be worth it.

On another front then, it would be interesting to hear from the perspective of the senior consultant who often turns his students away?  Do they really want to be doing this teaching role on top of their already chaotic schedule?  Is this what they really signed up for?  Have they actually received any additional training or support in how to mentor students whilst carrying out their own workload in addition?  And are they really able to comply with the requirements of being a ‘teacher’?  How then, do they think medical students are going to best learn in this environment?  How else are medical students expected to progress in their skills of professionalism and ‘doctoring’ if this form of teaching and learning is not revaluated.   

This is a common issue shared amongst many of us medical students, and is probably no less familiar in other medical schools more widespread, and in different clinical setups, such as nursing schools and for those healthcare staff members on their first day, new on the job.  Let’s then consider ways in which we can first, break down this unnecessary vision on social hierachy – it does us no favours and it extinguishes the presence of any form of stable, successful teamwork in the clinical environment.  We need to stop setting these bad examples and unhappy relationships in front of our patients, and we need to mingle more with the entire working team, both young and old, experienced and new.  Because this is what we ultimately want, and need, from the hospital curriculum. 

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