Medicine is an apprenticeship system and the time-honoured approach of “see one, do one, teach one” has stood the test of time and has developed and sustained the medicine we enjoy today.
We train medical students for free – the students are not paid for learning and the doctors who teach them are not paid for teaching – if we were, no-one would ever be able to afford to become a doctor, for they would not be able to bear the cost themselves, the community could not afford it, and there would be no-one to look after all of us!
My medical training
After our initial training in basic sciences at university (which gave us a basic grounding in the science of medicine and three years to grow up after leaving school), we were let loose on the unsuspecting public in public hospitals. We would go round the hospital in our little groups, seeking out the interesting, difficult, likely-to-be-examined-on patients, developing our skills, our craft, our trade, and learning the art of medicine. We would sit by their bedsides and patiently listen to their stories, for we did not have the pressure of time that plagues us later in our professional careers.
In return for our presence and patience, we were rewarded with the right to examine the patients, who submitted to our clumsy attempts at a medical examination with their own patience and grace.
It can a lovely symbiosis, the medical student and the hospital in-patient. The patient is confined to bed, bored, scared, or whatever state they are in, and the medical student can offer them company to fill in their time, respond to their emotional reactions with care, and offer them connection, explanation and reassurance, and even a sense of purpose and importance. In turn the patient, especially the seasoned ones with chronic diseases, can offer the student tips, clues and feedback that can further develop their skills and hone their art and craft, and can teach them how to be with people.
It can also be a terrible intrusion – packs of students descending like a flock of seagulls onto your fish and chips at the beach – calling out to each other to come and see “the liver in bed 9” or whatever the interesting phenomenon may be, with scant regard for the person the liver belongs to and resides in.
And the consultant can contribute to this, by standing around the bed of the person with ‘the liver’ and grilling his group of students, humiliating them in front of each other and the increasingly concerned patient, if they get the diagnosis wrong. The patient may react by feeling frightened, understanding little if any of the medical jargon used and possibly misinterpreting it. In their vulnerable state they may feel disempowered, disregarded, and disrespected.
Medicine is a trial-by-fire apprenticeship
Medicine is a trial-by-fire apprenticeship. The stakes are high – people’s lives are on the line – and some of our colleagues believe that we need to be harsh in our treatment of medical students to toughen them up, to condition them, so that they can stand the heat of the fire.
But caring for people is not the same as fighting a fire. And very few of us learn well or perform well under extreme pressure. Even fire-fighters are not thrown into the heat of a wildfire to learn how to fight it; they learn in disciplined, controlled and simulated environments where their own safety and that of others is not at risk.
I have found that students learn better if they are not criticised or humiliated or pitted against each other, but encouraged, confirmed in what they do know, and supported to expand their understanding to learn what they do not yet know.
We are forever students of medicine
Medicine is continually expanding in its breadth, depth and scope. Much of the medicine I practise today was not yet known when I was a student, so I have had to remain a student throughout my career, learning new information, new investigations, new drugs, new surgical techniques, and new ways of being to be able to offer my patients the best care available.
Developing an environment that supports us to learn, that does not make us afraid to say we don’t know, that allows us to make mistakes and learn from them without feeling like a failure or punishing us harshly, is vital for healthy doctors, and a healthy medical system.
Even if artificial intelligence and computer simulation become an increasingly important part of our training, there will always be a place for training on live people, for ultimately that is who we will be caring for. And we need to find ways of doing that supports everyone involved – doctors, students and the patients they serve.
Developing appreciation of medical students
Understanding that medical students are the life-blood of our profession is a great place to start to develop our appreciation of them, and to support them to develop that appreciation of themselves.
They tend to be treated as the lowest people in the food chain that is the hierarchy of medicine, and this can challenge their self-esteem and their sense of worth and value in the profession in ways that can affect them for the whole of their lives.
We need our medical students. They keep us honest, alert, up-to-date, spend time with our patients when no-one else has any, pick up things that we may have missed, and remind us of our own humble origins.
Medical students are beautiful and precious and deserve to be nurtured and cherished … they are people, and as deserving of love and care as we all are … and one day, when we are old and frail, they will be looking after us!